Text of NC S 838 (2024)

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2023 S D SENATE BILL DRS45439-MGa-157 Short Title: MOMnibus 2.5. (Public) Sponsors: Senators Murdock, Batch, and Robinson (Primary Sponsors). Referred to: *DRS45439-MGa-157* A BILL TO BE ENTITLED 1 AN ACT TO ENACT THE NORTH CAROLINA MOMNIBUS ACT OF 2024. 2 Whereas, every person should be entitled to dignity and respect during and after 3 pregnancy and childbirth, and patients should receive the best care possible regardless of age, 4 race, ethnicity, color, religion, ancestry, disability, medical condition, genetic information, 5 marital status, sex, gender identity, gender expression, sexual orientation, socioeconomic status, 6 citizenship, nationality, immigration status, primary language, or language proficiency; and 7 Whereas, the United States has the highest maternal mortality rate in the developed 8 world, where about 700 women die each year from childbirth and another 50,000 suffer from 9 severe complications; and 10 Whereas, according to the North Carolina Maternal Mortality Review and Prevention 11 Committee, sixty-three percent (63%) of all maternal deaths in 2014-2015 were determined to 12 be preventable, and black women are at increased risk to die from pregnancy complications 13 compared to white women; and 14 Whereas, the federal Centers for Disease Control and Prevention finds that the 15 majority of pregnancy-related deaths are preventable; and 16 Whereas, pregnancy-related deaths among black birthing people are also more likely 17 to be miscoded; and 18 Whereas, access to prenatal care, socioeconomic status, and general physical health 19 do not fully explain the disparity seen in maternal mortality and morbidity rates among black 20 individuals, and there is a growing body of evidence that black people are often treated unfairly 21 and unequally in the health care system; and 22 Whereas, implicit bias is a key driver of health disparities in communities of color; 23 and 24 Whereas, health care providers in North Carolina are not required to undergo any 25 implicit bias testing or training; and 26 Whereas, currently there does not exist any system to track the number of incidents 27 where implicit prejudice and implicit stereotypes led to negative birth and maternal health 28 outcomes; and 29 Whereas, it is in the interest of this State to reduce the effects of implicit bias in 30 pregnancy, childbirth, and postnatal care so that all people are treated with dignity and respect 31 by their health care providers; Now, therefore, 32 The General Assembly of North Carolina enacts: 33 34 PART I. IMPLICIT BIAS TRAINING PROGRAM FOR MATERNAL HEALTH CARE 35 PROVIDERS 36 FILED SENATE May 2, 2024 S.B. 838 PRINCIPAL CLERK General Assembly Of North Carolina Session 2023 Page 2 DRS45439-MGa-157 SECTION 1.1.(a) Effective October 1, 2024, Part 5 of Article 1B of Chapter 130A 1 of the General Statutes is amended by adding the following new sections to read: 2 "§ 130A-33.62. Department to establish implicit bias training program for maternal health 3 care providers. 4 (a) The following definitions apply in this section: 5 (1) Health care professional. – A licensed physician or other health care provider 6 licensed, registered, accredited, or certified to perform perinatal care and 7 regulated under the authority of a health care professional licensing authority. 8 (2) Health care professional licensing authority. – The Department of Health and 9 Human Services or an agency, board, council, or committee with the authority 10 to impose training or education requirements or licensure fees as a condition 11 of practicing in this State as a health care professional. 12 (3) Implicit bias. – A bias in judgment or behavior that results from subtle 13 cognitive processes, including implicit prejudice and implicit stereotypes, that 14 often operate at a level below conscious awareness and without intentional 15 control. 16 (4) Implicit prejudice. – Prejudicial negative feelings or beliefs about a group that 17 a person holds without being aware of them. 18 (5) Implicit stereotypes. – The unconscious attributions of particular qualities to 19 a member of a certain social group that are influenced by experience and based 20 on learned associations between various qualities and social categories, 21 including race and gender. 22 (6) Maternal care provider. – Includes both of the following: 23 a. A health care professional involved in perinatal care. 24 b. A mental health professional who provides mental health or substance 25 use disorder services to women during pregnancy, the postpartum 26 period, or both. 27 (7) Mental health professional. – Any of the following professionals: 28 a. A psychiatrist licensed under Article 1 of Chapter 90 of the General 29 Statutes. 30 b. A psychologist licensed under Article 18G of Chapter 90 of the 31 General Statutes. 