Text of NC S 875 (2024)

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2023 S D SENATE BILL DRS15440-MGa-153 Short Title: Total Maternal Care Act. (Public) Sponsors: Senators Smith and Batch (Primary Sponsors). Referred to: *DRS15440-MGa-153* A BILL TO BE ENTITLED 1 AN ACT ENACTING 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. SUPPORTING COMMUNITY-BASED ORGANIZATIONS 35 36 FILED SENATE May 2, 2024 S.B. 875 PRINCIPAL CLERK General Assembly Of North Carolina Session 2023 Page 2 DRS15440-MGa-153 ESTABLISHMENT OF MATERNAL MORTALITY PREVENTION GRANT 1 PROGRAM 2 SECTION 1.1.(a) Definitions. – The following definitions apply in this section: 3 (1) Culturally respectful congruent. – Sensitive to and respectful of the preferred 4 cultural values, beliefs, world view, and practices of the patient, and aware 5 that cultural differences between patients and health care providers or other 6 service providers must be proactively addressed to ensure that patients receive 7 equitable, high-quality services that meet their needs. 8 (2) Department. – The North Carolina Department of Health and Human 9 Services. 10 (3) Postpartum. – The one-year period beginning on the last day of a woman's 11 pregnancy. 12 SECTION 1.1.(b) Establishment of Grant Program. – The Department shall 13 establish and administer a Maternal Mortality Prevention Grant Program to award grants to 14 eligible entities to establish or expand programs for the prevention of maternal mortality and 15 severe maternal morbidity among black women. The Department shall establish eligibility 16 requirements for program participation which shall, at a minimum, require that applicants be 17 community-based organizations offering programs and resources aligned with evidence-based 18 practices for improving maternal health outcomes for black women. 19 SECTION 1.1.(c) Outreach and Application Assistance. – Beginning July 1, 2024, 20 the Department shall (i) conduct outreach to encourage eligible applicants to apply for grants 21 under this program and (ii) provide application assistance to eligible applicants on best practices 22 for applying for grants under this program. In conducting the outreach required by this section, 23 the Department shall give special consideration to eligible applicants that meet the following 24 criteria: 25 (1) Are based in, and provide support for, communities with high rates of adverse 26 maternal health outcomes and significant racial and ethnic disparities in 27 maternal health outcomes. 28 (2) Are led by black women. 29 (3) Offer programs and resources that are aligned with evidence-based practices 30 for improving maternal health outcomes for black women. 31 SECTION 1.1.(d) Grant Awards. – In awarding grants under this section, to the 32 extent possible, the grant recipients shall reflect different areas of the State. The Department shall 33 not award a single grant for less than ten thousand dollars ($10,000) or more than fifty thousand 34 dollars ($50,000) per grant recipient. In selecting grant recipients, the Department shall give 35 special consideration to eligible applicants that meet all of the following criteria: 36 (1) Meet all of the criteria specified in subdivisions (1) through (3) of subsection 37 (c) of this section. 38 (2) Offer programs and resources designed in consultation with and intended for 39 black women. 40 (3) Offer programs and resources in the communities in which they are located 41 that include any of the following activities: 42 a. Promoting maternal mental health and maternal substance use disorder 43 treatments that are aligned with evidence-based practices for 44 improving maternal mental health outcomes for black women. 45 b. Addressing social determinants of health for women in the prenatal 46 and postpartum periods, including, but not limited to, any of the 47 following: 48 1. Inadequate housing. 49 2. Transportation barriers. 50 3. Poor nutrition and a lack of access to healthy foods. 51 General Assembly Of North Carolina Session 2023 DRS15440-MGa-153 Page 3 4. Need for lactation support. 1 5. Need for lead abatement and other efforts to improve air and 2 water quality. 3 6. Lack of access to child care. 4 7. Need for baby supplies such as diapers, formula, clothing, baby 5 and child equipment, and safe car seat installation. 6 8. Need for wellness and stress management programs. 7 9. Education about maternal health and well-being. 8 10. Need for coordination across safety net and social support 9 services and programs. 10 11. Barriers to employment. 11 c. Promoting evidence-based health literacy and pregnancy, childbirth, 12 and parenting education for women in the prenatal and postpartum 13 periods, including group-based programs and peer support groups. 14 d. Providing individually tailored support from doulas and other perinatal 15 health workers to women from pregnancy through the postpartum 16 period. 17 e. Providing culturally respectful congruent training to perinatal health 18 workers such as doulas, community health workers, peer supporters, 19 certified lactation consultants, nutritionists and dietitians, social 20 workers, home visitors, and navigators. 21 f. Conducting or supporting research on issues affecting black maternal 22 health. 23 g. Developing other programs and resources that address 24 community-specific needs for women in the prenatal and postpartum 25 periods and are aligned with evidence-based practices for improving 26 maternal health outcomes for black women. 27 SECTION 1.1.