Amended in Senate September 4, 2015

Amended in Senate September 1, 2015

Amended in Assembly May 21, 2015

Amended in Assembly May 13, 2015

Amended in Assembly April 21, 2015

Amended in Assembly April 6, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 50

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.

LEGISLATIVE COUNSEL’S DIGEST

AB 50, as amended, Mullin. Medi-Cal: evidence-based home visiting programs.

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, in consultation with specified stakeholders, to develop a begin insert feasibility end insert plan on or before January 1, 2017, begin delete to determine the feasibility of end delete begin insert end insert begin insert that describes the costs, benefits, and any potential barriers related to end insert offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for Medi-Cal providers to offer those services, and would require the department, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services.

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) Voluntary evidence-based home visiting programs, such as
Nurse-Family Partnership, Healthy Families America, Early Head
Start (Home-Based Program Option), Parents as Teachers, and
Home Instruction for Parents of Preschool Youngsters, strengthen
the critical parent-child relationship and connect families with
information and resources during the pivotal time from pregnancy
to five years of age. Extensive research has shown that
evidence-based home visiting programs serving pregnant and
parenting mothers, prenatal to the child turning five years of age,
increase family self-sufficiency, positive parenting practices, child
literacy and school readiness, and maternal and child health.

(h) Voluntary evidence-based home visiting program models
begin insert focused on end insert the prenatal begin insert period end insert to five years of age range from low
to high intensity, reflecting the broad spectrum of family needs
that home visiting can impact. Many experts hail home visiting
program diversity as essential to providing parents with choices
and ensuring that programs are well matched with local needs and
strengths, as well as responsive to the diverse needs of California’s
children and families.

(i) 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.

(j) 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.

(k) 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.

(l) With more than three decades of evidence from randomized,
controlled trials and rigorous followup evaluation studies,
evidence-based home visiting programs have demonstrated
sustained improvements in maternal health, child health, positive
parenting practices, child development and school readiness,
reductions in child maltreatment, family economic self-sufficiency,
linkages and referrals, and reductions in family violence.

(m) Evidence-based home visiting programs have specifically
demonstrated reductions in preterm births, preventable maternal
mortality, smoking during pregnancy, complications of pregnancy,
closely spaced subsequent births, childhood injuries resulting in
costly emergency department use and hospitalizations, improved
childhood immunization rates, compliance with well child visit
schedules, lower body mass index rates, higher birth weights, and
improved family well-being, including increased family health
literacy, and parent self-help development. As a result of families
benefiting from evidence-based home visiting, there have 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.

(n) The strong evidence of effectiveness and predictable return
on investment demonstrate that evidence-based home visiting
programs should be brought to scale in California to improve
maternal and child health outcomes and help reduce health care
costs for generations to come.

(o) By supporting families from the start, voluntary
evidence-based home visiting programs serving families from
prenatal to five years of age provide a foundation for subsequent
early childhood programs and family support efforts to build upon,
and can help ensure that families are well-equipped to raise
California’s next generation of productive, healthy, and successful
adults.

(p) Therefore, it is the intent of the Legislature to develop a
means to leverage public and private dollars to substantially expand
the scale of evidence-based home visiting programs throughout
California, beginning with communities and populations with the
greatest need.

SEC. 2.  

Section 14148.25 is added to the Health and Safety
Code, to read:

14148.25.  

(a) The department shall, in consultation with
stakeholders, including, but not limited to, representatives from
Medi-Cal managed care plans, public and private hospitals,
evidence-based home visiting programs, and begin delete local governments, end delete
begin insert other governmental entities including local and state law
enforcement and corrections agencies, local and state social
services agencies, and local and state educational agencies, end insert
develop a begin insert feasibility end insert plan on or before January 1, 2017, begin delete to
determine the feasibility of end delete begin insert that describes the costs, benefits, and
any potential barriers related to end insert offering evidence-based home
visiting programs to Medi-Cal eligible pregnant and parenting
women. The department shall consult with stakeholders from
diverse geographical regions of the state. The department shall
consider all of the following in developing the plan:

(1) Establishing Medi-Cal coverage for evidence-based home
visiting program services.

(2) Incentives for Medi-Cal providers to offer evidence-based
home visiting program services.

(3) Other mechanisms to fund evidence-based home visiting
program services for Medi-Cal eligible pregnant and parenting
women.

(4) Identifying among evidence-based home visiting programs
those with established evidence to improve health outcomes, the
experience of care, and cost savings to the health care system.

(b) In developing the plan, the department shall prioritize the
identification of funding sources, other than General Fund moneys,
to fund evidence-based home visiting program services, including
local, federal, or private funds, or any other funds made available
for these program services.

(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) “Evidence-based home visiting program” means a program
or initiative that does all of the following:

(A) Meets, on or before April 1, 2015, the United States
Department of Health and Human Services Maternal, Infant, and
Early Childhood Home Visiting (MIECHV) criteria, as described
in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act
(42 U.S.C. Sec. 711).

(B) Contains home visiting as a primary service delivery strategy
by providers satisfying home visiting program requirements to
provide services to families with a pregnant or parenting woman
who is eligible for medical assistance.

(C) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children from
prenatal to five years of age.

(D) 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.