Bill Summary – FastDemocracy

PRINTER'S NO.     3574
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                         HOUSE BILL
                         No. 2136
                                               Session of
                                                 2024
     INTRODUCED BY CURRY, MAYES, VENKAT, KAZEEM, KINSEY, PROBST,
        O'MARA, WAXMAN, HOHENSTEIN, KHAN, CEPHAS, ISAACSON,
        SHUSTERMAN, BOYD, ROZZI, BOROWSKI, HILL-EVANS, DONAHUE,
        SANCHEZ, CEPEDA-FREYTIZ, D. WILLIAMS, FLEMING, SCHLOSSBERG,
        OTTEN, CERRATO, DALEY, HANBIDGE AND GREEN, AUGUST 21, 2024
     REFERRED TO COMMITTEE ON HEALTH, AUGUST 21, 2024
                                    AN ACT
 Providing for Maternal Care Access Program; and imposing duties
    on the Department of Health.
    The General Assembly of the Commonwealth of Pennsylvania
 hereby enacts as follows:
 Section 1.    Short title.
    This act shall be known and may be cited as the Maternal Care
 Access Act.
 Section 2.    Definitions.
    The following words and phrases when used in this act shall
 have the meanings given to them in this section unless the
 context clearly indicates otherwise:
    "At-risk."    A geographic area that has a limited number of
 hospitals providing obstetric care, birth centers, obstetrician
 gynecologists and certified nurse midwives.
    "Average childbearing age."    Women of ages ranging from 10 to
 60 years of age.
    "Birth center."     An entity licensed as a birth center under
 the act of July 19, 1979 (P.L.130, No.48), known as the Health
 Care Facilities Act.
    "Department."   The Department of Health of the Commonwealth.
    "Distressed hospital."     A hospital that:
        (1)   had a negative profit margin for at least the
    previous three consecutive calendar years; and
        (2)   is located more than 25 miles of travel distance on
    a roadway from another hospital located in this Commonwealth.
    "Health care provider."     As defined in section 103 of the act
 of March 20, 2002 (P.L.154, No.13), known as the Medical Care
 Availability and Reduction of Error (Mcare) Act.
    "Hospital."    As defined in section 802.1 of the Health Care
 Facilities Act.
    "Maternal Health Index."     The following factors:
        (1)   Prepregnancy obesity.
        (2)   Prepregnancy diabetes.
        (3)   Prepregnancy hypertension.
        (4)   Prenatal care initiation in the first trimester.
        (5)   Cigarette smoking.
        (6)   Behavioral health factors.
    "Maternal Vulnerability Index."      The measure of 43 county-
 level social indicators, as published in the August 20, 2021,
 report, updated June 22, 2022, entitled Getting Hyperlocal to
 Improve Outcomes & Achieve Racial Equity in Maternal Health: The
 U.S. Maternal Vulnerability Index, published by Surgo Ventures.
    "Maternity care desert."     An area that does not have any of
 the following:
        (1)   Hospitals providing obstetric care.
        (2)   Birth centers.
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        (3)    Obstetrician gynecologists.
        (4)    Certified nurse midwives.
    "Maternity emergency services."         Care provided by a health
 care provider to a pregnant or postpartum patient as a result of
 one or more of the following symptoms:
        (1)    Chest pain.
        (2)    Decrease in fetal movement.
        (3)    Dizziness.
        (4)    Vomiting.
        (5)    Heavy vaginal bleeding.
        (6)    Loss of consciousness.
        (7)    Seizures.
        (8)    Severe abdominal pain or cramping.
        (9)    Severe headache.
        (10)     Sudden, spontaneous delivery.
        (11)     Sudden swelling in the arms, legs or face.
        (12)     Sudden changes in vision.
        (13)     Shortness of breath.
        (14)     High blood pressure.
    "Program."    The Maternal Care Access Program established
 under section 3.
    "Social Vulnerability Index."         The use of United States
 Census Bureau factors, as used by the Centers for Disease
 Control and Prevention, as follows:
        (1)    Percentage of population unemployed.
        (2)    Percentage of population without a high school
    diploma.
        (3)    Percentage of population without health insurance.
        (4)    Percentage of population below 150% of the poverty
    rate.
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          (5)    Percentage of households 65 years of age and older.