(e) Technical Assistance to Grant Recipients. – The Department shall 28 provide technical assistance to grant recipients regarding all of the following: 29 (1) Capacity building to establish or expand programs to prevent adverse maternal 30 health outcomes among black women. 31 (2) Best practices in data collection, measurement, evaluation, and reporting. 32 (3) Planning centered around sustaining programs implemented with grant funds 33 to prevent maternal mortality and severe maternal morbidity among black 34 women when the grant funds have been expended. 35 SECTION 1.1.(f) Reports. – By October 1, 2026, the Department shall submit a 36 report on the grant program authorized by this section to the Joint Legislative Oversight 37 Committee on Health and Human Services and the Fiscal Research Division. The report shall 38 include 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 outreach efforts by the Department 42 during the application process in diversifying the pool of grant recipients. 43 (3) Recommendations for future outreach efforts to diversify the pool of grant 44 recipients for this program and other related grant programs, as well as for 45 funding opportunities related to the social determinants of maternal health. 46 SECTION 1.1.(g) The Maternal Mortality Prevention Grant Program authorized by 47 this section expires on June 30, 2026. 48 49 APPROPRIATIONS TO IMPLEMENT PART I 50 General Assembly Of North Carolina Session 2023 Page 4 DRS15440-MGa-153 SECTION 1.2.(a) The following sums are appropriated from the General Fund to 1 the Department of Health and Human Services, Division of Public Health, for the 2024-2025 2 fiscal year: 3 (1) Ninety-three thousand five hundred thirteen dollars ($93,513) in nonrecurring 4 funds to establish a time limited, full-time Public Health Program Coordinator 5 IV position within the Department of Health and Human Services dedicated 6 to performing the following duties: 7 a. Providing application assistance to Maternal Mortality Prevention 8 Grant Program applicants. 9 b. Providing technical assistance to Maternal Mortality Prevention Grant 10 Program recipients. 11 c. Preparing the reports due under Section 1.1(f) of this Part. 12 (2) Four hundred ninety-five thousand five hundred dollars ($495,500) in 13 nonrecurring funds to be allocated to the Maternal Mortality Prevention Grant 14 Program authorized by Section 1.1 of this Part. The Department of Health and 15 Human Services may use up to ten percent (10%) of these funds for 16 administrative purposes related to the grant program. The balance of these 17 funds shall be used to operate the grant program. 18 SECTION 1.2.(b) The Department of Health and Human Services is authorized to 19 hire one full-time, time-limited Public Health Program Coordinator IV position to perform the 20 duties described in subdivision (a)(1) of this section. 21 SECTION 1.2.(c) This section becomes effective July 1, 2024. 22 23 PART II. IMPLICIT BIAS IN HEALTH CARE 24 SECTION 2.1.(a) Part 5 of Article 1B of Chapter 130A of the General Statutes, as 25 amended by Section 1.1 of this act, is amended by adding new sections to read: 26 "§ 130A-33.62. Department to establish implicit bias training program for health care 27 professionals engaged in perinatal care. 28 (a) The following definitions apply in this section: 29 (1) Health care professional. – A licensed physician or other health care provider 30 licensed, registered, accredited, or certified to perform perinatal care and 31 regulated under the authority of a health care professional licensing authority. 32 (2) Health care professional licensing authority. – The Department of Health and 33 Human Services or an agency, board, council, or committee with the authority 34 to impose training or education requirements or licensure fees as a condition 35 of practicing in this State as a health care professional. 36 (3) Implicit bias. – A bias in judgment or behavior that results from subtle 37 cognitive processes, including implicit prejudice and implicit stereotypes, that 38 often operate at a level below conscious awareness and without intentional 39 control. 40 (4) Implicit prejudice. – Prejudicial negative feelings or beliefs about a group that 41 a person holds without being aware of them. 42 (5) Implicit stereotypes. – The unconscious attributions of particular qualities to 43 a member of a certain social group that are influenced by experience and based 44 on learned associations between various qualities and social categories, 45 including race and gender. 46 (6) Perinatal care. – The provision of care during pregnancy, labor, delivery, and 47 postpartum and neonatal periods. 48 (7) Perinatal facility. – A hospital, clinic, or birthing center that provides perinatal 49 care in this State. 50 General Assembly Of North Carolina Session 2023 DRS15440-MGa-153 Page 5 (b) The Department, in collaboration with (i) community-based organizations led by 1 black women that serve primarily black birthing people and (ii) a historically black college or 2 university or other institution that primarily serves minority populations, shall create or identify 3 an evidence-based implicit bias training program for health care professionals involved in 4 perinatal care. The implicit bias training program shall include, at a minimum, all of the following 5 components: 6 (1) Identification of previous or current unconscious biases and misinformation. 7 (2) Identification of personal, interpersonal, institutional, structural, and cultural 8 barriers to inclusion. 9 (3) Corrective measures to decrease implicit bias at the interpersonal and 10 institutional levels, including ongoing policies and practices for that purpose. 