88R7534 LRM-D
 
  By: Thierry H.B. No. 1958
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to maternal mortality and morbidity in this state and
  Medicaid eligibility of and coverage for certain services provided
  to pregnant women.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 34.001, Health and Safety Code, is
  amended by adding Subdivision (11-a) and amending Subdivision (12)
  to read as follows:
               (11-a)  "Pregnancy-associated death" means the death
  of a woman from any cause that occurs during or within one year of
  delivery or end of pregnancy, regardless of the outcome or location
  of the pregnancy.
               (12)  "Pregnancy-related death" means the death of a
  woman while pregnant or within one year of delivery or end of
  pregnancy, regardless of the outcome, duration, or location [and
  site] of the pregnancy, from any cause related to or aggravated by
  the pregnancy or its management, but not from accidental or
  incidental causes.
         SECTION 2.  The heading to Section 34.002, Health and Safety
  Code, is amended to read as follows:
         Sec. 34.002.  TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
  COMMITTEE; REFERENCE IN LAW.
         SECTION 3.  Section 34.002, Health and Safety Code, is
  amended by adding Subsection (a-1) and amending Subsections (b) and
  (e) to read as follows:
         (a-1)  Notwithstanding any other law, a reference in this
  chapter or other law to the Maternal Mortality and Morbidity Task
  Force means the Texas Maternal Mortality and Morbidity Review
  Committee.
         (b)  The review committee is a multidisciplinary advisory
  committee within the department and is composed of the following 23
  [17] members:
               (1)  21 [15] 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)  one physician specializing in psychiatry;
                     (G)  one physician specializing in pathology;
                     (H)  one epidemiologist, biostatistician, or
  researcher of pregnancy-related deaths;
                     (I)  one social worker or social service provider;
                     (J)  two [one] community advocates [advocate] in a
  relevant field;
                     (K)  one medical examiner or coroner responsible
  for recording deaths; [and]
                     (L)  one physician specializing in critical care;
                     (M)  one physician specializing in emergency
  care;
                     (N)  one physician specializing in cardiology;
                     (O)  one physician specializing in
  anesthesiology;
                     (P)  one physician specializing in oncology; and
                     (Q)  one representative of a managed care
  organization;
               (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.
         (e)  A member of the review committee appointed under
  Subsection (b)(1) is not entitled to compensation for service on
  the review committee but, subject to Section 34.014(b), may be
  reimbursed [or reimbursement] for travel or other expenses incurred
  by the member while conducting the business of the review
  committee.
         SECTION 4.  Section 34.003(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Review committee members appointed by the commissioner
  serve staggered six-year terms, with one-third or as near as
  possible to one-third of the members' terms [of four or five
  members, as appropriate,] expiring February 1 of each odd-numbered
  year.
         SECTION 5.  Section 34.008, Health and Safety Code, is
  amended by adding Subsection (e) to read as follows:
         (e)  For purposes of this chapter, a health care provider,
  including a nurse, who is involved in obtaining information
  relevant to a case of pregnancy-associated death,
  pregnancy-related death, or severe maternal morbidity under this
  chapter and who is required under other law to report a violation
  related to the provider's profession is exempt from that reporting
  requirement for the information obtained under this chapter.
         SECTION 6.  Section 34.009(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Any information pertaining to a pregnancy-associated
  death, a pregnancy-related death, or severe maternal morbidity is
  confidential for purposes of this chapter.
         SECTION 7.  Section 34.014, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.014.  FUNDING. (a) The department may accept gifts
  and grants from any source to fund the duties of the department and
  the review committee under this chapter.
         (b)  The department may use only gifts, grants, or federal
  funds to reimburse travel or other expenses incurred by a member of
  the review committee in accordance with Section 34.002(e).
         SECTION 8.  Section 34.017, Health and Safety Code, is
  amended by adding Subsections (c), (d), and (e) to read as follows:
         (c)  The department may allow voluntary and confidential
  reporting to the department of pregnancy-associated deaths and
  pregnancy-related deaths by health care providers and persons who
  complete the medical certification for a death certificate for
  deaths reviewed or analyzed by the review committee.
