PERINATAL AND MATERNAL HEALTH SERVICES S.B. 818 - 827:
SUMMARY OF INTRODUCED BILL
IN COMMITTEE
Senate Bills 818 through 827 (as introduced 4-10-24)
Sponsor: Senator Erika Geiss (S.B. 818 & 819)
Senator Mary Cavanagh (S.B. 820 & 821)
Senator Sarah Anthony (S.B. 822 & 825)
Senator Stephanie Chang (S.B. 823 & 826)
Senator Sylvia Santana (S.B. 824 & 827)
Committee: Housing and Human Services
Date Completed: 6-18-24
INTRODUCTION
The bills would amend existing and enact new laws governing perinatal care in the State.
They would require the Department of Health and Human Services (DHHS) and the
Department of Civil Rights (MDCR) to research the status of maternal and perinatal health in
the State and provide regular reports on the best methods to address racial and ethnic
disparities and improve patient care within the field. They also would prohibit discrimination
based on pregnancy or lactating status.
The bills would require insurers covering perinatal care to provide information on malpractice
policies related to such care and to cover perinatal services provided in homes or health care
facilities. They would require health facilities to stabilize pregnant patients in labor before
terminating the patient-provider relationship if that patient refused or denied care. They would
allow patient advocate designations to include directives on treatment during pregnancy.
Additionally, the bills would allow the DHHS to provide loan reimbursement and other support
to qualified certified nurse midwives working in Health Professional Shortage Areas (HPSA).
They would establish a Doula Scholarship Program within the DHHS and require health
facilities to allow a pregnant patient's doula to accompany the patient. Finally, they would
modify reporting and notification requirements for newborns exposed to alcohol or controlled
substances and require the DHHS to develop a safe care plan to address the needs of newborn
infants and their parents in these situations.
BRIEF FISCAL IMPACT
The bills would have no fiscal impact on local units of government and an indeterminate
negative fiscal impact on the State, mainly stemming from costs to the MDCR and the DHHS.
Both Departments would face increased costs due to the need to hire additional full-time
equivalents (FTEs) to fulfill the requirements in the bills as well as increased administrative
costs related to new reporting requirements. These costs would be significant for the MDCR.
Senate Bills 825 and 826 would have the potential for increased costs, but any costs would
depend on an appropriation being made to support the Michigan Essential Health Provider
Program or the proposed Doula Scholarship Program. The magnitude of the cost would depend
on the magnitude of the potential appropriation.
Legislative Analyst: Eleni Lionas
Fiscal Analyst: Ellyn Ackerman; Humphrey Akujobi; Bobby Canell
Nathan Leaman; John P. Maxwell; Elizabeth Raczkowski
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CONTENT
Senate Bill 818 would amend the Public Health Code to do the following:
-- Require the DHHS to include in its statewide strategic plan for the reduction of
racial and ethnic disparities a plan to reduce inequities.
-- Require the DHHS to include on its website links and information of published
studies and reports on biased or unjust perinatal care, including studies or
reports on instances of obstetric racism and obstetric violence.
-- Require the DHHS to provide statistics on the incidence and prevalence of
obstetric violence and obstetric racism.
-- Require the DHHS to maintain a team to comprehensibly review statewide
maternal deaths.
-- Require the DHHS to study policies concerning perinatal labor and delivery
services in the State and submit a report on the study to the Legislature by
January 1, 2026.
-- By January 1, 2026, and every three years following, require the DHHS to report
to the Legislature causes of maternal mortality and best practices to reduce
maternal mortality and morbidity in the State.
Senate Bill 819 would enact the "Biased and Unjust Care Reporting Act" to do the
following:
-- Require the MDCR to collect data using the Patient-reported Experience Measure
of Obstetric Racism (PREM-OB) Scale or a similar tool to collect and analyze
reports from pregnant or postpartum individuals that received care that was not
culturally congruent, unbiased and just, did not prevent harm, did not maintain
dignity and confidentiality, or did not meet informed consent requirements.1
-- Require the MDCR to report the prevalence of care described above to the
Governor, the Legislature, the DHHS Director, and the Director of the Department
of Licensing and Regulatory Affairs (LARA).
Senate Bill 820 would amend the Public Health Code to do the following:
-- Require a health facility to stabilize a patient or resident who was pregnant and
in labor before ending the patient or resident relationship upon the patient or
resident's refusal or denial of care.
-- Prohibit an owner, operator, or governing body of a hospital from discriminating
on the basis of an individual's pregnancy or lactating status.
-- By January 1, 2026, require a hospital to demonstrate to the DHHS that the
hospital had a policy allowing a patient who was giving birth to have present
with the patient a doula and the patient's partner or a companion of the patient.
-- By January 1, 2026, require a hospital to demonstrate to the DHHS that the
hospital had a policy on informed consent.
