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A BILL TO BE ENTITLED
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AN ACT
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relating to maternal mortality and morbidity in this state and |
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Medicaid eligibility of and coverage for certain services provided |
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to pregnant women. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 34.001, Health and Safety Code, is |
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amended by adding Subdivision (11-a) and amending Subdivision (12) |
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to read as follows: |
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(11-a) "Pregnancy-associated death" means the death |
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of a woman from any cause that occurs during or within one year of |
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delivery or end of pregnancy, regardless of the outcome or location |
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of the pregnancy. |
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(12) "Pregnancy-related death" means the death of a |
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woman while pregnant or within one year of delivery or end of |
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pregnancy, regardless of the outcome, duration, or location [and |
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site] of the pregnancy, from any cause related to or aggravated by |
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the pregnancy or its management, but not from accidental or |
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incidental causes. |
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SECTION 2. The heading to Section 34.002, Health and Safety |
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Code, is amended to read as follows: |
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Sec. 34.002. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW |
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COMMITTEE; REFERENCE IN LAW. |
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SECTION 3. Section 34.002, Health and Safety Code, is |
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amended by adding Subsection (a-1) and amending Subsections (b) and |
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(e) to read as follows: |
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(a-1) Notwithstanding any other law, a reference in this |
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chapter or other law to the Maternal Mortality and Morbidity Task |
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Force means the Texas Maternal Mortality and Morbidity Review |
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Committee. |
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(b) The review committee is a multidisciplinary advisory |
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committee within the department and is composed of the following 23 |
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[17] members: |
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(1) 21 [15] members appointed by the commissioner as |
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follows: |
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(A) four physicians specializing in obstetrics, |
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at least one of whom is a maternal fetal medicine specialist; |
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(B) one certified nurse-midwife; |
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(C) one registered nurse; |
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(D) one nurse specializing in labor and delivery; |
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(E) one physician specializing in family |
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practice; |
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(F) one physician specializing in psychiatry; |
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(G) one physician specializing in pathology; |
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(H) one epidemiologist, biostatistician, or |
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researcher of pregnancy-related deaths; |
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(I) one social worker or social service provider; |
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(J) two [one] community advocates [advocate] in a |
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relevant field; |
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(K) one medical examiner or coroner responsible |
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for recording deaths; [and] |
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(L) one physician specializing in critical care; |
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(M) one physician specializing in emergency |
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care; |
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(N) one physician specializing in cardiology; |
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(O) one physician specializing in |
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anesthesiology; |
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(P) one physician specializing in oncology; and |
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(Q) one representative of a managed care |
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organization; |
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(2) a representative of the department's family and |
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community health programs; and |
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(3) the state epidemiologist for the department or the |
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epidemiologist's designee. |
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(e) A member of the review committee appointed under |
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Subsection (b)(1) is not entitled to compensation for service on |
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the review committee but, subject to Section 34.014(b), may be |
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reimbursed [or reimbursement] for travel or other expenses incurred |
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by the member while conducting the business of the review |
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committee. |
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SECTION 4. Section 34.003(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) Review committee members appointed by the commissioner |
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serve staggered six-year terms, with one-third or as near as |
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possible to one-third of the members' terms [of four or five |
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members, as appropriate,] expiring February 1 of each odd-numbered |
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year. |
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SECTION 5. Section 34.008, Health and Safety Code, is |
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amended by adding Subsection (e) to read as follows: |
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(e) For purposes of this chapter, a health care provider, |
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including a nurse, who is involved in obtaining information |
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relevant to a case of pregnancy-associated death, |
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pregnancy-related death, or severe maternal morbidity under this |
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chapter and who is required under other law to report a violation |
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related to the provider's profession is exempt from that reporting |
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requirement for the information obtained under this chapter. |
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SECTION 6. Section 34.009(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) Any information pertaining to a pregnancy-associated |
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death, a pregnancy-related death, or severe maternal morbidity is |
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confidential for purposes of this chapter. |
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SECTION 7. Section 34.014, Health and Safety Code, is |
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|
amended to read as follows: |
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Sec. 34.014. FUNDING. (a) The department may accept gifts |
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and grants from any source to fund the duties of the department and |
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the review committee under this chapter. |
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(b) The department may use only gifts, grants, or federal |
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|
funds to reimburse travel or other expenses incurred by a member of |
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the review committee in accordance with Section 34.002(e). |
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SECTION 8. Section 34.017, Health and Safety Code, is |
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|
amended by adding Subsections (c), (d), and (e) to read as follows: |
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(c) The department may allow voluntary and confidential |
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reporting to the department of pregnancy-associated deaths and |
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pregnancy-related deaths by health care providers and persons who |
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complete the medical certification for a death certificate for |
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|
deaths reviewed or analyzed by the review committee. |
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(d) The department shall allow voluntary and confidential |
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|
reporting to the department of pregnancy-associated deaths and |
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|
pregnancy-related deaths by family members of or other appropriate |
