Bill Text: CA AB50 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: evidence-based home visiting programs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2016-01-15 - Consideration of Governor's veto stricken from file. [AB50 Detail]
Download: California-2015-AB50-Amended.html
Bill Title: Medi-Cal: evidence-based home visiting programs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2016-01-15 - Consideration of Governor's veto stricken from file. [AB50 Detail]
Download: California-2015-AB50-Amended.html
BILL NUMBER: AB 50 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 21, 2015
AMENDED IN ASSEMBLY APRIL 6, 2015
INTRODUCED BY Assembly Member Mullin
DECEMBER 1, 2014
An act to add Section 14148.25 to the Welfare and
Institutions Code, relating to perinatal care. An act
to amend Section 123492 of the Health and Safety Code, relating to p
erinatal care.
LEGISLATIVE COUNSEL'S DIGEST
AB 50, as amended, Mullin. Medi-Cal: nurse home visiting
programs. Nurse-Family Partnership.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services,
including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program,
which is administered by the State Department of Public Health, to
provide grants for voluntary nurse home visiting programs for
expectant first-time mothers, their children, and their families.
Under existing law, a county is required to satisfy specified
requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health
Care Services, Public Health to additionally develop a
grant application and award grants to counties for other
evidence-based home visiting programs, and would require the
department, in consultation with stakeholders,
stakeholders and the State Department of Health Care
Services, to develop and implement a plan on or before January
1, 2017, to ensure that Nurse-Family Partnership and other
evidence-based nurse home visiting programs are offered and provided
to Medi-Cal eligible pregnant women, and would require the
department, on or before January 1, 2022, and every 5 years
thereafter, to report to the Legislature, as specified. The bill
would also require the department, in developing the plan, to
consider, among other things, establishing Medi-Cal coverage for
evidence-based nurse home visiting program services and incentives
for providers to offer those services. women.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) According to United States Census Bureau, California has a
poverty rate of 23.5 percent, the highest rate of any state in the
country.
(b) Children born into poverty are at higher risk of health and
developmental disparities, including, but not limited to, premature
birth, low birth weight, infant mortality, crime, domestic violence,
developmental delays, dropping out of high school, substance abuse,
unemployment, and child abuse and neglect.
(c) In 2014, the Legislature passed Assembly Concurrent Resolution
No. 155 by Assembly Member Raul Bocanegra, recognizing that research
over the last two decades in the evolving fields of neuroscience,
molecular biology, public health, genomics, and epigenetics reveals
that experiences in the first few years of life build changes into
the biology of the human body that, in turn, influence the person's
physical and mental health over his or her lifetime.
(d) On May 3, 2012, Governor Edmund G, Brown Jr. issued Executive
Order B-19-12, establishing the "Let's Get Healthy California Task
Force" to develop a 10-year plan for improving the health of
Californians, controlling health care costs, promoting personal
responsibility for individual health, and advancing health equity."
(e) The task force identified several priorities, including a
subset for "Healthy Beginnings," which include reducing infant
deaths, increasing vaccination rates, reducing childhood trauma, and
reducing adolescent tobacco use.
(f) The final report of the task force states "the challenge going
forward is to identify evidence-based interventions and quicken the
pace of uptake across the state," in order to meet the ambitious
goals in the Governor's directive.
(g) In 2013, more than 248,000 Medi-Cal beneficiaries gave birth
to a child. Because Medi-Cal covers half of all births in the state,
this has increased costs for taxpayers. Medi-Cal expansion has
resulted in an 18 percent increase in Medi-Cal enrollment to a total
of 11.3 million, and enrollment is expected to exceed 12
million in 2015.
(h) The California Health and Human Services Agency recently
submitted its State Health Care Innovation Plan, including the
Maternity Care initiative, which addresses issues of high costs in
maternity care, to the federal Center for Medicare and
Medicaid Innovation. Child deliveries and related expenses, including
high-risk births, rank among the top 10 high cost episodes of health
care, and in the last 15 years, California has seen a continual rise
in maternal mortality.