-- By January 1, 2026, require a hospital to demonstrate to the DHHS that the
hospital had a policy on receiving a pregnant patient's information upon a
transfer including a transfer initiated by a midwife or certified nurse midwife.
Senate Bill 821 would amend the Insurance Code to require an insurer that offered
a medical malpractice insurance policy to provide the DHHS with information
1
The PREM-OB Scale is a survey tool aimed to improve Black birthing experiences and outcomes during
childbirth hospitalization and offers measures on humanity, kinship, and racism.
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regarding that insurer's policies related to perinatal care services upon the DHHS's
request for use in the study required by Senate Bill 818.
Senate Bill 822 would amend the Estates and Protected Individuals Code (EPIC) to
allow a patient advocate designation to include a statement on which life-sustaining
treatment the patient would desire or not desire if the patient were pregnant at the
time the designation became effective.
Senate Bill 823 would amend the Elliot-Larson Civil Rights Act (ELCRA) to specify
discrimination based on "sex" would include pregnancy or lactating status.
Senate Bill 824 would amend the Child Protection Law to do the following:
-- Modify a provision requiring certain mandatory reporters to report evidence or
suspicion of a newborn infant affected by any amount of alcohol, controlled
substance, or metabolite of a controlled substance as a case of child abuse or
neglect.
-- Require a mandatory reporter to notify the DHHS of a newborn affected by an
amount of alcohol, controlled substance, or metabolite of a controlled substance
if the newborn infant's health or welfare were threatened by the parent's
substance abuse.
-- Upon notification described above, require the DHHS to develop a plan of safe
care to address the needs of newborn infants and the newborn infant's parents
and require the plan to provide services during and after pregnancy.
Senate Bill 825 would amend the Part 27 (Michigan Essential Health Provider
Recruitment Strategy) of the Public Health Code to allow a midwife who attended a
midwifery program to participate in the DHHS's health provider loan repayment
program, which generally provides loan repayment to professionals who meet the
program's obligations, including participation in full-time, primary healthcare
services at an eligible nonprofit located in an HPSA for two years.
Senate Bill 826 would enact a new law to do the following:
-- Establish the Doula Scholarship Program administered by the DHHS and
prescribe the Program's eligibility requirements.
-- Allow the DHHS to award a maximum $3,000 scholarship per awardee.
-- Require a scholarship recipient to be working toward the completion of doula
training within six months of receiving the funds.
-- Create the Doula Scholarship Fund within the State Treasury.
Senate Bill 827 would amend the Insurance Code to do the following:
-- Require an insurance provider in the State that provided health insurance
covering gynecological and pregnancy services to cover those services in a
healthcare facility or at a patient's home by a qualified physician, nurse midwife,
or midwife.
-- Required the insurance to reimburse a provider in a way that provided for high-
quality, cost-effective, evidence-based care, supported efficient payment
models, and reduced risks in future pregnancies.
Senate Bill 818 and Senate Bill 821 are tie barred. Senate Bill 818 is tie-barred to Senate Bill
819 and House Bill 5636. Senate Bills 819, 825, and 827 are also tie-barred to House Bill
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5636, which generally would amend the Public Health Code to establish licensing and
regulation of freestanding birth centers, among other things.
Senate Bill 818
Information on Disparities and Inequities
The Public Health Code requires the DHHS to take certain actions to address racial and ethnic
health disparities in the State and to submit to the Legislature, the standing committees
pertaining to public health, and to the Senate and House Fiscal Agencies an annual report on
the status, impact, and effectiveness of those efforts.
The DHHS must develop and implement an effective statewide strategic plan for the reduction
of racial and ethnic disparities. The bill also would require this plan to work toward the
reduction of inequities.
Additionally, the DHHS must establish a webpage on its website in coordination with the Office
of Equity and Minority Health that provides information or links to all the following:
-- Research within minority populations.
-- A resources directory that can be distributed to local organizations interested in minority
health.
-- Racial and ethnic specific data including morbidity and mortality.
Under the bill, the DHHS also would have to include information or links on its website to
published studies and reports on biased or unjust perinatal care, including studies or reports
on instances of obstetric racism and obstetric violence predicated on the PREM-OB Scale or a
similar tool.
"Obstetric racism" would mean that a health facility or agency, health professional, or other
person that provides care to a patient during the perinatal period is influenced by the patient's
race in making a treatment or diagnostic decision and that decision places the patient's health
and well-being at risk. "Health facility or agency" would mean, except as otherwise provided,
any of the following:
-- An ambulance operation, aircraft transport operation, nontransport prehospital life
support operation, or a medical first response service.
-- A county medical care facility.
-- A freestanding surgical outpatient facility.
-- A health maintenance organization.
-- A home for the aged.
-- A hospital.
-- A nursing home.
-- A facility listed above located in a university, college, or other educational institution.
-- A hospice.
-- A hospice residence.