          (6)    Percentage of households aged 17 and younger.
          (7)    Percentage of households with individuals with a
    disability.
          (8)    Percentage of single-parent households.
          (9)    English language proficiency.
          (10)    Racial and ethnic minority population.
          (11)    Number of mobile homes.
          (12)    Number of multiunit housing structures.
          (13)    Number of households without a vehicle.
          (14)    Housing crowding.
          (15)    Group quarters.
    "Zone."      A maternal care access zone established under
 section 4.
 Section 3.      Maternal Care Access Program.
    (a)   Establishment.--The Maternal Care Access Program is
 established in the department for the purpose of identifying
 counties in this Commonwealth that would benefit from increased
 access to skilled and licensed maternal health care providers
 and resources to improve maternal health outcomes. The
 department may promulgate regulations necessary for the
 implementation of the program.
    (b)   Oversight.--The department may assign oversight
 authority of the program to another office or program in the
 department.
    (c)   Program resources.--The program may only distribute
 resources to birth centers, obstetrician gynecologists,
 certified nurse midwives or county health departments or
 hospitals providing obstetric care in zones designated in this
 act.
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 Section 4.      Maternal care access zones.
    (a)   Designation.--A county that meets the specified
 qualifications in this section may be designated by the
 department as a zone. The department may determine whether a
 zone is considered at-risk or a maternity care desert.
    (b)   Qualifications.--The department shall consider the
 following criteria when designating a zone as either at-risk or
 a maternity care desert:
          (1)    The ratio of females of average childbearing age to
    full-time equivalent maternity care health professionals.
          (2)    The percentage of females of average childbearing
    age with income at or below 200% of the Federal poverty
    level.
          (3)    Travel time and distance to the nearest provider
    trained and licensed to provide the necessary care, and 9.7
    miles and above constitutes an at-risk or maternity care
    desert.
          (4)    The Social Vulnerability Index.
          (5)    Lack of maternity emergency services.
          (6)    The Maternal Health Index.
          (7)    The number of distressed hospitals in the area.
          (8)    The number of health care providers of color in the
    area.
          (9)    The maternal mortality rate.
          (10)    The percentage of births covered by Medicaid.
          (11)    The number of birth centers in the area.
          (12)    Total obstetrician gynecologists in the area.
          (13)    The number of certified nurse midwives in the area.
          (14)    The Maternal Vulnerability Index.
          (15)    The number of births per day in the area and the
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    number of skilled and licensed maternal health care providers
    per birth.
    (c)   Scoring.--The department shall provide scoring for all
 counties in this Commonwealth based on the criteria specified in
 this section. The scoring of criteria shall determine the need
 for designation as a zone and whether a zone is considered to be
 at-risk or a maternity care desert. An at-risk county shall have
 a lower score and a maternity care desert shall have a higher
 score. The department shall determine the scoring parameters.
    (d)   Reporting.--A hospital shall report the criteria under
 this section to the appropriate county health department or the
 department. The county health department shall report the
 criteria under this section to the department.
 Section 5.     Regions.
    (a)   Establishment.--The following regions are established
 throughout this Commonwealth for the purpose of resource
 distribution:
          (1)   Region 1 shall consist of Cameron, Clarion,
    Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango,
    and Warren Counties.
          (2)   Region 2 shall consist of Allegheny, Armstrong,
    Beaver, Butler, Cambria, Fayette, Greene, Indiana, Jefferson,
    Lawrence, Somerset, Washington and Westmoreland Counties.
          (3)   Region 3 shall consist of Adams, Bedford,
    Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata,
    Lancaster, Lebanon, Mifflin, Perry and York Counties.
          (4)   Region 4 shall consist of Blair, Bradford, Centre,
    Clearfield, Clinton, Columbia, Lycoming, Montour,
    Northumberland, Snyder, Tioga, Union and Sullivan Counties.
          (5)   Region 5 shall consist of Carbon, Lackawanna,
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    Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill,
    Susquehanna, Wyoming and Wayne Counties.
          (6)   Region 6 shall consist of Berks, Bucks, Chester,
    Delaware, Montgomery and Philadelphia Counties.
    (b)   Resource distribution.--The department must equitably
 distribute resources to regions as specified in this section.
 Section 6.     Effective date.
    This act shall take effect in 180 days.
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