BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 407
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|AUTHOR: |Morrell |
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|VERSION: |February 25, 2015 |
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|HEARING DATE: |April 15, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Comprehensive Perinatal Services Program: licensed
midwives
SUMMARY : Expands the definition of "comprehensive perinatal provider" as
used in the Comprehensive Perinatal Services Program (CPSP) to
include a licensed midwife. Authorizes a health care provider to
employ or contract with licensed midwives for the purpose of
providing comprehensive perinatal services in the CPSP.
Existing law:
1.Establishes the Medi-Cal program, which is administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services,
including comprehensive perinatal services. Comprehensive
perinatal services are a Medi-Cal benefit, as provided through
an agreement with a CPSP designated health care provider
meeting the standards developed by the Department of Public
Health (DPH), and subject to utilization controls.
2.Requires, to the extent that federal financial participation
is available, that midwifery services provided by a licensed
midwife are covered under the Medi-Cal program.
3.Establishes the CPSP, administered by DPH, 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.
4.Defines, for purposes of the CPSP, a "comprehensive perinatal
provider" to mean any general practice physician, family
practice physician, obstetrician-gynecologist, pediatrician,
SB 407 (Morrell) Page 2 of ?
certified nurse midwife, a group, any of whose members is one
of the above-named physicians, or any preferred provider
organization or clinic enrolled in the Medi-Cal program and
CPSP certified.
5.Authorizes, for the purpose of providing comprehensive
perinatal services, a health care provider to employ or
contract specified practitioners, including physicians,
certified nurse midwives, nurses, nurse practitioners,
physician assistants, social workers, health and childbirth
educations and registered dieticians.
This bill:
1.Expands the definition of "comprehensive perinatal provider"
as used in the CPSP to include a licensed midwife, thereby
allowing a licensed midwife to receive reimbursement for CPSP
services.
2.Authorizes a health care provider to employ or contract with
licensed midwives for the purpose of providing comprehensive
perinatal services in the CPSP.
3.Requires DHCS to commence, no later than March 1, 2016, the
revision of existing regulations, in accordance with the
Administrative Procedure Act, as it determines necessary for
the implementation of this bill.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, licensed
midwives provide comprehensive childbirth, prenatal health,
and breastfeeding education to their patients. Studies have
shown that women who receive these services during pregnancy
have healthier pregnancies and less complicated births. This
bill expands health care access by adding licensed midwives
to the list of Medi-Cal-eligible comprehensive perinatal
services providers. Expectant mothers of all income levels
should have options when it comes to deciding where and how
they bring their children into the world. The current
non-inclusion of licensed midwives from the list of eligible
Medi-Cal providers limits these choices for low-income
individuals. This bill would expand the choices available to
low-income, pregnant women. Increasing the number of
SB 407 (Morrell) Page 3 of ?
comprehensive perinatal Medi-Cal providers alleviates wait
times and access issues within the overall perinatal health
delivery system, allowing women to receive timely and
personalized care. Authorizing licensed midwives as Medi-Cal
providers of comprehensive perinatal services will help all
low-income women, even if they do not choose a licensed
midwife as their provider. Lastly, authorizing licensed
midwives as comprehensive perinatal services providers will
save the state resources. A home birth or "birth center"
birth with a licensed midwife can save the state up to 80
percent when compared to the cost of a hospital birth.
Increasing access to licensed midwives drives down the cost
in the state health care system while also ensuring safe,
quality care for pregnancy and childbirth.
2.CPSP. Under CPSP, Medi-Cal-eligible women receive
comprehensive services, including prenatal care, health
education, nutrition services, and psychosocial support for
up to 60 days after delivery of their infants. Local health
department staff offer technical assistance and consultation
to potential and approved providers in the implementation of
CPSP program standards. The Maternal Child and Adolescent
Health Program in DPH develops standards and policies,
provides technical assistance and consultation to the local
health perinatal services coordinators, and maintains an
ongoing program of training for all CPSP practitioners
throughout the state.
CPSP provides reimbursement for some services that Medi-Cal
does not provide reimbursement for, including early entry
into care, vitamins, case coordination, a 10th antepartum
visit, and support services. The goals of the CPSP program
are to decrease and maintain the decreased level of
perinatal, maternal and infant mortality and morbidity and to
support methods of providing comprehensive prenatal care that
prevent prematurity and the incidence of low birth weight
infants.
