SF 2062 (LSB 5089XS (13) 88)

SENATE FILE 2062

BY  PETERSEN, RAGAN, MATHIS, BOULTON, CELSI, J. SMITH, JOCHUM, WAHLS, KINNEY, DOTZLER, R. TAYLOR, BISIGNANO, LYKAM, GIDDENS, BOLKCOM, QUIRMBACH, HOGG, and T. TAYLOR

A BILL FOR

An Act relating to maternal and child health.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
MEDICAID COVERAGE —— MATERNAL AND CHILD HEALTH IMPROVEMENTS

    Section 1.  Section 249A.3, subsection 1, paragraph h, Code 2020, is amended to read as follows:
   h.  Is a woman who, while pregnant, meets eligibility requirements for assistance under the federal Social Security Act, section 1902(l), and continues to meet the requirements except for income. The woman is eligible to receive assistance until sixty days twelve months after the date pregnancy ends.
    Sec. 2.  MEDICAID REIMBURSEMENT FOR MATERNAL HEALTH.  Under both fee-for-service and managed care administration of Medicaid, the department of human services shall adopt rules pursuant to chapter 17A, amend any contract with a managed care organization, and apply for any Medicaid state plan amendment or waiver as may be necessary to provide for all of the following:
   1.  Reimbursement in an amount appropriate to cover the entire standard of care costs for labor and delivery.
   2.  The same reimbursement for maternal-fetal medicine services and comprehensive maternity care, including both facility and professional fees, whether provided in person or through the use of telehealth.
   3.  Continuous Medicaid eligibility for a woman for a twelve-month postpartum period, if the woman applied for Medicaid coverage before the end of the woman’s pregnancy, was determined Medicaid eligible, and remains eligible for coverage during the month in which the woman’s pregnancy ends. The woman’s eligibility for coverage shall continue during the twelve-month postpartum period beginning with the last day of the woman’s pregnancy through the end of the month in which the twelve-month period ends; shall continue without regard to the basis for the woman’s eligibility or changes in family income or resources; and shall continue in the same coverage group under which the woman received Medicaid coverage while pregnant unless the woman qualifies for Medicaid under another coverage group once the pregnancy ends or unless the woman’s eligibility is through the medically needy program.
   4.  Comprehensive maternity care, to include the basic number of prenatal and postpartum visits recommended by the American college of obstetricians and gynecologists; additional prenatal and postpartum visits that are medically necessary; necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach, and follow-up services; treatment of conditions which may complicate pregnancy; and doula care. For the purposes of this subsection, “doula” means a trained professional who provides continuous physical, emotional, and informational support to a woman before, during, and after childbirth, to help the woman achieve the healthiest, most satisfying experience possible.
   5.  Reimbursement for breast-feeding supports, counseling, and supplies including the standard cost of breast pumps, including electronic breast pumps.
   6.  Reimbursement for transportation to all prenatal and postpartum care appointments.
   7.  Reimbursement for all postpartum care products such as breast pads, period pads, comfort products, pain relievers, and other similar products.
DIVISION II
MATERNAL BEST PRACTICES OR SAFETY BUNDLES —— REQUIREMENTS FOR HOSPITALS

    Sec. 3.  NEW SECTION.  135B.36  Maternal best practices or safety bundles —— information.
   A hospital licensed under this chapter that provides labor and delivery services shall do all of the following:
   1.  Adopt and implement the current best practices or safety bundles recommended by the American college of obstetricians and gynecologists and the alliance for innovation on maternal health including but not limited to action measures for obstetrical hemorrhage, severe hypertension or preeclampsia, prevention of venous thromboembolism, reduction of low-risk primary cesarean births and support for intended vaginal births, reduction of peripartum racial disparities, and postpartum care access and standards.
   2.  Provide all of the following information to the public: 
   a.  Maternity and neonatal level of care status and the meaning of a maternity or neonatal level of care status. 
   b.  Cesarean birth statistics.
   c.  Vaginal birth after cesarean statistics.
   d.  Vaginal birth after two cesarean sections statistics.
   e.  The rate of exclusive breastfeeding upon discharge from a hospital.
   3.  Provide all women receiving labor and delivery services with information and assistance in applying for services and health care coverage available for the woman and the infant including but not limited to those available through Medicaid; area education agencies; the federal women, infants, and children program; and home visiting programs; and other relevant programs prior to discharge from the hospital.
   4.  Have in place a comprehensive labor and delivery unit closure plan that includes a plan for future births and pregnancies and the capacity of other providers to absorb the services in case of unit closure.
DIVISION III
MATERNAL AND INFANT HOME VISITING PROGRAM

