Bill Text: CA AB904 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care coverage: doulas.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Passed) 2023-10-07 - Chaptered by Secretary of State - Chapter 349, Statutes of 2023. [AB904 Detail]
Download: California-2023-AB904-Amended.html
Section 1367.626 is added to the Health and Safety Code, to read:
Section 10123.868 is added to the Insurance Code, to read:
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
Bill Title: Health care coverage: doulas.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Passed) 2023-10-07 - Chaptered by Secretary of State - Chapter 349, Statutes of 2023. [AB904 Detail]
Download: California-2023-AB904-Amended.html
|
Amended
IN
Assembly
March 29, 2023 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Assembly Bill
No. 904
| Introduced by Assembly Member Calderon |
February 14, 2023 |
An act to add Section 1367.626 to the Health and Safety Code, and to add Section 10123.868 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 904, as amended, Calderon.
Health care coverage: doulas.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to develop a maternal mental health program designed to promote quality and cost-effective outcomes. Existing law encourages a plan or insurer to include coverage for doulas.
This bill would require a health care service plan or health insurer, on or before January 1, 2025, to develop a maternal and infant health equity program that addresses racial health disparities in maternal and infant health outcomes through the use of doulas. The bill would
authorize the departments to jointly convene workgroups a workgroup to examine the implementation of these programs. The bill would specify workgroup membership and duties. The bill would require the Department of Managed Health Care, in consultation with the Department of insurance, to collect data and submit a report on doula coverage and the above-described programs to the Legislature by January 1, 2027. Because a willful violation of the provisions relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
The
California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
The Legislature finds and declares all of the following:(a) The United States has the highest rates of maternal mortality among higher-income countries. There are an estimated 1,200 deaths per year in the United States that are pregnancy-related, with about three in five deaths deemed preventable.
(b) The United States has an infant mortality rate that is higher than most
higher-income countries. Currently, the United States is ranked 33 out of 36 countries belonging to the Organization for Economic Cooperation and Development, with an average of 5.7 deaths per 1,000 live births.
(c) California’s Native American infant mortality rate is 11.7 deaths per 1,000 live births, followed by Black infants at 8.7 deaths per 1,000 live births. Both figures are far above the state’s average of 4.2 deaths per 1,000 live births.
(d) Prematurity is a leading cause of infant mortality and has been linked to lifelong conditions, such as behavioral development issues, learning difficulties, and chronic disease.
(e) Racism and racial bias in health care contribute to both the national maternal mortality and morbidity crisis and infant mortality and morbidity, in particular for pregnant and postpartum
people and infants who are Black or Native American.
(f) A study looking at over 32,000,000 births in the United States found that cisgender women of color, especially Black cisgender women, were more likely to experience additional negative birth outcomes from exposure to the effects of climate change, including increased temperature and air pollution from fires, which lead to increases in stillbirth and low birth weight, respectively.
(g) California has made great progress in the last decade to improve maternity care, and now boasts the lowest maternal mortality rate in the country. However, the improvements in maternal mortality have not come with a corresponding improvement in the racial disparities in maternal health. Black and Native American pregnant and postpartum people in California continue to die at higher rates than non-Hispanic white pregnant and postpartum
people.
(h) California is failing pregnant and postpartum people, especially those in some of the state’s most vulnerable and marginalized communities. Pregnant and postpartum people in California report discrimination and bias in care based on their race, gender, and language. This leads to fear and distrust of the institutionalized maternal health care system, particularly by people of color.
(i) One of the essential goals of the State Department of Public Health is to reduce health and mental health disparities among vulnerable and underserved communities to achieve health equity throughout California. This goal should extend to health equity for birthing people and infants.
(j) California can do a better job to support pregnant, birthing, and postpartum people in our state, especially Black pregnant, birthing,
and postpartum people, who are experiencing the brunt of racism, disparities, and inequities in health care access, services, and delivery.
(k) The State Department of Health Care Services rolled out doula benefits on January 1, 2023, by adding it to the list of preventive services covered under the Medi-Cal program.
(l) Existing law requires a health care service plan or health insurer to develop a maternal mental health program designed to promote quality and cost-effective outcomes, and encourages a plan or insurer to include coverage for doulas.
(m) To date, doula services are not covered by private health care service plans and insurers. California’s commercial plans and insurers, including Blue Shield of
California, HealthNet, Inland Empire Health Plan, and Anthem, have sponsored several doula pilot programs throughout the state. Participants of those pilots have reported positive health outcomes.