3.Licensed Midwives. Licensed midwives are licensed by the
Medical Board of California and practice under the Midwifery
Practice Act, which specifies the requirements for licensure
and the scope of practice for a licensed midwife. There are
332 licensed midwives in California as of December 31, 2014.
Existing law defines the practice of midwifery as the
furthering or undertaking by any licensed midwife to assist a
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woman in childbirth as long as progress meets criteria
accepted as normal. AB 1308 (Bonilla) Chapter 665, Statutes
of 2013, made significant amendments to various Business and
Professions Code sections governing the practice of midwifery
in California.
Licensed midwives can practice without physician supervision,
and their scope of practice allows them to attend cases of
normal pregnancy and childbirth (as defined), and provide
prenatal, intrapartum, and postpartum care, including
family-planning care, for the mother, and immediate care for
the newborn. A licensed midwife is authorized to directly
obtain supplies and devices, obtain and administer drugs and
diagnostic tests, order testing, and receive reports that are
necessary to his or her practice of midwifery and consistent
with his or her scope of practice. The scope of practice of
midwifery does not include the assisting of childbirth by any
artificial, forcible, or mechanical means, and licensed
midwives are not authorized to practice medicine, perform
surgery or perform abortions.
Licensed midwives are a different licensure category than
certified nurse midwives (certified nurse midwives are
included as CPSP providers under current law.) Certified nurse
midwives are licensed and regulated by the Board of Registered
Nursing and practice under physician supervision. A certified
nurse-midwife, under the supervision of a physician, is
allowed to attend cases of normal childbirth and to provide
prenatal, intrapartum, and postpartum care, including
family-planning care, for the mother, and immediate care for
the newborn. As of March 1, 2015, there were 1,316 certified
nurse midwives in California.
4.Support. The California Association of Midwives (CAW) writes
that licensed midwives work in various health care settings
and have specialized training in attending births in
out-of-hospital settings, such as California's licensed
alternative birth centers. CAW argues the passage of this bill
will allow more California mothers to receive care in these
safe, specialized settings as there is increasing consumer
demand for prenatal care with midwives in birth centers. CAW
states this bill will allow LMs to help fill the shortage of
maternity care providers who take Medi-Cal and CPSP as many
rural and medically underserved communities have no health
care provider who accepts CPSP, while licensed midwives are
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waiting to fill that gap. CAW concludes that pregnant women
who receive prenatal care with licensed midwives have reduced
rates of costly pregnancy complications such as prematurity
and cesarean section, which could lead to significant cost
savings for the state.
The California Nurse-Midwives Association writes in support
that this bill will increase the number of maternity care
providers who accept Medi-Cal. According to a recent report,
California ranks second lowest in percentage of physicians
currently accepting new Medi-Cal patients, at a rate of 54
percent. California's underserved deserve better health care
access. Increasing CPSP providers will make it easier for
women to receive quality prenatal care early in their
pregnancy resulting in better health outcomes for themselves
and their babies, at a lower cost to the taxpayers.
5.Opposition. The California Right to Life Committee (CRLC)
writes it is concerned about the expansion of the scope of
practice for licensed midwives into a very medically sensitive
area. CRLC writes that midwives have specific training to
serve pregnant women and do well in assisting at births, but
there are some services that only doctors with years of
education and
practice can provide. CRLC argues midwives cannot replace
doctors, even if additional training would be required.
6.Oppose Unless Amended. The American College of Obstetricians
and Gynecologists Region IV (ACOG) writes it is opposed unless
amended to this bill, arguing they do not believe the licensed
midwives have the qualifications to be the lead "comprehensive
perinatal provider" under CPSP. ACOG writes that it recognize
the licensed midwives have a barrier to providing care through
licensed midwife-owned alternative birth centers, that of the
requirement to be a CPSP provider. ACOG writes they believe
licensed midwives' problem with regard to the alternative
birth centers could be remedied by adding them as
practitioners (which this bill does) as the alternative birth
center licensing law requires that licensed midwives be a
provider of comprehensive services, but not the lead
comprehensive perinatal provider. ACOG indicates it would
remove its opposition to deleting licensed midwives from the
definition of a "comprehensive perinatal provider."
SUPPORT AND OPPOSITION :
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Support: California Association of Midwives
California Nurse-Midwives Association
Capital OB/GYN, Inc.
Monterey County Board of Supervisors
Wellspace Health
Two individuals
Oppose: American Congress of Obstetricians and Gynecologists
District IX (unless amended)
California Right to Life Committee
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