BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 407|
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UNFINISHED BUSINESS
Bill No: SB 407
Author: Morrell (R), et al.
Amended: 7/7/15
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/15/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/11/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 36-0, 5/18/15 (Consent)
AYES: Allen, Anderson, Bates, Beall, Block, Cannella, De León,
Fuller, Gaines, Galgiani, Hancock, Hernandez, Hertzberg, Hill,
Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen,
Nielsen, Pan, Roth, Runner, Stone, Vidak, Wieckowski, Wolk
NO VOTE RECORDED: Berryhill, Hall, Pavley
ASSEMBLY FLOOR: 78-0, 8/27/15 (Consent) - See last page for
vote
SUBJECT: Comprehensive Perinatal Services Program: licensed
midwives
SOURCE: California Association of Midwives
DIGEST: This bill makes licensed midwives eligible to be
comprehensive perinatal provider as used in the Comprehensive
Perinatal Services Program (CPSP) when regulations have been
adopted by the Medical Board of California (MBC). Authorizes a
health care provider to employ or contract with licensed
midwives for the purpose of providing comprehensive perinatal
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services in the CPSP.
Assembly Amendments make licensed midwives eligible to be
comprehensive perinatal providers in CPSP when regulations have
been adopted by the MBC, and remove the opposition of the
American College of Obstetricians and Gynecologists, District IX
California.
ANALYSIS:
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)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.
3)Defines, for purposes of the CPSP, a "comprehensive perinatal
provider" to mean 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 physicians, or any preferred provider
organization or clinic enrolled in the Medi-Cal program and
CPSP certified.
4)Defines, for purposes of the CPSP, "comprehensive perinatal
services" to include, but not be limited to, the provision of
the combination of services developed through the Department
of Health Services Obstetrical Access Pilot Program.
5)Authorizes, for the purpose of providing comprehensive
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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.
6)Allows a licensed midwife to attend cases of normal pregnancy
and childbirth. Requires the MBC to adopt regulations
specifying the conditions that fall outside a normal pregnancy
and childbirth (where there is an absence of any preexisting
maternal disease or condition likely to affect the pregnancy
or a significant disease arising from the pregnancy or a
significant disease arising from the pregnancy).
This bill:
1)Allows licensed midwifes to be eligible to serve as a
comprehensive perinatal providers in CSPS on the effective
date of the regulations adopted by the MBC.
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)Clarifies that "comprehensive perinatal services" in CPSP are
services provided or coordinated by a comprehensive perinatal
provider.
4)Prohibits this bill from being construed to revise or expand
the scope of practice of licensed midwives.
5)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.
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
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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 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,
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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
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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee, negligible
state fiscal effect. DHCS is already in the process of making
the necessary changes to the California Medicaid State Plan to
include licensed midwives on the list of medical professionals
who are legally authorized to provide services.
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SUPPORT: (Verified8/27/15)
American Nurses Association California
Association of California Healthcare Districts
California Association of Midwives
California Black Health Network
California Families for Access to Midwives
California Nurse-Midwives Association
Capital OB/GYN, Inc.
Central California Alliance for Health
Improving Birth, Inc.
Monterey County Board of Supervisors
Santa Cruz County Board of Supervisors
Wellspace Health
OPPOSITION: (Verified8/27/15)
None received
ARGUMENTS IN 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 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.
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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.
ASSEMBLY FLOOR: 78-0, 8/27/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,
Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,
Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,
Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,
Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Wood, Atkins
NO VOTE RECORDED: Frazier, Williams
Prepared by:Scott Bain / HEALTH /
8/28/15 17:13:55
**** END ****
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