"Obstetric violence" would mean physical, sexual, emotional, verbal abuse; bullying; coercion,
humiliation, or assault, perpetrated by a health care professional on a patient during the
perinatal period.
The Code requires the DHHS to provide statistics relevant to the causes, effects, extent, and
nature of illness and disability of the people of the State, or a grouping of its people, which
may include the incidence and prevalence of various acute and chronic illnesses and infant
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and maternal morbidity and mortality, among other things. Under the bill, the statistics also
would have to include the incidence and prevalence of obstetric violence and obstetric racism.
Review of Maternal Statewide Mortality
Under the bill, the DHHS would have to maintain a team that comprehensibly reviewed maternal
deaths in the State, facilities best practices for sharing data regarding maternal deaths,
coordinated meetings with maternal mortality review teams throughout the country, and
participated in regional or national maternal mortality review activities.
As used above, "health facility" would mean a hospital, freestanding birth center licensed under
proposed House Bill 5636, freestanding surgical outpatient facility, or other outpatient facility
that is licensed or otherwise authorized to operate in the State under Article 17 (Facilities and
Agencies) of the Code.
The DHHS would have to study the use of research evidence in policies related to the perinatal
period in the State, including all the following:
-- The public payment systems and the systems' policies related to labor and delivery services.
-- In consultation with the Department of Insurance and Financial Services (DIFS), malpractice
insurance policies related to perinatal care, including labor and delivery services.
-- In consultation with DIFS, the private payment systems and the systems' policies related to
labor and delivery services.
The bill would allow the DHHS to contract with a third-party to complete the study.
By January 1, 2026, using the implementation science framework, the DHHS would have to
report to the Legislature's standing committees concerned with health policy the results of the
study described above.
By January 1, 2026, and every three years following, the DHHS would have to submit a report
to the same committees on all the following:
-- A list of the most preventable causes of maternal mortality that the DHHS identified as
having the greatest impact on the pregnant and postpartum population in the State.
-- In consultation with the Michigan Perinatal Care Quality Collaborative (PQC), a list of
recommendations for best practices and quality improvement in clinical settings that could
reduce the incidence of pregnancy related-deaths, maternal mortality, and morbidity in
prenatal, perinatal, and postnatal clinal settings.2
The bill would require the DHHS to incorporate in the report any findings from the MDCR under
the "Biased and Unjust Care Reporting Act" proposed by Senate Bill 819.
Senate Bill 819
Reports on Pregnancy and Postpartum Care
The bill would enact the "Biased and Unjust Care Reporting Act" to require the MDCR to use
the PREM-OB Scale or a tool with equivalent validation to receive reports from individuals who
2 The DHHS oversees the PQC, which is comprised of nine regional PQCs and is part of the National PQC;
members include health care professionals, community partners, families, faith-based organizations,
Great Start Collaboratives and home visiting agencies, all focused on addressing outcomes related to
clinical care, as well as environment, socioeconomic factors, and health-related behavior.
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were pregnant or in the postpartum period and who received gynecological or perinatal care
that did not meet at least one of the following:
-- Was provided in a manner that was culturally congruent, unbiased, and just.
-- Maintained dignity, privacy, and confidentiality.
-- Prevented harm or mistreatment.
-- Met requirements for informed consent.
The MDCR would have to use the patient self-reporting tools described above and other
methods to identify incidences of obstetric violence or obstetric racism.
Additionally, the MDCR would have to provide a report on the incidence and prevalence of
obstetric violence and obstetric racism to the Governor, the Legislature's standing committees
concerned with public health, the DHHS Director, and the LARA Director.
Senate Bill 820
Patient or Resident General Standards of Care
Under the Public Health Code, a licensed health facility or agency that provides services
directly to patients or residents must adopt a policy describing a patient's or resident's rights
and responsibilities. The facility must treat patients and residence according to the policy.
Among other requirements, the policy must include that a patient or resident is entitled to
refuse treatment to the extent provided by law and to be informed of the consequences of
that refusal. If a refusal of treatment prevents a health facility or agency or its staff from
providing appropriate care according to ethical and professional standards, the relationship
with the patient or resident may be terminated upon reasonable notice. Under the bill, if the
patient or resident were pregnant and in labor at the health facility, the facility would have to
stabilize the patient or resident before terminating the relationship as described above.
Additionally, the Code prohibits an owner, operator, and governing body of a licensed hospital
from discriminating because of race, religion, color, national origin, age, or sex in the
operation of the hospital, including employment, patient admission and care, room
assignment, and professional or nonprofessional selection and training programs. The bill
specifies that the term "sex" would include pregnancy or lactating status.
Hospital Policy on Transfer and Delivery
Under the bill, beginning January 1, 2026, a hospital would have to demonstrate to the DHHS,
in a form and manner required by the DHHS, that the hospital had a policy that complied with