BILL NUMBER: SB 407 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 7, 2015
AMENDED IN ASSEMBLY JUNE 17, 2015
AMENDED IN SENATE APRIL 21, 2015
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. Existing
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.
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 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 bill would expand the
definition of "comprehensive perinatal provider" as used in these
provisions to include would provide that, on the
effective date of the regulations adopted by the board pursuant to
the provisions described above, a licensed midwife.
midwife shall be eligible to serve as a "comprehensive
perinatal provider," as defined. 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:
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
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 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
counseling.
(2) Nutrition assessments and when appropriate referral to
counseling on food supplement programs, vitamins, and breastfeeding.
(3) Health, childbirth, and parenting education.
(e) (1) 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)
(A) Physicians, including a general practitioner, a
family practice physician, a pediatrician, or an
obstetrician-gynecologist.
(2)
(B) Certified nurse midwives.
(3)
(C) Licensed midwives.
(4)
(D) Nurses.
(5)
(E) Nurse practitioners.
(6)
(F) Physician assistants.
(7)
(G) Social workers.
(8)
(H) Health and childbirth educators.
(9)
(I) Registered dietitians.
The
(2) The department shall adopt
regulations 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 that reflect the linguistic and cultural
features of the populations they serve.
(f) The California Medical Assistance Program and the Maternal and
Child Health Branch of the State Department of Public Health 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) (1) It is the intent of the Legislature
that the department shall establish a method for reimbursement of
comprehensive perinatal providers that shall include a fee for
coordinating services and 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
(2) 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 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 the monitoring and
oversight of the comprehensive perinatal services provided in this
section. The monitoring shall include, but shall not be limited to,
the 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.
(k) The amendments made to this section by the act that added this
subdivision shall not be construed to revise or expand the scope of
practice of licensed midwives, as defined in Article 24 (commencing
with Section 2505) of Chapter 5 of Division 2 of the Business and
Professions Code.
(l) Notwithstanding subdivision (a), on the effective date of the
regulations adopted by the Medical Board of California pursuant to
Section 2507 of the Business and Professions Code, a licensed midwife
shall be eligible to serve as a comprehensive perinatal provider.
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).