HOUSE BILL REPORT
HB 1963
BYRepresentatives Vekich, Brooks, Braddock, Morris, Bristow, Day, Sprenkle, Spanel, Wolfe, Rector, K. Wilson, D. Sommers, Cantwell, Jones, Wang, Todd, Prentice, Winsley, P. King, Heavey, Walk, Cooper, Jacobsen, R. King, Brough, Basich, Dellwo, Zellinsky, Kremen, Phillips, Pruitt, Nelson, Hine, G. Fisher, Rust, Rasmussen, Leonard, H. Myers, Fraser and Miller
Establishing the maternity care access act.
House Committe on Health Care
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. (10)
Signed by Representatives Braddock, Chair; Day, Vice Chair; Brooks, Ranking Republican Member; Cantwell, Morris, Prentice, D. Sommers, Sprenkle, Vekich and Wolfe.
House Staff:Bill Hagens (786-7131)
Rereferred House Committee on Appropriations
Majority Report: The substitute bill by Committee on Health Care be substituted therefor and the substitute bill do pass. (26)
Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Appelwick, Belcher, Bowman, Braddock, Brekke, Bristow, Brough, Dorn, Ebersole, Hine, May, McLean, Nealey, Padden, Peery, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.
House Staff: Dave Knutson (786-7146)
AS REPORTED BY COMMITTEE ON APPROPRIATIONS MARCH 4, 1989
BACKGROUND:
Access to maternity care (prenatal, delivery, and postpartum) has become increasingly difficult for low-income women. Of the 70,000 births in Washington state during 1988, approximately 9,000 were delivered without consistent maternity care. Washington state has a higher rate of infant mortality than the national average. This is particularly important when the United States, as a whole, has one of the highest rates of infant mortality among industrialized nations.
Low birth weight deliveries (5.5 lbs or 2500 grams) are identified as the major factor in infant death and illness. Adequate maternity care is identified as an effective tool in reducing low birth weight deliveries. It is estimated that for every $1 spent on prenatal care, over $3 are saved in medical cost during the first year of an infant's life.
In addition to adequate medical care, availability of support services is identified as an important factor in having healthy babies. These include: education, nutrition counseling, transportation, child care, and other services.
Recent changes to federal Medicaid law permit a state to expand its federally matched program for low-income pregnant women and their children. A state is now able to extend medicaid coverage to pregnant women and children, under the age of one, whose income is below 185 percent of the federal poverty level (FPL), and children up to age eight below 100 percent FPL.
SUMMARY:
SUBSTITUTE BILL: The legislature finds that there is a high rate of infant death and illness in the state of Washington. Further, this problem is closely related to the lack of adequate maternity care. To provide adequate health care to low-income pregnant women and their young children, a maternity care access system is established.
Nothing in this act creates a vested right that cannot be repealed by the legislature.
Definitions of "at risk person," "eligible person," "maternity care services," and "support services" are provided.
The Department of Social and Health Services (DSHS) is required to establish a maternity care access program with the following features: providing maternity care to low income women, and health care to their children to the extent made possible by federal law and having in place, by December 1, 1989, a system that expedites the medical assistance eligibility process for pregnant women. This shall include a short and simplified application form, and the capability of determining eligibility within 15 days of application.
The Department of Social and Health Services is required to study the desirability and feasibility of implementing the presumptive eligibility provisions for pregnant women, recently made possible by federal Medicaid law.
The Department of Social and Health Services is required to establish a case management program for women who are at risk of having difficulty in the pregnancy. Treatment for pregnant women who are substance abusive is provided through funding included in the Omnibus Drug Act (HB 1793).
Maternity care provider reimbursement levels are established at appropriate levels, consistent with available funds.
Areas of the state where the lack of access to maternity care is at a crisis proportion are designated as distressed areas. DSHS, in cooperation with the affected counties and a variety of community interests, shall develop an alternative service plan to alleviate the shortage. Criteria for designating a county or group of counties as a distressed area is provided in the act. If necessary to ensure maternity care access, DSHS may contract with or directly employ health practitioners to provide maternity care. In the latter case, DSHS may pay a related portion of the practitioner's liability insurance.
To the extent federal matching funds are available, DSHS, or its successor, shall develop a health education loan repayment program to assist maternity care providers who agree to practice in underserved areas.
The Department of Social and Health Services is required to contract with an independent non-profit entity to evaluate the maternity care access program and report to the legislature by December 1, 1990.
SUBSTITUTE BILL COMPARED TO ORIGINAL: The requirement that DSHS implement presumptive eligibility provisions is deleted from the bill; DSHS is required to study the concept.
The statutory authority for funding prenatal programs is clarified.
The definition of support services is clarified regarding the funding of treatment for substance abusive pregnant women.
The period of time counties have to develop remedial plans is changed from 60 to 120 days.
Community involvement in the development of the remedial plan is expanded to include DSHS and its local offices, local health officers, and community clinics.
CHANGES PROPOSED BY COMMITTEE ON APPROPRIATIONS: None.
Fiscal Note: Requested February 15, 1989.
House Committee ‑ Testified For: (Health Care) Elaine Morgan, Kitsap Community Clinic and Kitsap Pre-Natal Care Program; Roxann Lee, Kitsap Pre-Natal Care Program Client; Len Eddinger, Washington State Medical Association; Diane Schleuning, Access to Maternity Care Committee and Inland Empire Perinatal Center; George Rice, Washington State Medical Association, Kathleen Eussen, Thurston County Health Department; Kay Koontz, Southwest Washington Health District; Bud Nicola, Washington State Association of Local Public Health; Willa Fisher, Washington State Association of Local Public Health Officers; Maxine Hayes, Department of Social and Health Services; Sharon Case, Primary Health Care Association; Beverly Jacobson, Washington State Hospital Association and Seattle Area Hospital Association; Arnie Whedbee, Evergreen Legal Services; Ron Kero, Medical Assistance, Department of Social and Health Services; Patty Joynes and Washington State Nurses Association.
(Appropriations) Len Eddinger, State Medical Association, Dr. Nicola, King County Health Department, Seattle, Washington; and Ron Kero, Department of Social and Health Services.
House Committee - Testified Against: (Health Care) None Presented.
(Appropriations) None Presented.
House Committee - Testimony For: (Health Care) For the first time, state and local governmental efforts are joined to assist in prenatal, perinatal and post-partum care for women who cannot afford such care or are ineligible for like services. Investing in this program is imperative; for every dollar we invest in maternity care, we will save three dollars in the future. By implementing a program which aims to provide quality maternity care to low-income pregnant women and their infants, the state is responding to the ever increasing incidence of unwanted teenage pregnancy, infant mortality, and birth defects.
(Appropriations) Improved prenatal care will result in healthier low-income women and babies. This is a cost-effective investment in our state's future.
House Committee - Testimony Against: (Health Care) None Presented.
(Appropriations) None Presented.