(i) The cost of health care specifically related to high-risk
pregnancies, neonatal intensive-care unit (NICU) services, toxic
stress, and emergency room visits has increased and is projected to
continue to rise. Average health care costs for women were 25 percent
more than men primarily due to higher costs of health care during
childbearing years.
(j) The Nurse-Family Partnership is a voluntary, evidence-based,
prevention program that partners low-income, pregnant women having
their first child with a registered nurse who provides home visits
from early in pregnancy until the child's second birthday.
(k) With more than 37 years of evidence from randomized,
controlled trials, the Nurse-Family Partnership has demonstrated
sustained improvements in maternal health, child health and
development, and the economic stability of families.
(l) The Nurse-Family Partnership has consistently demonstrated
reductions in preterm births and preventable maternal mortality via
controlled trial and longitudinal follow-ups over two decades.
(m) Randomized, controlled trials have also demonstrated that the
use of Nurse-Family Partnership nurse home visitors increases
positive outcomes during the prenatal period and the first two years
of life compared to the use of paraprofessionals.
(n) Research has shown that the Nurse-Family Partnership can
reduce smoking during pregnancy, complications of pregnancy, preterm
births, closely spaced subsequent births, and childhood injuries
resulting in costly emergency department use and hospitalizations.
The Nurse-Family Partnership also can improve childhood immunization
rates and compliance with well child visit schedules. As a result of
families benefiting from Nurse-Family Partnership, there has been
cost savings to federal, state, and local governments with respect to
programs and services, including Medicaid, the Supplemental
Nutrition Assistance Program (SNAP), and the Temporary Assistance for
Needy Families (TANF) program.
(o) By enrolling recipients no later than 28 weeks of gestation,
the Nurse-Family Partnership maximizes the impact on prenatal care,
birth outcomes, and critical early brain development of infants.
(p) The Nurse-Family Partnership's evidence base and benefits to
society are well documented and validated by independent analyses.
(q) The Nurse-Family Partnership's strong evidence of
effectiveness and predictable return on investment demonstrate that
this evidence-based intervention should be brought to scale in
California to improve maternal and child health outcomes and help
reduce health care costs for generations to come.
(r) Twenty-one California counties currently operate a
Nurse-Family Partnership program providing services to 4,000
residents. Only a fraction of the 100,000 potentially eligible
recipients annually are receiving these highly beneficial and
cost-effective services.
(s) However, if California were to provide these services to
significantly more eligible first-time mothers, the state could see
population-wide health and economic benefits that would carry over to
future generations.
(t) Therefore, it is the intent of the Legislature to develop a
means to leverage public and private dollars to substantially expand
the scale of the Nurse-Family Partnership and other evidence-based
nurse home visiting throughout California, beginning with communities
and populations with the greatest need.
SEC. 2. Section 14148.25 is added to the
Welfare and Institutions Code, immediately following Section 14148.2,
to read:
14148.25. (a) The department shall, in consultation with
stakeholders, develop and implement a plan on or before January 1,
2017, to ensure that Nurse-Family Partnership and other
evidence-based nurse home visiting programs are offered and provided
to all Medi-Cal eligible pregnant women. The department shall
consider all of the following in developing the plan:
(1) Establishing Medi-Cal coverage for evidence-based nurse home
visiting program services.
(2) Incentives for providers to offer evidence-based nurse home
visiting program services.
(3) Other mechanisms to fund evidence-based nurse home visiting
program services.
(b) (1) The department shall, on or before January 1, 2022, and
every five years thereafter, report to the Legislature on
implementation progress and the effectiveness of evidence-based nurse
home visiting services in improving maternal and child health
outcomes, the experience of care, and cost savings to the Medi-Cal
program and the state.
(2) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government Code.