         (d)  The department shall allow voluntary and confidential
  reporting to the department of pregnancy-associated deaths and
  pregnancy-related deaths by family members of or other appropriate
  individuals associated with a deceased patient. The department
  shall:
               (1)  post on the department's Internet website the
  contact information of the person to whom a report may be submitted
  under this subsection; and
               (2)  conduct outreach to local health organizations on
  the availability of the review committee to review and analyze the
  deaths described by this subsection.
         (e)  Information reported to the department under this
  section is confidential in accordance with Section 34.009.
         SECTION 9.  Chapter 34, Health and Safety Code, is amended by
  adding Section 34.022 to read as follows:
         Sec. 34.022.  DEVELOPMENT OF WORK GROUP ON ESTABLISHMENT OF
  MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY. (a) In this
  section, "maternal mortality and morbidity data registry" means an
  Internet website or database established to collect individualized
  patient information and aggregate statistical reports on the health
  status, health behaviors, and service delivery needs of maternal
  patients.
         (b)  The department shall establish a work group to advise
  the department on the report and recommendations required by
  Subsection (e). The work group consists of the following members
  appointed by the commissioner unless otherwise provided:
               (1)  one member with appropriate expertise appointed by
  the governor;
               (2)  two members with appropriate expertise appointed
  by the lieutenant governor;
               (3)  two members with appropriate expertise appointed
  by the speaker of the house of representatives;
               (4)  the chair of the Texas Hospital Association or the
  chair's designee;
               (5)  the president of the Texas Medical Association or
  the president's designee;
               (6)  the president of the Texas Nurses Association or
  the president's designee;
               (7)  one member who is a physician specializing in
  obstetrics and gynecology;
               (8)  one member who is a physician specializing in
  maternal and fetal medicine;
               (9)  one member who is a registered nurse specializing
  in labor and delivery;
               (10)  one member who is a representative of a hospital
  located in a rural area of this state;
               (11)  one member who is a representative of a hospital
  located in a county with a population of four million or more;
               (12)  one member who is a representative of a hospital
  located in an urban area of this state in a county with a population
  of less than four million;
               (13)  one member who is a representative of a public
  hospital;
               (14)  one member who is a representative of a private
  hospital;
               (15)  one member who is an epidemiologist;
               (16)  one member who is a statistician;
               (17)  one member who is a public health expert; and
               (18)  any other member with appropriate expertise as
  the commissioner determines necessary.
         (c)  The work group shall elect from among the membership a
  presiding officer.
         (d)  The work group shall meet periodically and at the call
  of the presiding officer.
         (e)  With the goals of improving the quality of maternal care
  and combating maternal mortality and morbidity and with the advice
  of the work group, the department shall assess and prepare a report
  and recommendations on the establishment of a secure maternal
  mortality and morbidity data registry to record information
  submitted by participating health care providers on the health
  status of maternal patients over varying periods, including the
  frequency and characteristics of maternal mortality and morbidity
  during pregnancy and the postpartum period.
         (f)  In developing the report and recommendations required
  by Subsection (e), the department shall:
               (1)  consider individual maternal patient information
  related to health status and health care received over varying
  periods that should be submitted to the registry;
               (2)  review existing and developing registries used
  within and outside this state that serve the same or a similar
  purpose as a maternal mortality and morbidity data registry;
               (3)  review ongoing health data collection efforts and
  initiatives in this state to avoid duplication and ensure
  efficiency;
               (4)  review and consider existing laws that govern data
  submission and sharing, including laws governing the
  confidentiality and security of individually identifiable health
  information; and
               (5)  evaluate the clinical period during which a health
  care provider should submit to a maternal mortality and morbidity
  data registry known and available information, including
  information:
                     (A)  from a maternal patient's first appointment
  with an obstetrician and each subsequent appointment until the date
  of delivery;
                     (B)  for the 42 days following a patient's
  delivery; and
                     (C)  until the 364th day following a patient's
  delivery.