32 c. A licensed clinical mental health counselor licensed under Article 24 33 of Chapter 90 of the General Statutes. 34 d. A substance use disorder professional licensed under Article 5C of 35 Chapter 90 of the General Statutes. 36 e. A social worker licensed to engage in clinical social work under 37 Chapter 90B of the General Statutes. 38 f. A fee-based pastoral counselor licensed under Article 26 of Chapter 39 90 of the General Statutes. 40 g. A licensed marriage and family therapist licensed under Article 18C 41 of Chapter 90 of the General Statutes. 42 h. Any other mental health service provider who performs or purports to 43 perform psychotherapy, as defined in G.S. 90-21.41(3). 44 (8) Mental health professional licensing authority. – The Department of Health 45 and Human Services or an agency, board, council, or committee with the 46 authority to impose training or education requirements or licensure fees as a 47 condition of practicing in this State as a mental health professional. 48 (9) Perinatal care. – The provision of care during pregnancy, labor, delivery, and 49 postpartum and neonatal periods. 50 General Assembly Of North Carolina Session 2023 DRS45439-MGa-157 Page 3 (10) Perinatal facility. – A hospital, clinic, or birthing center that provides perinatal 1 care in this State. 2 (b) The Department shall develop, in collaboration with (i) community-based 3 organizations led by black women that serve primarily black birthing people and (ii) a historically 4 black college or university or other institution that primarily serves minority populations, an 5 evidence-based implicit bias training program for maternal care providers that includes, at a 6 minimum, all of the following components: 7 (1) Identification of previous or current unconscious biases and misinformation. 8 (2) Identification of personal, interpersonal, institutional, structural, and cultural 9 barriers to inclusion. 10 (3) Corrective measures to decrease implicit bias at the interpersonal and 11 institutional levels, including ongoing policies and practices for that purpose. 12 (4) Information about the effects of implicit bias, including, but not limited to, 13 ongoing personal effects of racism and the historical and contemporary 14 exclusion and oppression of minority communities. 15 (5) Information about cultural identity across racial or ethnic groups. 16 (6) Information about how to communicate more effectively across identities, 17 including racial, ethnic, religious, and gender identities. 18 (7) Information about power dynamics and organizational decision making. 19 (8) Trauma-informed care best practices and an emphasis on shared decision 20 making between providers and patients. 21 (9) Information about health inequities within the perinatal care field, including 22 information on how implicit bias impacts maternal and infant health 23 outcomes. 24 (10) Perspectives of diverse, local constituency groups and experts on particular 25 racial, identity, cultural, and provider-community relations issues in the 26 community. 27 (11) Information about socioeconomic bias. 28 (12) Information about reproductive justice. 29 (c) The Department shall administer the implicit bias training program developed 30 pursuant to subsection (b) of this section and, notwithstanding any provision of Chapter 90 or 31 Chapter 93B of the General Statutes, or any other provision of law, all maternal care providers 32 are required to complete the implicit bias training program as follows: 33 (1) Maternal care providers who hold a current license, registration, accreditation, 34 or certification on December 31, 2024, shall complete the training program no 35 later than December 31, 2025. 36 (2) Maternal care providers issued an initial license, registration, accreditation, or 37 certification on or after January 1, 2025, shall complete the training program 38 no later than one year after the date of issuance. 39 A health care professional licensing authority or mental health professional licensing 40 authority shall not renew the license, registration, accreditation, or certification of a health care 41 professional or mental health professional unless the professional provides proof of completion 42 of the training program established under this section within the 24-month period leading up to 43 the date of the renewal application. 44 (d) The Department is encouraged to seek opportunities to promote and make the implicit 45 bias training program authorized by this section available to the following groups: 46 (1) Any employees who interact with pregnant and postpartum individuals in the 47 provider setting, including front desk employees, sonographers, schedulers, 48 health system–employed lactation consultants, hospital or health system 49 administrators, security staff, and other employees. 