Florida Senate - 2021                             CS for SB 1540
       By the Committee on Health Policy; and Senator Gibson
       588-03617-21                                          20211540c1
    1                        A bill to be entitled                      
    2         An act relating to maternal health outcomes; amending
    3         s. 381.7353, F.S.; revising the Department of Health’s
    4         duties under the Closing the Gap grant program;
    5         amending s. 381.7355, F.S.; revising the requirements
    6         for Closing the Gap grant proposals; creating s.
    7         383.2163, F.S.; requiring the department to establish
    8         telehealth minority maternity care pilot programs in
    9         Duval County and Orange County by a specified date;
   10         defining terms; providing program purposes; requiring
   11         the pilot programs to provide specified telehealth
   12         services, or coordinate with prenatal home visiting
   13         programs to provide specified services, to eligible
   14         pregnant women for a specified period; requiring pilot
   15         programs to train participating health care
   16         practitioners and perinatal professionals on specified
   17         topics; providing for funding for the pilot programs;
   18         requiring the department’s Division of Community
   19         Health Promotion and Office of Minority Health and
   20         Health Equity to apply for certain federal funding;
   21         authorizing the department to adopt rules; providing
   22         an effective date.
   24  Be It Enacted by the Legislature of the State of Florida:
   26         Section 1. Paragraph (e) of subsection (2) of section
   27  381.7353, Florida Statutes, is amended to read:
   28         381.7353 Reducing Racial and Ethnic Health Disparities:
   29  Closing the Gap grant program; administration; department
   30  duties.—
   31         (2) The department shall:
   32         (e) Coordinate with existing community-based programs, such
   33  as chronic disease community intervention programs, cancer
   34  prevention and control programs, diabetes control programs, the
   35  Healthy Start program, the Florida Kidcare Program, the HIV/AIDS
   36  program, immunization programs, maternal health programs, and
   37  other related programs at the state and local levels, to avoid
   38  duplication of effort and promote consistency.
   39         Section 2. Paragraph (a) of subsection (2) of section
   40  381.7355, Florida Statutes, is amended to read:
   41         381.7355 Project requirements; review criteria.—
   42         (2) A proposal must include each of the following elements:
   43         (a) The purpose and objectives of the proposal, including
   44  identification of the particular racial or ethnic disparity the
   45  project will address. The proposal must address one or more of
   46  the following priority areas:
   47         1. Decreasing racial and ethnic disparities in maternal and
   48  infant mortality rates.
   49         2. Decreasing racial and ethnic disparities in severe
   50  maternal morbidity rates and other maternal health outcomes.
   51         3. Decreasing racial and ethnic disparities in morbidity
   52  and mortality rates relating to cancer.
   53         4.3. Decreasing racial and ethnic disparities in morbidity
   54  and mortality rates relating to HIV/AIDS.
   55         5.4. Decreasing racial and ethnic disparities in morbidity
   56  and mortality rates relating to cardiovascular disease.
   57         6.5. Decreasing racial and ethnic disparities in morbidity
   58  and mortality rates relating to diabetes.
   59         7.6. Increasing adult and child immunization rates in
   60  certain racial and ethnic populations.
   61         8.7. Decreasing racial and ethnic disparities in oral
   62  health care.
   63         9.8. Decreasing racial and ethnic disparities in morbidity
   64  and mortality rates relating to sickle cell disease.
   65         10.9. Decreasing racial and ethnic disparities in morbidity
   66  and mortality rates relating to Lupus.
   67         11.10. Decreasing racial and ethnic disparities in
   68  morbidity and mortality rates relating to Alzheimer’s disease
   69  and dementia.
   70         12.11. Improving neighborhood social determinants of
   71  health, such as transportation, safety, and food access, as
   72  outlined by the Centers for Disease Control and Prevention’s
   73  “Tools for Putting Social Determinants of Health into Action.”
   74         Section 3. Effective January 1, 2022, section 383.2163,
   75  Florida Statutes, is created to read:
   76         383.2163 Telehealth minority maternity care pilot
   77  programs.—By July 1, 2022, the department shall establish a
   78  telehealth minority maternity care pilot program in Duval County
   79  and Orange County which uses telehealth to expand the capacity
   80  for positive maternal health outcomes in racial and ethnic
   81  minority populations. The department shall direct and assist the
   82  county health departments in Duval County and Orange County to
   83  implement the programs.
   84         (1)DEFINITIONS.—As used in this section, the term:
   85         (a)“Department” means the Department of Health.
   86         (b)“Eligible pregnant woman” means a pregnant woman who is
   87  receiving, or is eligible to receive, maternal or infant care
   88  services from the department under chapter 381 or chapter 383.
   89         (c)“Health care practitioner” has the same meaning as in
   90  s. 456.001.
   91         (d)“Health professional shortage area” means a geographic
   92  area designated as such by the Health Resources and Services
   93  Administration of the United States Department of Health and
   94  Human Services.
   95         (e) “Indigenous population” means any Indian tribe, band,
   96  or nation or other organized group or community of Indians
   97  recognized as eligible for services provided to Indians by the
   98  United States Secretary of the Interior because of their status
   99  as Indians, including any Alaskan native village as defined in
  100  43 U.S.C. s. 1602(c), the Alaska Native Claims Settlement Act,
  101  as that definition existed on the effective date of this act.
  102         (f) “Maternal mortality” means a death occurring during
  103  pregnancy or the postpartum period which is caused by pregnancy
  104  or childbirth complications.