(c) For the purposes of this section, the following definitions
shall apply:
(1) "Evidence-based program" means a program that is based on
scientific evidence demonstrating that the program model is
effective. An evidence-based program shall be reviewed on site and
compared to program model standards by the model developer or the
developer's designee at least every five years to ensure that the
program continues to maintain fidelity with the program model. The
program model shall have had demonstrated and replicated significant
and sustained positive outcomes that have been in one or more
well-designed and rigorous randomized controlled research designs,
and the evaluation results shall have been published in a
peer-reviewed journal.
(2) "Nurse home visiting program" means a program or initiative
that does all of the following:
(A) Contains home visiting as a primary service delivery strategy
by registered nurses to families with a pregnant woman who is
eligible for medical assistance.
(B) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children from
prenatal to two years old; and
(C) Targets participant outcomes that include all of the
following:
(i) Improved maternal and child health.
(ii) Prevention of child injuries, child abuse or maltreatment,
and reduction of emergency department visits.
(iii) Improvements in school readiness and achievement.
(iv) Reduction in crime or domestic violence.
(v) Improvements in family economic self-sufficiency.
(vi) Improvements in coordination of, and referrals to, other
community resources and support.
(vii) Improvements in parenting skills related to child
development.
SEC. 2. Section 123492 of the Health and
Safety Code is amended to read:
123492. (a) The department shall develop a
grant application and award grants on a competitive basis to counties
for the startup, continuation, and expansion of the
Nurse-Family Partnership program established pursuant to
Section 123491. 123491 and other
evidence-based home visiting programs. To be eligible to
receive a grant for purposes of that section, a county shall agree to
do all of the following:
(a)
(1) Serve through the program only pregnant, low-income
women who have had no previous live births. Notwithstanding
subdivision (b) of Section 123485, women who are juvenile offenders
or who are clients of the juvenile system shall be deemed eligible
for services under the program.
(b)
(2) Enroll women in the program while they are still
pregnant, before the 28th week of gestation, and preferably before
the 16th week of gestation, and continue those women in the program
through the first two years of the child's life.
(c)
(3) Use as home visitors only registered nurses who
have been licensed in the state.
(d)
(4) Have nurse home visitors undergo training according
to the program and follow the home visit guidelines developed by the
Nurse-Family Partnership program.
(e)
(5) Have nurse home visitors specially trained in
prenatal care and early child development.
(f)
(6) Have nurse home visitors follow a visit schedule
keyed to the developmental stages of pregnancy and early childhood.
(g)
(7) Ensure that, to the extent possible, services shall
be rendered in a culturally and linguistically competent manner.
(h)
(8) Limit a nurse home visitor's caseload to no more
than 25 active families at any given time.
(i)
(9) Provide for every eight nurse home visitors a
full-time nurse supervisor who holds at least a bachelor's degree in
nursing and has substantial experience in community health nursing.
(j)
(10) Have nurse home visitors and nurse supervisors
trained in effective home visitation techniques by qualified
trainers.
(k)
(11) Have nurse home visitors and nurse supervisors
trained in the method of assessing early infant development and
parent-child interaction in a manner consistent with the program.
(l)
(12) Provide data on operations, results, and
expenditures in the formats and with the frequencies specified by the
department.
(m)
(13) Collaborate with other home visiting and family
support programs in the community to avoid duplication of services
and complement and integrate with existing services to the extent
practicable.
(n)
(14) Demonstrate that adoption of the Nurse-Family
Partnership program is supported by a local governmental or
government-affiliated community planning board, decisionmaking board,
or advisory body responsible for assuring the availability of
effective, coordinated services for families and children in the
community.
(o)
(15) Provide cash or in-kind matching funds in the
amount of 100 percent of the grant award.
(p)
(16) Prohibit the use of moneys received for the
program as a match for grants currently administered by the
department.
(b) The department shall, in consultation with stakeholders and
the State Department of Health Care Services, develop and implement a
plan on or before January 1, 2017, to ensure that Nurse-Family
Partnership and other evidence-based nurse home visiting programs are
offered and provided to all Medi-Cal eligible pregnant women.