    Sec. 4.  MATERNAL AND INFANT HOME VISITING PROGRAM.  The department of human services shall engage in a cross-agency collaboration with the department of public health and the department of education to identify and leverage funding sources and opportunities, including Medicaid, to expand home visiting services for women and infants that promote healthy pregnancies, positive birth outcomes, and healthy infant growth and development. The departments shall involve key stakeholders in designing a home visiting services approach for the state that maximizes the coordination and integration of programs and funding streams, reduces duplication of efforts, and ensures that the services provided meet federal evidence-based criteria. The approach shall ensure that home visiting services shall be available to women prenatally, throughout the pregnancy, and postpartum, and shall include mental and physical health, social, educational, and other services and interventions based upon the risk factors and needs identified. The departments may conduct a feasibility study to consider the various options available to increase Medicaid coverage and funding of home visiting services, either through a state plan amendment or waiver. The department of human services shall seek federal approval of any Medicaid state plan amendment or waiver necessary to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to maternal and child health.
   Division I of the bill relates to maternal and child health improvements under the Medicaid program. The bill directs the department of human services (DHS) under both fee-for-service and managed care administration of Medicaid to adopt rules pursuant to Code chapter 17A, amend any contract with a managed care organization, and apply for any Medicaid state plan amendment or waiver as may be necessary to provide all of the following: 1) reimbursement in an amount appropriate to cover the entire standard of care costs for labor and delivery, 2) the same reimbursement for maternal-fetal medicine services and comprehensive maternity care, including facility and professional fees, whether provided in person or through the use of telehealth, 3) continuous Medicaid eligibility for a woman for a 12-month postpartum period, 4) comprehensive maternity care, to include the basic number of prenatal and postpartum visits recommended by the American college of obstetricians and gynecologists; additional prenatal and postpartum visits that are medically necessary; necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach, and follow-up services; treatment of conditions which may complicate pregnancy; and doula care, 5) reimbursement for breastfeeding supports, counseling, and supplies including the standard cost of breast pumps including electronic breast pumps, 6) reimbursement for transportation to all prenatal and postpartum care appointments, and 7) reimbursement for all postpartum care products such as breast pads, period pads, comfort products, pain relievers, and other similar products.
   Division II of the bill relates to maternal best practices or safety bundle requirements for hospitals. The bill requires a licensed hospital that provides labor and delivery services to 1) adopt and implement the current best practices or safety bundles recommended by the American college of obstetricians and gynecologists and the alliance for innovation on maternal health; 2) provide information to the public, including but not limited to maternity and neonatal level of care status and the meaning of a maternity and neonatal level of care status, cesarean birth, vaginal births following cesarean births, and exclusive breast-feeding statistics; 3) provide all women receiving labor and delivery services with information and assistance in applying for services and health care coverage available for the woman and the infant including but not limited to those available through Medicaid; area education agencies; the federal women, infants, and children program; and home visiting programs; and other programs prior to discharge from the hospital; and 4) have in place a comprehensive labor and delivery unit closure plan that includes a plan for future births and pregnancies and the capacity of other providers to absorb the services in case of unit closure.
   Division III of the bill requires DHS to engage in a cross-agency collaboration with the departments of public health and education to identify and leverage funding sources and opportunities, including Medicaid, to expand home visiting services for women, infants, and young children that promote healthy pregnancies, positive birth outcomes, and healthy infant growth and development. The departments shall involve key stakeholders in designing a home visiting services approach for the state. Home visiting services shall be available to women prenatally, throughout the pregnancy, and postpartum, and shall include mental and physical health, social, educational, and other services and interventions based upon the risk factors and needs identified. The departments may conduct a feasibility study to consider the various options available to increase Medicaid coverage and funding of home visiting services, either through a state plan amendment or waiver. DHS shall seek federal approval of any Medicaid state plan amendment or waiver necessary to administer this division of the bill.