BILL NUMBER: SB 407 ENROLLED
BILL TEXT
PASSED THE SENATE SEPTEMBER 1, 2015
PASSED THE ASSEMBLY AUGUST 27, 2015
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, 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, 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 provide that, on the
effective date of the regulations adopted by the board pursuant to
the provisions described above, a licensed 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.
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, 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:
(A) Physicians, including a general practitioner, a family
practice physician, a pediatrician, or an obstetrician-gynecologist.
(B) Certified nurse midwives.
(C) Licensed midwives.
(D) Nurses.
(E) Nurse practitioners.
(F) Physician assistants.
(G) Social workers.
(H) Health and childbirth educators.
(I) Registered dietitians.
(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.
(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).