TO:	Honorable Gary VanDeaver, Chair, House Committee on Public Health

FROM:	Jerry McGinty, Director, Legislative Budget Board

IN RE:	HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced

Estimated Two-year Net Impact to General Revenue Related Funds for HB4553, As Introduced: a negative impact of ($250,000) through the biennium ending August 31, 2027.

The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.

Fiscal Year	Probable Net Positive/(Negative) Impact to General Revenue Related Funds
2026	($250,000)
2027	$0
2028	$0
2029	$0
2030	$0

Fiscal Year	Probable Savings/(Cost) from General Revenue Fund 1
2026	($250,000)
2027	$0
2028	$0
2029	$0
2030	$0

The bill would require that a midwife disclose the required informed choice and disclosure statement if the midwife is under active investigation by Texas Department of Licensing and Regulation (TDLR) before the client consents to care.

The bill would require a licensed midwife to submit a Birth and Outcomes Report to the Department of State Health Services (DSHS) Vital Statistics and TDLR within 10 days of attending any birth in a home birthing center, or other non-hospital setting.

The bill would require TDLR to conduct random audits of Birth and Outcome Reports to ensure compliance and accuracy.

The bill requires hospitals to report all deaths and morbidities linked to midwife-attended births to DSHS Vital Statistics, and requires DSHS to cross-check the data with midwife-submitted reports. The bill requires an investigation for any missing reports.

The bill provides fines and civil and criminal penalties for a midwife who fails to submit a report within the 10-day period.

The bill requires TDLR and DSHS to adopt rules for implementation.

According to DSHS, the agency would need to modify the Texas Electronic Vital Events Registrar (TxEVER) system to include a Birth and Outcomes registry. DSHS would use existing Information Technology (IT) staff for approximately 100 hours in FY 2026 to implement the TxEVER modifications.

Costs related to training of staff and data providers who report births on the new requirements, displaying de-identified statistics on maternal and neonatal outcomes from midwife-attended births, and promulgating any needed rules can be accomplished within existing resources by DSHS.

It is assumed that any costs for TDLR and the Health and Human Services Commission can be absorbed within existing resources.

One-time costs for TxEVER system modifications are estimated by DSHS to total $250,000 from the General Revenue Fund in fiscal year 2026. Additional IT staff time to implement TxEVER modifications can be absorbed within existing resources by DSHS.

LEGISLATIVE BUDGET BOARD
Austin, Texas

FISCAL NOTE, 89TH LEGISLATIVE REGULAR SESSION


April 27, 2025