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|
individuals associated with a deceased patient. The department |
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|
shall: |
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(1) post on the department's Internet website the |
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|
contact information of the person to whom a report may be submitted |
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|
under this subsection; and |
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(2) conduct outreach to local health organizations on |
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the availability of the review committee to review and analyze the |
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deaths described by this subsection. |
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(e) Information reported to the department under this |
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|
section is confidential in accordance with Section 34.009. |
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SECTION 9. Chapter 34, Health and Safety Code, is amended by |
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|
adding Section 34.022 to read as follows: |
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Sec. 34.022. DEVELOPMENT OF WORK GROUP ON ESTABLISHMENT OF |
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MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY. (a) In this |
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|
section, "maternal mortality and morbidity data registry" means an |
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|
Internet website or database established to collect individualized |
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|
patient information and aggregate statistical reports on the health |
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|
status, health behaviors, and service delivery needs of maternal |
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patients. |
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(b) The department shall establish a work group to advise |
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|
the department on the report and recommendations required by |
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Subsection (e). The work group consists of the following members |
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appointed by the commissioner unless otherwise provided: |
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(1) one member with appropriate expertise appointed by |
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the governor; |
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(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 |
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|
chair's designee; |
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(5) the president of the Texas Medical Association or |
|
|
the president's designee; |
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(6) the president of the Texas Nurses Association or |
|
|
the president's designee; |
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(7) one member who is a physician specializing in |
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|
obstetrics and gynecology; |
|
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(8) one member who is a physician specializing in |
|
|
maternal and fetal medicine; |
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|
(9) one member who is a registered nurse specializing |
|
|
in labor and delivery; |
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|
(10) one member who is a representative of a hospital |
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|
located in a rural area of this state; |
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|
(11) one member who is a representative of a hospital |
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|
located in a county with a population of four million or more; |
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(12) one member who is a representative of a hospital |
|
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located in an urban area of this state in a county with a population |
|
|
of less than four million; |
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(13) one member who is a representative of a public |
|
|
hospital; |
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(14) one member who is a representative of a private |
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|
hospital; |
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(15) one member who is an epidemiologist; |
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(16) one member who is a statistician; |
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(17) one member who is a public health expert; and |
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|
(18) any other member with appropriate expertise as |
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|
the commissioner determines necessary. |
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(c) The work group shall elect from among the membership a |
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|
presiding officer. |
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(d) The work group shall meet periodically and at the call |
|
|
of the presiding officer. |
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(e) With the goals of improving the quality of maternal care |
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|
and combating maternal mortality and morbidity and with the advice |
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|
of the work group, the department shall assess and prepare a report |
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and recommendations on the establishment of a secure maternal |
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mortality and morbidity data registry to record information |
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submitted by participating health care providers on the health |
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status of maternal patients over varying periods, including the |
|
|
frequency and characteristics of maternal mortality and morbidity |
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|
during pregnancy and the postpartum period. |
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|
(f) In developing the report and recommendations required |
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|
by Subsection (e), the department shall: |
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(1) consider individual maternal patient information |
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related to health status and health care received over varying |
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|
periods that should be submitted to the registry; |
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(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: |
|
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(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 |
|
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delivery; and |
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(C) until the 364th day following a patient's |
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delivery. |
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(g) If the department recommends the establishment of a |
|
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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: |
|
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(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: |
|
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(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, 2024, 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, 2025. |
|
|
SECTION 10. Section 32.024(l-1), Human Resources Code, is |
|
|
amended to read as follows: |
|
|
(l-1) The commission shall continue to provide medical |
|
|
assistance to a woman who is eligible for medical assistance for |
|
|
pregnant women for a period of not less than 12 [six] months |
|
|
following the last month of the woman's pregnancy [date the woman |
|
|
delivers or experiences an involuntary miscarriage]. |
|
|
SECTION 11. Subchapter B, Chapter 32, Human Resources Code, |
|
|
is amended by adding Section 32.02481 to read as follows: |
|
|
Sec. 32.02481. MEDICAL ASSISTANCE PILOT 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 pilot 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 pilot program. |
|
|
(c) Not later than September 1, 2024, the commission shall |
|
|
implement the pilot program in: |
|
|
(1) the most populous county in this state; and |
|
|
(2) the county with the greatest maternal health |
|
|
support needs, as determined by the county's maternal and infant |
|
|
mortality rates and the number of births in the county by Medicaid |
|
|
recipients. |
|
|
(d) The commission shall prescribe eligibility requirements |
|
|
for participation in the pilot program. |
|
|
(e) Not later than September 1 of each year during the |
|
|
operation of the pilot 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 pilot program; and |
|
|
(2) the impact on birth outcomes for women who receive |
|
|
doula services under the pilot program. |
|
|
(f) Not later than September 1, 2028, the commission shall |
|
|
prepare and submit to the legislature a written report that: |
|
|
(1) summarizes the results of the pilot program, |
|
|
including the effectiveness of the pilot program in reducing |
|
|
maternal mortality rates and racial disparities in health outcomes |
|
|
in the geographic areas of this state in which the pilot program |
|
|
operates; |
|
|
(2) includes feedback from participating doulas and |
|
|
recipients who received doula services under the pilot program; and |
|
|
(3) includes a recommendation on whether the pilot |
|
|
program should be continued, expanded, or terminated. |
|
|
(g) The pilot program terminates and this section expires |
|
|
September 1, 2029. |
|
|
SECTION 12. (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, 2024, 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, 2024. |
|
|
SECTION 13. 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, 2023. |
|
|
SECTION 14. Notwithstanding Section 32.02481(e), Human |
|
|
Resources Code, as added by this Act, the Health and Human Services |
|
|
Commission shall prepare and publish the first report required by |
|
|
that section not later than September 1, 2025. |
|
|
SECTION 15. 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 16. 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, 2023. |