Amended in Assembly July 7, 2015

Amended in Assembly June 17, 2015

Amended in Senate April 21, 2015

Senate BillNo. 407


Introduced by Senator Morrell

(Coauthors: Senators Mitchell and Wolk)

February 25, 2015


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

LEGISLATIVE COUNSEL’S DIGEST

SB 407, as amended, 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.begin delete Existingend delete

begin insert Existing law, the Licensed Midwifery Practice Act of 1993, provides for the licensure of midwives by the Medical Board of California. Existing law authorizes a licensed midwife to assist a woman only in normal pregnancy and childbirth, which is defined as meeting specified conditions, including, among others, a pregnancy in which there is an absence of any preexisting maternal disease or condition likely to affect the pregnancy and of significant disease arising from the pregnancy. Existing law requires the board to adopt regulations further specifying those conditions.end insert

begin insertExistingend insert 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 services.

This bill would additionally authorize a health care provider to employ or contract licensed midwives for the purpose of providing comprehensive perinatal services. The billbegin delete would expand the definition of “comprehensive perinatal provider” as used in these provisions to includeend deletebegin insert would provide that, on the effective date of the regulations adopted by the board pursuant to the provisions described above,end insert a licensedbegin delete midwife.end deletebegin insert midwife shall be eligible to serve as a “comprehensive perinatal provider,” as defined.end insert The bill would declare that its provisions shall not be construed to revise or expand the scope of practice, as defined, of licensed midwives. 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.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 14134.5 of the Welfare and Institutions
2Code
is amended to read:

3

14134.5.  

All of the following provisions apply to the provision
4of services pursuant to subdivision (u) of Section 14132:

5(a) “Comprehensive perinatal provider” means any general
6practice physician, family practice physician,
7obstetrician-gynecologist, pediatrician, certified nurse midwife,
8begin delete licensed midwife,end delete a group, any of whose members is one of the
9above-named providers, or any preferred provider organization or
P3    1clinic enrolled in the Medi-Cal program and certified pursuant to
2the standards of this section.

3(b) “Perinatal” means the period from the establishment of
4pregnancy to one month following delivery.

5(c) “Comprehensive perinatal services” shall include, but not
6be limited to, the provision of the combination of services
7developed through the former Department of Health Services
8Obstetrical Access Pilot Program provided or coordinated by a
9comprehensive perinatal provider.

10(d) The comprehensive perinatal provider shall schedule visits
11with appropriate providers and shall track the patient to verify
12whether services have been received. As part of the reimbursement
13for coordinating these services, the comprehensive perinatal
14provider shall ensure the provision of the following services either
15through the provider’s own service or through subcontracts or
16referrals to other providers:

17(1) A psychosocial assessment and when appropriate referrals
18to counseling.

19(2) Nutrition assessments and when appropriate referral to
20counseling on food supplement programs, vitamins, and
21breastfeeding.

22(3) Health, childbirth, and parenting education.

23(e) begin insert(1)end insertbegin insertend insert Except where existing law prohibits the employment
24of physicians, a health care provider may employ or contract with
25all of the following medical and other practitioners for the purpose
26of providing the comprehensive services delineated in this section:

begin delete

27(1)

end delete

28begin insert(A)end insert Physicians, including a general practitioner, a family practice
29physician, a pediatrician, or an obstetrician-gynecologist.

begin delete

30(2)

end delete

31begin insert(B)end insert Certified nurse midwives.

begin delete

32(3)

end delete

33begin insert(C)end insert Licensed midwives.

begin delete

34(4)

end delete

35begin insert(D)end insert Nurses.

begin delete

36(5)

end delete

37begin insert(E)end insert Nurse practitioners.

begin delete

38(6)

end delete

39begin insert(F)end insert Physician assistants.

begin delete

40(7)

end delete

P4    1begin insert(G)end insert Social workers.

begin delete

2(8)

end delete

3begin insert(H)end insert Health and childbirth educators.

begin delete

4(9)

end delete

5begin insert(I)end insert Registered dietitians.

begin delete

6 The

end delete

7begin insert(2)end insertbegin insertend insertbegin insertTheend insert department shall adopt regulations that define the
8qualifications of any of these practitioners who are not currently
9included under the regulations adopted pursuant to this chapter.
10Providers shall, as feasible, utilize staffing patterns that reflect the
11linguistic and cultural features of the populations they serve.

12(f) The California Medical Assistance Program and the Maternal
13and Child Health Branch of the State Department of Public Health
14in consultation with the California Conference of Local Health
15Officers shall establish standards for health care providers and for
16services rendered pursuant to this subdivision.

17(g) The department shall assist local health departments to
18establish a community perinatal program whose responsibilities
19may include certifying and monitoring providers of comprehensive
20perinatal services. The department shall provide the local health
21departments with technical assistance for the purpose of
22implementing the community perinatal program. The department
23shall, to the extent feasible, and to the extent funding for
24administrative costs is available, utilize local health departments
25in the administration of the perinatal program. If these funds are
26not available, the department shall use alternative means to
27 implement the community perinatal program.

28(h) begin insert(1)end insertbegin insertend insert It is the intent of the Legislature that the department
29shall establish a method for reimbursement of comprehensive
30perinatal providers that shall include a fee for coordinating services
31and shall be sufficient to cover reasonable costs for the provision
32of comprehensive perinatal services. The department may utilize
33fees for service, capitated fees, or global fees to reimburse
34providers. However, if capitated or global fees are established, the
35department shall set minimum standards for the provision of
36services including, but not limited to, the number of prenatal visits
37and the amount and type of psychosocial, nutritional, and
38educational services patients shall receive.

begin delete

39 Notwithstanding

end delete

P5    1begin insert(2)end insertbegin insertend insertbegin insertNotwithstandingend insert the type of reimbursement system, the
2comprehensive perinatal provider shall not be financially at risk
3for the provision of inpatient services. The provision of inpatient
4services that are not related to perinatal care shall not be subject
5to the provisions of this section. Inpatient services related to
6services pursuant to this subdivision shall be reimbursed, in
7accordance with Section 14081, 14086, 14087, or 14087.2,
8whichever is applicable.

9(i) The department shall develop systems for the monitoring
10and oversight of the comprehensive perinatal services provided in
11this section. The monitoring shall include, but shall not be limited
12to, the collection of information using the perinatal data form.

13(j) Participation for services provided pursuant to this section
14shall be voluntary. The department shall adopt patient rights
15safeguards for recipients of the comprehensive perinatal services.

16(k) The amendments made to this section by the act that added
17this subdivision shall not be construed to revise or expand the
18scope of practice of licensed midwives, as defined in Article 24
19(commencing with Section 2505) of Chapter 5 of Division 2 of
20the Business and Professions Code.

begin insert

21(l) Notwithstanding subdivision (a), on the effective date of the
22regulations adopted by the Medical Board of California pursuant
23to Section 2507 of the Business and Professions Code, a licensed
24midwife shall be eligible to serve as a comprehensive perinatal
25provider.

end insert
26

SEC. 2.  

The State Department of Health Care Services shall
27commence, no later than March 1, 2016, the revision of existing
28regulations as it determines are necessary for the implementation
29of the amendments made to Section 14134.5 of the Welfare and
30Institutions Code by this act, in accordance with the Administrative
31Procedure Act (Chapter 3.5 (commencing with Section 11340) of
32Part 1 of Division 3 of Title 2 of the Government Code).



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