         (g)  If the department recommends the establishment of a
  maternal mortality and morbidity data registry, the report under
  Subsection (e) must include specific recommendations on the
  relevant individual patient information and categories of
  information to be submitted to the registry and on the intervals for
  submission of information. The categories must include:
               (1)  notifiable maternal deaths, including
  individualized patient data on:
                     (A)  patients who die during pregnancy; and
                     (B)  patients who were pregnant at any point in
  the 12 months preceding their death;
               (2)  individualized patient information on each
  pregnancy and birth;
               (3)  individualized patient data on the most common
  high-risk conditions for maternal patients and severe cases of
  maternal morbidity;
               (4)  nonidentifying demographic data from the
  provider's patient admissions records, including age, race, and
  patient health benefit coverage status; and
               (5)  a statistical summary based on an aggregate of
  individualized patient data that includes the following:
                     (A)  total live births;
                     (B)  maternal age distributions;
                     (C)  maternal race and ethnicity distributions;
                     (D)  health benefit plan issuer distributions;
                     (E)  incidence of diabetes, hypertension, and
  hemorrhage among patients;
                     (F)  gestational age distributions;
                     (G)  birth weight distributions;
                     (H)  total preterm birth rate;
                     (I)  rate of vaginal deliveries; and
                     (J)  rate of cesarean sections.
         (h)  If the department establishes a maternal mortality and
  morbidity data registry, a health care provider submitting
  information to the registry shall comply with all applicable
  federal and state laws relating to patient confidentiality and
  quality of health care information.
         (i)  The report and recommendations required under
  Subsection (e) must outline potential uses of a maternal mortality
  and morbidity data registry, including:
               (1)  periodic department analysis of information
  submitted to the registry; and
               (2)  the feasibility of preparing and issuing reports,
  using aggregated information, to each health care provider
  participating in the registry to improve the quality of maternal
  care.
         (j)  Not later than September 1, 2024, the department shall
  prepare and submit to the governor, the lieutenant governor, the
  speaker of the house of representatives, the Legislative Budget
  Board, and each standing committee of the legislature having
  primary jurisdiction over the department and post on the
  department's Internet website the report and recommendations
  required under Subsection (e).
         (k)  This section expires September 1, 2025.
         SECTION 10.  Section 32.024(l-1), Human Resources Code, is
  amended to read as follows:
         (l-1)  The commission shall continue to provide medical
  assistance to a woman who is eligible for medical assistance for
  pregnant women for a period of not less than 12 [six] months
  following the last month of the woman's pregnancy [date the woman
  delivers or experiences an involuntary miscarriage].
         SECTION 11.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.02481 to read as follows:
         Sec. 32.02481.  MEDICAL ASSISTANCE PILOT PROGRAM FOR DOULA
  SERVICES. (a) In this section:
               (1)  "Doula" means a nonmedical birthing coach who
  provides doula services and meets the qualifications for a doula as
  determined by commission rule.
               (2)  "Doula services" means nonmedical childbirth
  education, coaching, and support services, including emotional and
  physical support provided during pregnancy, labor, delivery, and
  the postpartum period, or provided intermittently during pregnancy
  and the postpartum period.
         (b)  The commission shall establish a pilot program to
  provide medical assistance reimbursement for doula services
  provided by a doula. The executive commissioner, in consultation
  with the Perinatal Advisory Council established under Section
  241.187, Health and Safety Code, by rule shall determine the
  qualifications necessary for an individual to be considered a doula
  and the doula services to be covered under the pilot program.
         (c)  Not later than September 1, 2024, the commission shall
  implement the pilot program in:
               (1)  the most populous county in this state; and
               (2)  the county with the greatest maternal health
  support needs, as determined by the county's maternal and infant
  mortality rates and the number of births in the county by Medicaid
  recipients.
         (d)  The commission shall prescribe eligibility requirements
  for participation in the pilot program.