  105         (g) “Medically underserved population” means the population
  106  of an urban or rural area designated by the United States
  107  Secretary of Health and Human Services as an area with a
  108  shortage of personal health care services or a population group
  109  designated by the United States Secretary of Health and Human
  110  Services as having a shortage of such services.
  111         (h) “Perinatal professionals” means doulas, personnel from
  112  Healthy Start and home visiting programs, childbirth educators,
  113  community health workers, peer supporters, certified lactation
  114  consultants, nutritionists and dietitians, social workers, and
  115  other licensed and nonlicensed professionals who assist women
  116  through their prenatal or postpartum periods.
  117         (i) “Postpartum” means the 1-year period beginning on the
  118  last day of a woman’s pregnancy.
  119         (j) “Severe maternal morbidity” means an unexpected outcome
  120  caused by a woman’s labor and delivery which results in
  121  significant short-term or long-term consequences to the woman’s
  122  health.
  123         (k) “Technology-enabled collaborative learning and capacity
  124  building model” means a distance health care education model
  125  that connects health care professionals, particularly
  126  specialists, with other health care professionals through
  127  simultaneous interactive videoconferencing for the purpose of
  128  facilitating case-based learning, disseminating best practices,
  129  and evaluating outcomes in the context of maternal health care.
  130         (2) PURPOSE.—The purpose of the pilot programs is to:
  131         (a) Expand the use of technology-enabled collaborative
  132  learning and capacity building models to improve maternal health
  133  outcomes for the following populations and demographics:
  134         1. Ethnic and minority populations.
  135         2. Health professional shortage areas.
  136         3. Areas with significant racial and ethnic disparities in
  137  maternal health outcomes and high rates of adverse maternal
  138  health outcomes, including, but not limited to, maternal
  139  mortality and severe maternal morbidity.
  140         4. Medically underserved populations.
  141         5. Indigenous populations.
  142         (b) Provide for the adoption and use of telehealth services
  143  that allow for screening and treatment of common pregnancy
  144  related complications, including, but not limited to, anxiety,
  145  depression, substance use disorder, hemorrhage, infection,
  146  amniotic fluid embolism, thrombotic pulmonary or other embolism,
  147  hypertensive disorders relating to pregnancy, diabetes,
  148  cerebrovascular accidents, cardiomyopathy, and other
  149  cardiovascular conditions.
  150         (3) TELEHEALTH SERVICES AND EDUCATION.—The pilot programs
  151  shall adopt the use of telehealth or coordinate with prenatal
  152  home visiting programs to provide all of the following services
  153  and education to eligible pregnant women up to the last day of
  154  their postpartum periods, as applicable:
  155         (a) Referrals to Healthy Start’s coordinated intake and
  156  referral program to offer families prenatal home visiting
  157  services.
  158         (b) Services and education addressing social determinants
  159  of health, including, but not limited to, all of the following:
  160         1. Housing placement options.
  161         2. Transportation services or information on how to access
  162  such services.
  163         3. Nutrition counseling.
  164         4. Access to healthy foods.
  165         5. Lactation support.
  166         6. Lead abatement and other efforts to improve air and
  167  water quality.
  168         7. Child care options.
  169         8. Car seat installation and training.
  170         9. Wellness and stress management programs.
  171         10. Coordination across safety net and social support
  172  services and programs.
  173         (c) Evidence-based health literacy and pregnancy,
  174  childbirth, and parenting education for women in the prenatal
  175  and postpartum periods.
  176         (d) For women during their pregnancies through the
  177  postpartum periods, connection to support from doulas and other
  178  perinatal health workers.
  179         (e) Tools for prenatal women to conduct key components of
  180  maternal wellness checks, including, but not limited to, all of
  181  the following:
  182         1. A device to measure body weight, such as a scale.
  183         2. A device to measure blood pressure which has a verbal
  184  reader to assist the pregnant woman in reading the device and to
  185  ensure that the health care practitioner performing the wellness
  186  check through telehealth is able to hear the reading.
  187         3. A device to measure blood sugar levels with a verbal
  188  reader to assist the pregnant woman in reading the device and to
  189  ensure that the health care practitioner performing the wellness
  190  check through telehealth is able to hear the reading.
  191         4. Any other device that the health care practitioner
  192  performing wellness checks through telehealth deems necessary.
  193         (4)TRAINING.—The pilot programs shall provide training to
  194  participating health care practitioners and other perinatal
  195  professionals on all of the following:
  196         (a)Implicit and explicit biases, racism, and
  197  discrimination in the provision of maternity care and how to
  198  eliminate these barriers to accessing adequate and competent
  199  maternity care.
  200         (b)The use of remote patient monitoring tools for
  201  pregnancy-related complications.
  202         (c)How to screen for social determinants of health risks
  203  in the prenatal and postpartum periods, such as inadequate
  204  housing, lack of access to nutritional foods, environmental
  205  risks, transportation barriers, and lack of continuity of care.
  206         (d)Best practices in screening for and, as needed,
  207  evaluating and treating maternal mental health conditions and
  208  substance use disorders.
  209         (e)Information collection, recording, and evaluation
  210  activities to:
  211         1.Study the impact of the pilot program;
  212         2.Ensure access to and the quality of care;
  213         3.Evaluate patient outcomes as a result of the pilot
  214  program;
  215         4.Measure patient experience; and
  216         5.Identify best practices for the future expansion of the
  217  pilot program.
  218         (5)FUNDING.—The pilot programs shall be funded using funds
  219  appropriated by the Legislature for the Closing the Gap grant
  220  program. The department’s Division of Community Health Promotion
  221  and Office of Minority Health and Health Equity shall also work
  222  in partnership to apply for federal funds that are available to
  223  assist the department in accomplishing the program’s purpose and
  224  successfully implementing the pilot programs.
  225         (6)RULES.—The department may adopt rules to implement this
  226  section.
  227         Section 4. This act shall take effect July 1, 2021.