(n) While California is one of 10 states with Medicaid doula benefits, this bill would position the state to be one of the first to also expand doula access in the private coverage context. With 40 percent of births being funded by Medi-Cal every year, this act has the potential to reach even more births with the support of doulas.
SECTION 1.SEC. 2.
Section 1367.626 is added to the Health and Safety Code, to read:1367.626.
(a) On or before January 1, 2025, a health care service plan shall develop a maternal and infant health equity program that addresses racial health disparities in maternal and infant health outcomes through the use of doulas. This may be achieved by integrating the program into existing maternal mental health programs, including those encouraging the coverage of doula care, expanding existing doula pilot programs, or relying on a Medi-Cal doula benefit for local health plans.(b) The department and the Department of Insurance
may jointly convene a workgroup, composed of doulas, including community-based doulas, birth workers, activists, health care providers, consumer and community advocates, community members, health plans, county representatives, and other stakeholders with experience with doula services to meet on a monthly basis, as determined by the department,
departments, to examine the implementation of the programs required pursuant to subdivision (a).
(1) The workgroup membership shall be 80 percent practicing doulas. Of those doulas, at least 75 percent shall be doulas who are providing services to Medi-Cal enrollees through the doula Medi-Cal benefit.
(2) The workgroup shall refer to the existing Medi-Cal doula benefit, including the state plan amendment and provider manual, during the course of the workgroup. The workgroup shall also consider all of the following:
(A) Reimbursement rates and payment models, which shall not be lower than Medi-Cal rates and shall be aligned with current regional rates of pay for preventive care for perinatal practitioners in private practice or comparable to pay reflected in doula pilot programs held in California.
(B) Barriers to the development of a Medi-Cal doula benefit.
(C) Workforce development and sustainability.
(D) Including culturally concordant doula services to be used at the discretion of enrollees and insureds.
(E) Collaborating with community-based doula groups, birth workers, activists, advocates, and
community members throughout program development.
(F) Standardizing benefits across health care service plans and health insurers.
(c) The department, in consultation with the Department of Insurance, shall collect data and submit a report on doula coverage and programs required pursuant to subdivision (a) to the Legislature by January 1, 2027. The report may do both of the following:
(1) Include the department’s Healthcare Effectiveness Data and Information Set (HEDIS) measures or the Center for Data Insights and Innovation’s quality of care report card.
(2) Assess quality of care, increased access, ongoing barriers to access, and more.
(d) For purposes of this section:
(1) “Community-based doula” means a birth worker who provides doula care throughout the perinatal period, who is a trusted member of the community they serve, and who specializes in the provision of culturally congruent care, addressing discrimination, and meeting language gaps. A doula is not a medical professional and does not diagnose medical conditions, give medical advice, or perform any type of clinical procedures or conduct any type of physical or behavioral assessment or exam. Doulas are not licensed, and they do not require supervision.
(2) “Community-based doula group” means a group or collective of community-based doulas working together that prioritizes access to
doula care for underserved populations. The doula care that is provided by community-based doula groups often goes beyond doula services provided during prenatal and postpartum care, to encompass a broader and more holistic vision of support for the pregnant and birthing person and their family or supporting loved ones. Many community-based doula groups draw their membership directly from the communities that they serve. This often allows community-based doula groups to offer culturally congruent care, and not simply culturally appropriate care.
(3) “Full-spectrum doula care” means prenatal and postpartum doula care, presence during labor and delivery, and doula support for miscarriage, stillbirth, and abortion. Doula care includes physical, emotional, and other nonmedical care.
(4) “Perinatal period” means the period including pregnancy, labor, delivery, and postpartum.
(5) “Postpartum” means the one-year period following the end of a pregnancy.
SEC. 2.SEC. 3.
Section 10123.868 is added to the Insurance Code, to read:10123.868.
(a) On or before January 1, 2025, a health insurer shall develop a maternal and infant health equity program that addresses racial health disparities in maternal and infant health outcomes through the use of doulas.(b)The department may convene a workgroup, composed of doulas, health care providers, consumer and community advocates, health plans, county representatives, and other stakeholders with experience with doula services as determined by the department,
(b) Pursuant to subdivision (b) of Section 1367.626 of the Health and Safety Code, the department and the Department of Managed Health Care may jointly convene a workgroup to examine the implementation of the programs required pursuant to subdivision (a).
