S.B. No. 17

AN ACT

relating to maternal health and safety, pregnancy-related deaths, and maternal morbidity, including postpartum depression.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 34.002(b), Health and Safety Code, is amended to read as follows:

(b) The task force is a multidisciplinary advisory committee within the department and is composed of the following 17 [15] members:

(1) 15 [13] members appointed by the commissioner as follows:

(A) four physicians specializing in obstetrics, at least one of whom is a maternal fetal medicine specialist;

(B) one certified nurse-midwife;

(C) one registered nurse;

(D) one nurse specializing in labor and delivery;

(E) one physician specializing in family practice;

(F) [(E)] one physician specializing in psychiatry;

(G) [(F)] one physician specializing in pathology;

(H) [(G)] one epidemiologist, biostatistician, or researcher of pregnancy-related deaths;

(I) [(H)] one social worker or social service provider;

(J) [(I)] one community advocate in a relevant field; [and]

(K) [(J)] one medical examiner or coroner responsible for recording deaths; and

(L) one physician specializing in critical care;

(2) a representative of the department's family and community health programs; and

(3) the state epidemiologist for the department or the epidemiologist's designee.

SECTION 2. Section 34.004, Health and Safety Code, is amended by amending Subsection (b) and adding Subsection (c) to read as follows:

(b) Meetings of the task force are [closed to the public and are not] subject to Chapter 551, Government Code, except that the task force shall conduct a closed meeting to review cases under Section 34.007.

(c) The task force shall:

(1) allow for public comment during at least one public meeting each year;

(2) present in open session recommendations made under Section 34.005 to help reduce the incidence of pregnancy-related deaths and severe maternal morbidity in this state; and

(3) post public notice for meetings conducted for the sole purpose of reviewing cases for selection under Section 34.007.

SECTION 3. Section 34.005, Health and Safety Code, is amended to read as follows:

Sec. 34.005. DUTIES OF TASK FORCE. The task force shall:

(1) study and review:

(A) cases of pregnancy-related deaths; [and]

(B) trends, rates, or disparities in pregnancy-related deaths and [in] severe maternal morbidity;

(C) health conditions and factors that disproportionately affect the most at-risk population as determined in the joint biennial report required under Section 34.015; and

(D) best practices and programs operating in other states that have reduced rates of pregnancy-related deaths;

(2) compare rates of pregnancy-related deaths based on the socioeconomic status of the mother;

(3) determine the feasibility of the task force studying cases of severe maternal morbidity; and

(4) in consultation with the Perinatal Advisory Council, [(3)] make recommendations to help reduce the incidence of pregnancy-related deaths and severe maternal morbidity in this state.

SECTION 4. Chapter 34, Health and Safety Code, is amended by adding Section 34.0055 to read as follows:

Sec. 34.0055. SCREENING AND EDUCATIONAL MATERIALS FOR SUBSTANCE USE AND DOMESTIC VIOLENCE. (a) Using existing resources, the commission, in consultation with the task force, shall:

(1) make available to physicians and other persons licensed or certified to conduct a substance use screening and domestic violence screening of pregnant women information that includes:

(A) guidance regarding best practices for verbally screening a pregnant woman for substance use and verbally screening a pregnant woman for domestic violence using a validated screening tool; and

(B) a list of substance use treatment resources and domestic violence prevention and intervention resources in each geographic region of this state; and

(2) review and promote the use of educational materials on the consequences of opioid drug use and on domestic violence prevention and intervention during pregnancy.

(b) The commission shall make the information and educational materials described by Subsection (a) available on the commission's Internet website.

SECTION 5. Sections 34.007(a) and (b), Health and Safety Code, are amended to read as follows:

(a) The department shall determine a statistically significant number of cases of pregnancy-related deaths for review. The department shall either randomly select cases or select all cases for the task force to review under this subsection to reflect a cross-section of pregnancy-related deaths in this state.

(b) The department shall statistically analyze aggregate data of pregnancy-related deaths and severe maternal morbidity in this state to identify any trends, rates, or disparities.

SECTION 6. Section 34.009(d), Health and Safety Code, is amended to read as follows:

(d) Information is not confidential under this section if the information is general information that cannot be connected with any specific individual, case, or health care provider, such as:

(1) total expenditures made for specified purposes;

(2) the number of families served by particular health care providers or agencies;

(3) aggregated data on social and economic conditions;

(4) medical data and information related to health care services that do not include any identifying information relating to a patient or the patient's family; [and]

(5) information, including the source, value, and purpose, related to gifts, grants, or donations to or for use by the task force; and

(6) other statistical information.

SECTION 7. Section 34.015(b), Health and Safety Code, is amended to read as follows:

(b) The report must include the task force's recommendations under Section 34.005(4) [34.005(3)].

