The Texas Legislature gaveled to a close late last month. What action did legislators take on maternal mortality and morbidity issues? Here’s a summary of key activity.

Legislature Modifies Neonatal/Maternal
Designations Requirements

On May 25, the Texas Legislature sent Senate Bill 749 by Sen. Lois Kolkhorst (R-Brenham) to the governor for his review/approval. The bill establishes contingency surveys, a waiver process and an appeals process for maternal level of care certifications. The bill also extends the date for hospitals to complete maternal designation until Aug. 31, 2021. The bill also clarifies that the rules regarding the use of telemedicine by Levels I, II and III facilities must be made in consultation with physicians, hospital associations, DSHS and other “appropriate interested persons.”

House sponsor Rep. Four Price (R-Amarillo) offered two amendments on the House floor relating to the waiver process, which were approved. One amendment requires the hospital to give notice of its intent to seek a waiver to the hospital’s medical staff members who practice in a specialty service area affected by the waiver. The second clarified that the department can determine the waiver is justified after considering the expected impact on the accessibility of care in the geographic area served by the hospital if a waiver is not granted, and quality of care and patient safety. The Senate concurred with the House amendments.

The deadline for hospitals to have a designation level of maternal care was extended until Aug. 31, 2021. The requirement of a hospital having a maternal level of care designation to obtain Medicaid reimbursement was extended until Sept. 1, 2021. The bill allows hospitals to pursue designation before the deadlines, and to amend any application filed prior to the effective date of the bill, if necessary to comply with new provisions in the law. Texas Perinatal Services already has conducted several surveys and has many other scheduled.

The bill makes the Texas Perinatal Advisory Council subject to sunset review in conjunction with the evaluation of the Texas Department of State Health Services. In consultation with the PAC, the agency must conduct a strategic review of the practical implementation of the rules for NICU and maternal care designation, identifying barriers to a hospital obtaining its requested level of care designation. The review also must look at requirements for a level of care designation that relate to gestational age; and if designation determination should consider the hospital’s geographic location or the number of patients of a particular gestational age treated by the hospital and the hospital’s capabilities in providing care to patients of a particular gestational age. Based on the findings, the review also would include recommendations for modification of the rules to improve the process and methodology of assigning levels of care designation.

A written report on the review of neonatal care must be submitted to the Legislature by Dec. 31, 2019, and one on the review of maternal care by Dec. 31, 2020.

TETAF and Texas Perinatal Services will be very involved in the rulemaking process as SB 749 is implemented. Since the bill passed both chambers with super majorities, it takes effect immediately upon the governor’s signature, and TETAF/TPS will push for prompt rulemaking.

Legislature Approves Study of Postpartum Depression

House Bill 253 by Rep. Jessica Farrar (D-Houston) has been sent to the governor by the Legislature. The bill requires the Texas Health and Human Services Commission to develop a five-year strategic plan to improve access to postpartum depression screening, referral, treatment and support services.

The plan must provide strategies to:

• increase awareness about the prevalence and effects of postpartum depression among state-administered program providers who serve women at risk;
• establish a referral network of community-based mental health providers and support services addressing postpartum depression;
• increase women’s access to formal and informal peer support services, including certified peer specialists who have received additional training related to postpartum depression;
• raise public awareness of and reduce the stigma related to postpartum depression; and
• leverage sources of funding to support existing community-based postpartum depression screening, referral, treatment and support services.

In developing the strategic plan, the Texas Health and Human Services Commission is required to coordinate with the Texas Department of State Health Services, the statewide health coordinating council, the office of mental health coordination and the statewide behavioral health coordinating council. This group must annually review the strategic plan and update it as needed.

Maternal Mortality Register Bill Dies

House Bill 2703 by Rep. Shawn Thierry (D-Houston) would have created a workgroup of stakeholders to provide recommendations on the type of maternal mortality and morbidity data that should be collected by the state, and the time spans to be covered. The bill was heard in the House Public Health Committee and was reported favorably. It died in the House Calendars Committee.

The governor has until June 16 to veto bills.