50 General Assembly Of North Carolina Session 2023 Page 4 DRS45439-MGa-157 (2) Undergraduate programs that funnel into schools with master's programs in 1 the health professions or mental health professions. 2 (3) Providers of the special supplemental nutrition program for women, infants, 3 and children under section 17 of the Child Nutrition Act of 1966. 4 (4) Obstetric emergency simulation trainings or related trainings. 5 (5) Emergency department employees, emergency medical technicians, and other 6 specialized health care providers who interact with pregnant and postpartum 7 individuals. 8 (e) The Department shall collect the following information for the purpose of informing 9 ongoing improvements to the implicit bias training program: 10 (1) Data on the causes of maternal mortality. 11 (2) Rates of maternal mortality, including rates distinguished by age, race, 12 ethnicity, socioeconomic status, and geographic location within this State. 13 (3) Other factors the Department deems relevant for assessing and improving the 14 implicit bias training program. 15 "§ 130A-33.63. Rights of perinatal care patients. 16 (a) A patient receiving care at a perinatal care facility, defined as a hospital, clinic, or 17 birthing center that provides perinatal care in this State, has the following rights: 18 (1) To be informed of continuing health care requirements following discharge. 19 (2) To be informed that, if the patient so authorizes, and to the extent permitted 20 by law, the hospital or health care facility may provide to a friend or family 21 member information about the patient's continuing health care requirements 22 following discharge. 23 (3) To actively participate in decisions regarding the patient's medical care and 24 the right to refuse treatment. 25 (4) To receive appropriate pain assessment and treatment. 26 (5) To receive care and treatment free from discrimination on the basis of age, 27 race, ethnicity, color, religion, ancestry, disability, medical condition, genetic 28 information, marital status, sex, gender identity, gender expression, sexual 29 orientation, socioeconomic status, citizenship, nationality, immigration status, 30 primary language, or language proficiency. 31 (6) To receive information on how to file a complaint with the Division of Health 32 Service Regulation or the Human Rights Commission or both about any 33 violation of these rights. 34 (b) Each perinatal care facility shall provide to each perinatal care patient upon admission 35 to the facility, or as soon as reasonably practical following admission to the facility, a written 36 copy of the rights enumerated in subsection (a) of this section. The facility may provide this 37 information to the patient by electronic means, and it may be provided with other notices 38 regarding patient rights." 39 SECTION 1.1.(b) Effective July 1, 2024, there is appropriated from the General 40 Fund to the Department of Health and Human Services, Division of Public Health, the sum of 41 one million five hundred thousand dollars ($1,500,000) in recurring funds for the 2024-2025 42 fiscal year. These funds shall be allocated and used as follows: 43 (1) The sum of up to five hundred thousand dollars ($500,000) in recurring funds 44 shall be used to cover costs incurred by the Department in developing and 45 administering the implicit bias training program authorized by 46 G.S. 130A-33.62, as enacted by subsection (a) of this section. 47 (2) The remainder of these funds shall be allocated to the Women, Infant, and 48 Community Wellness Section to support the North Carolina Maternal Mental 49 Health MATTERS (Making Access to Treatment, Evaluation, Resources & 50 Screening Better) Program, which strives to enhance systems for screening, 51 General Assembly Of North Carolina Session 2023 DRS45439-MGa-157 Page 5 assessing, and treating depression, substance use disorder, and other 1 behavioral health disorders in pregnant and postpartum patients. 2 3 PART II. PERINATAL EDUCATION GRANT PROGRAM 4 SECTION 2.1.(a) Definitions. – The following definitions apply in this section: 5 (1) Department. – The North Carolina Department of Health and Human 6 Services. 7 (2) Perinatal education program. – A program that operates for the primary 8 purpose of educating pregnant women and their families about healthy 9 pregnancy, preparation for labor and birth, breastfeeding, newborn care, or 10 any combination of these. 11 SECTION 2.1.(b) Establishment of Grant Program. – The Department shall 12 establish and administer a Perinatal Education Grant Program to award competitive grants to 13 eligible entities to establish or expand perinatal education programs in rural, underserved, or 14 low-wealth areas of the State. The Department shall establish eligibility requirements for 15 program participation which shall, at a minimum, require that applicants be community-based 16 organizations that offer perinatal education and resources aligned with evidence-based practices 17 for improving maternal health outcomes for black women. 