SECTION 8. Chapter 34, Health and Safety Code, is amended by adding Sections 34.0155, 34.0156, and 34.0157 to read as follows:

Sec. 34.0155. REPORT ON PREGNANCY-RELATED DEATHS, SEVERE MATERNAL MORBIDITY, AND POSTPARTUM DEPRESSION. The commission shall:

(1) evaluate options for reducing pregnancy-related deaths, focusing on the most prevalent causes of pregnancy-related deaths as identified in the joint biennial report required under Section 34.015, and for treating postpartum depression in economically disadvantaged women;

(2) in coordination with the department and the task force, identify strategies to:

(A) lower costs of providing medical assistance under Chapter 32, Human Resources Code, related to severe maternal morbidity and chronic illness; and

(B) improve quality outcomes related to the underlying causes of severe maternal morbidity and chronic illness; and

(3) not later than December 1 of each even-numbered year, submit to the governor, the lieutenant governor, the speaker of the house of representatives, the Legislative Budget Board, and the appropriate standing committees of the legislature a written report that includes:

(A) a summary of the commission's and department's efforts to accomplish the tasks described by Subdivisions (1) and (2); and

(B) a summary of the report required by Section 34.0156.

Sec. 34.0156. MATERNAL HEALTH AND SAFETY INITIATIVE. (a) Using existing resources, the department, in collaboration with the task force, shall promote and facilitate the use among health care providers in this state of maternal health and safety informational materials, including tools and procedures related to best practices in maternal health and safety.

(b) Not later than December 1 of each even-numbered year, the department shall submit a report to the executive commissioner that includes:

(1) a summary of the initiative's implementation and outcomes; and

(2) recommendations for improving the effectiveness of the initiative.

Sec. 34.0157. FEASIBILITY STUDY RELATED TO MATERNAL HEALTH AND SAFETY INITIATIVE. (a) Using existing resources and not later than December 1, 2018, the commission shall study and determine the feasibility of adding a provider's use of procedures included in the maternal health and safety initiative described by Section 34.0156 as an indicator of quality for commission data and medical assistance quality-based payment purposes.

(b) The department shall collaborate with the commission in compiling available data and information needed to complete the feasibility study.

(c) The commission shall include the commission's determination from the feasibility study in the report required by Section 34.0155.

(d) This section expires May 1, 2019.

SECTION 9. Section 34.018, Health and Safety Code, is amended to read as follows:

Sec. 34.018. SUNSET PROVISION. The task force is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the task force is abolished and this chapter expires September 1, 2023 [2019].

SECTION 10. Subchapter D, Chapter 1001, Health and Safety Code, is amended by adding Section 1001.0712 to read as follows:

Sec. 1001.0712. CAUSE OF DEATH DATA IMPROVEMENT. (a) Not later than December 1 of each even-numbered year, the department shall submit to the governor, lieutenant governor, speaker of the house of representatives, and appropriate standing committees of the legislature a report on the processes and procedures for collecting cause of death information, including any challenges to collecting accurate information relating to maternal mortality.

(b) In preparing the report, the department may examine:

(1) issues relating to the quality of the death information being collected, including the accuracy and completeness of the information;

(2) the role of medical certifiers in death information collection;

(3) the perceptions of the individuals collecting the death information regarding the information's integrity;

(4) the training required for the individuals collecting death information; and

(5) the structural, procedural, and technological issues of collecting the information.

(c) The department, in consultation with the Maternal Mortality and Morbidity Task Force, shall examine national standards regarding the collection of death information and may convene a panel of experts to advise the department and the task force in developing recommendations for improving the collection of accurate information related to cause of death.

(d) The report may be included as part of another report the department is required to submit to the legislature.

(e) This section expires September 1, 2021.

SECTION 11. Not later than June 1, 2018, the Health and Human Services Commission shall make available the information and educational materials described by Section 34.0055, Health and Safety Code, as added by this Act.

SECTION 12. If before implementing any provision of this Act a state agency determines that an additional waiver or additional authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 13. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect on the 91st day after the last day of the legislative session.

______________________________ ______________________________

President of the Senate Speaker of the House

I hereby certify that S.B. No. 17 passed the Senate on July 25, 2017, by the following vote: Yeas 31, Nays 0; and that the Senate concurred in House amendments on August 15, 2017, by the following vote: Yeas 31, Nays 0.

______________________________ Secretary of the Senate

I hereby certify that S.B. No. 17 passed the House, with amendments, on August 14, 2017, by the following vote: Yeas 146, Nays 0, two present not voting.

______________________________ Chief Clerk of the House

Approved:

______________________________

Date

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Governor