         (e)  Not later than September 1 of each year during the
  operation of the pilot program, the commission shall prepare and
  publish on the commission's Internet website a report evaluating:
               (1)  the total costs during the preceding year of
  providing medical assistance reimbursement for doula services
  under the pilot program; and
               (2)  the impact on birth outcomes for women who receive
  doula services under the pilot program.
         (f)  Not later than September 1, 2028, the commission shall
  prepare and submit to the legislature a written report that:
               (1)  summarizes the results of the pilot program,
  including the effectiveness of the pilot program in reducing
  maternal mortality rates and racial disparities in health outcomes
  in the geographic areas of this state in which the pilot program
  operates;
               (2)  includes feedback from participating doulas and
  recipients who received doula services under the pilot program; and
               (3)  includes a recommendation on whether the pilot
  program should be continued, expanded, or terminated.
         (g)  The pilot program terminates and this section expires
  September 1, 2029.
         SECTION 12.  (a) In this section:
               (1)  "Department" means the Department of State Health
  Services.
               (2)  "Review committee" means the Texas Maternal
  Mortality and Morbidity Review Committee established under Chapter
  34, Health and Safety Code.
         (b)  The review committee and the department shall jointly
  conduct a study to evaluate maternal mortality and morbidity among
  Black women in this state. In conducting the study, the review
  committee and department shall:
               (1)  compare maternal mortality and morbidity rates
  among Black women in this state in relation to maternal mortality
  and morbidity rates among each other race and ethnicity;
               (2)  compare maternal mortality and morbidity rates
  among Black women in this state in relation to socioeconomic status
  and education level;
               (3)  assess the impact of social determinants of
  health, including an evaluation of data on pregnancy-related
  deaths, pregnancy-related complications that almost resulted in
  death, and morbidities, to identify any correlation in that data to
  women who are uninsured, women who receive health care coverage
  under Medicaid, and women who receive health care coverage through
  a private insurer;
               (4)  evaluate the impact of the following health
  conditions on maternal mortality and morbidity:
                     (A)  cardiac health conditions;
                     (B)  preeclampsia, eclampsia, and other
  hypertensive disorders;
                     (C)  hemorrhage;
                     (D)  obesity; and
                     (E)  stress-related health conditions; and
               (5)  assess the extent to which implicit biases held by
  health care providers against Black individuals affect maternal
  mortality and morbidity among Black women.
         (c)  Based on the results of the study conducted under this
  section, the review committee and department shall develop
  recommendations to address disparities in maternal mortality and
  morbidity among Black women, including recommendations on:
               (1)  strategies to reduce the incidence of
  pregnancy-related deaths and severe maternal morbidity;
               (2)  patient outreach and education;
               (3)  health care provider training, including a
  recommendation on the potential benefit of training on cultural
  competency and implicit biases against Black individuals;
               (4)  best practices identified as successful in
  reducing maternal mortality and morbidity; and
               (5)  the implementation in this state of programs
  operating in other states that have reduced maternal mortality and
  morbidity rates.
         (d)  Not later than September 1, 2024, the review committee
  and department shall prepare and submit to the governor, lieutenant
  governor, speaker of the house of representatives, and appropriate
  committees of the legislature a written report that summarizes the
  results of the study and includes the recommendations developed
  under this section. The report may be consolidated with the
  biennial report required under Section 34.015, Health and Safety
  Code.
         (e)  This section expires December 31, 2024.
         SECTION 13.  The executive commissioner of the Health and
  Human Services Commission shall adopt rules as necessary to
  implement Section 34.022, Health and Safety Code, as added by this
  Act, not later than December 1, 2023.
         SECTION 14.  Notwithstanding Section 32.02481(e), Human
  Resources Code, as added by this Act, the Health and Human Services
  Commission shall prepare and publish the first report required by
  that section not later than September 1, 2025.
         SECTION 15.  If before implementing any provision of this
  Act a state agency determines that a waiver or 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 16.  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 September 1, 2023.