18 SECTION 2.1.(c) Outreach and Application Assistance. – Beginning July 1, 2024, 19 the Department shall (i) conduct outreach to encourage eligible applicants to apply for grants 20 under this program and (ii) provide application assistance to eligible applicants on best practices 21 for applying for grants under this program. In conducting the outreach required by this section, 22 the Department shall give special consideration to eligible applicants that meet the following 23 criteria: 24 (1) Are based in, and provide support for, communities with high rates of adverse 25 maternal health outcomes and significant racial and ethnic disparities in 26 maternal health outcomes. 27 (2) Are led by black women. 28 (3) Offer programs and resources that are aligned with evidence-based practices 29 for improving maternal health outcomes for black women. 30 SECTION 2.1.(d) Grant Awards. – In awarding grants under this section, to the 31 extent possible, the grant recipients shall reflect different areas of the State. The Department shall 32 not award a single grant for less than ten thousand dollars ($10,000) or more than fifty thousand 33 dollars ($50,000) per grant recipient. 34 SECTION 2.1.(e) Termination of Grant Program. – The Perinatal Grant Program 35 authorized by this section expires on June 30, 2025. 36 SECTION 2.1.(f) Report. – By October 1, 2026, the Department shall submit a report 37 to the Joint Legislative Oversight Committee on Health and Human Services and the Fiscal 38 Research Division that includes at least all of the following components: 39 (1) A detailed report on funds expended for the program for the 2024-2025 fiscal 40 year. 41 (2) An assessment of the effectiveness of programs funded by grants awarded 42 under this section in improving maternal health outcomes for black women. 43 (3) Recommendations for future grant programs to be administered by the 44 Department and for future funding opportunities for community-based 45 organizations to improve maternal health outcomes for black women through 46 programs and resources that are aligned with evidence-based practices for 47 improving maternal health outcomes for black women. 48 SECTION 2.1.(g) Effective July 1, 2024, there is appropriated from the General 49 Fund to the Department of Health and Human Services, Division of Public Health, the sum of 50 one million five hundred thousand dollars ($1,500,000) in nonrecurring funds for the 2024-2025 51 General Assembly Of North Carolina Session 2023 Page 6 DRS45439-MGa-157 fiscal year to fund the Perinatal Education Grant Program authorized by this section. The 1 Department of Health and Human Services may use up to ten percent (10%) of these funds for 2 administrative purposes related to the grant program. 3 4 PART III. TRAINING PROGRAM FOR COMMUNITY HEALTH WORKERS IN 5 POST-BIRTH WARNING SIGNS 6 SECTION 3.1.(a) Effective July 1, 2024, there is appropriated from the General 7 Fund to the Department of Health and Human Services, Division of Public Health, the sum of 8 two million dollars ($2,000,000) in recurring funds for the 2024-2025 fiscal year to be used to 9 develop a training program for community health workers that provides comprehensive 10 education on the warning signs of complications after birth, including strategies to educate 11 pregnant and postpartum women and their families to recognize post-birth warning signs. The 12 purpose of the training program is to decrease delays in seeking care among women experiencing 13 post-birth warning signs, with the goal of reducing racial and ethnic disparities in maternal 14 mortality rates in North Caolina. The DPH shall make this training program available free of 15 charge to community health workers serving rural, underserved, or low-wealth areas of the State. 16 SECTION 3.1.(b) As used in this section, the term "community health worker" 17 means a frontline public health worker who meets all of the following criteria: 18 (1) Is either or both a trusted member of, or has an unusually close understanding 19 of, the community served. 20 (2) Serves as a liaison, link, or intermediary between health or social services and 21 the community to facilitate access to services and improve the quality and 22 cultural competence of service delivery within the community. 23 (3) Builds individual and community capacity by increasing health knowledge 24 and self-sufficiency of the community through a range of activities such as 25 outreach, community education, informal counseling, social support, and 26 advocacy. 27 28 PART IV. EFFECTIVE DATE 29 SECTION 4.1. Except as otherwise provided, this act is effective when it becomes 30 law. 31