Relating to maternal mortality and morbidity in this state and Medicaid eligibility of and coverage for certain services provided to pregnant women.

89(R) HB 3121 - Introduced version - Bill Text

89R13726 LRM-D

By: Collier

H.B. No. 3121

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 Subsection (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.

(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 34.008, 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 5. 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 6. 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 7. 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 8. 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, 2026, 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, 2027.

SECTION 9. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.02481 to read as follows:

Sec.

32.02481.

MEDICAL ASSISTANCE 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 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 program.

(c)

The commission shall prescribe eligibility requirements

for participation in the program.

(d)

Not later than September 1 of each year during the

operation of the 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 program; and

(2)

the impact on birth outcomes for women who receive

doula services under the program.

(e)

Not later than September 1, 2030, the commission shall

prepare and submit to the legislature a written report that:

(1)

summarizes the results of the program, including

the effectiveness of the program in reducing maternal mortality

rates and racial disparities in health outcomes in the geographic

areas of this state in which the program operates;

(2)

includes feedback from participating doulas and

recipients who received doula services under the program; and

(3)

includes a recommendation on whether the program

should be continued, expanded, or terminated.

(f)

The program terminates and this section expires

September 1, 2031.

SECTION 10. (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, 2026, 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, 2026.

SECTION 11. 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, 2025.

SECTION 12. 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 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 September 1, 2025.