11 (4) Information about the effects of implicit bias, including, but not limited to, 12 ongoing personal effects of racism and the historical and contemporary 13 exclusion and oppression of minority communities. 14 (5) Information about cultural identity across racial or ethnic groups. 15 (6) Information about how to communicate more effectively across identities, 16 including racial, ethnic, religious, and gender identities. 17 (7) Information about power dynamics and organizational decision making. 18 (8) Trauma-informed care best practices and an emphasis on shared decision 19 making between providers and patients. 20 (9) Information about health inequities within the perinatal care field, including 21 information on how implicit bias impacts maternal and infant health 22 outcomes. 23 (10) Perspectives of diverse, local constituency groups and experts on particular 24 racial, identity, cultural, and provider-community relations issues in the 25 community. 26 (11) Information about socioeconomic bias. 27 (12) Information about reproductive justice. 28 (c) Notwithstanding any provision of Chapter 90 or Chapter 93B of the General Statutes, 29 or any other provision of law to the contrary, all health care professionals are required to complete 30 the implicit bias training program established under this section as follows: 31 (1) Health care professionals who hold a current license, registration, 32 accreditation, or certification on December 31, 2023, shall complete the 33 training program no later than December 31, 2024. 34 (2) Health care professionals issued an initial license, registration, accreditation, 35 or certification on or after January 1, 2024, shall complete the training 36 program no later than one year after the date of issuance. 37 A health care professional licensing authority shall not renew the license, registration, 38 accreditation, or certification of a health care professional unless the health care professional 39 provides proof of completion of the training program established under this section within the 40 24-month period leading up to the date of the renewal application. 41 (d) The Department is encouraged to seek opportunities to make the implicit bias training 42 program established under this section available to all health care professionals and to promote 43 its use among the following groups: 44 (1) All maternity care providers and any employees who interact with pregnant 45 and postpartum individuals in the provider setting, including front desk 46 employees, sonographers, schedulers, health system–employed lactation 47 consultants, hospital or health system administrators, security staff, and other 48 employees. 49 (2) Undergraduate programs that funnel into health professions schools. 50 General Assembly Of North Carolina Session 2023 Page 6 DRS15440-MGa-153 (3) Providers of the special supplemental nutrition program for women, infants, 1 and children under Section 17 of the Child Nutrition Act of 1966. 2 (4) Obstetric emergency simulation trainings or related trainings. 3 (5) Emergency department employees, emergency medical technicians, and other 4 specialized health care providers who interact with pregnant and postpartum 5 individuals. 6 (e) The Department shall collect the following information for the purpose of informing 7 ongoing improvements to the implicit bias training program: 8 (1) Data on the causes of maternal mortality. 9 (2) Rates of maternal mortality, including rates distinguished by age, race, 10 ethnicity, socioeconomic status, and geographic location within this State. 11 (3) Other factors the Department deems relevant for assessing and improving the 12 implicit bias training program. 13 "§ 130A-33.63. Rights of perinatal care patients. 14 (a) A patient receiving care at a perinatal care facility, defined as a hospital, clinic, or 15 birthing center that provides perinatal care in this State, has the following rights: 16 (1) To be informed of continuing health care requirements following discharge. 17 (2) To be informed that, if the patient so authorizes, and to the extent permitted 18 by law, the hospital or health care facility may provide to a friend or family 19 member information about the patient's continuing health care requirements 20 following discharge. 21 (3) To actively participate in decisions regarding the patient's medical care and 22 the right to refuse treatment. 23 (4) To receive appropriate pain assessment and treatment. 24 (5) To receive care and treatment free from discrimination on the basis of age, 25 race, ethnicity, color, religion, ancestry, disability, medical condition, genetic 26 information, marital status, sex, gender identity, gender expression, sexual 27 orientation, socioeconomic status, citizenship, nationality, immigration status, 28 primary language, or language proficiency. 29 (6) To receive information on how to file a complaint with the Division of Health 30 Service Regulation or the Human Rights Commission or both about any 31 violation of these rights. 32 (b) Each perinatal care facility shall provide to each perinatal care patient upon admission 33 to the facility, or as soon as reasonably practical following admission to the facility, a written 34 copy of the rights enumerated in subsection (a) of this section. The facility may provide this 35 information to the patient by electronic means, and it may be provided with other notices 36 regarding patient rights." 37 SECTION 2.1.(b) There is appropriated from the General Fund to the Department 38 of Health and Human Services, Division of Public Health, the sum of fifty thousand dollars 39 ($50,000) in recurring funds for the 2024-2025 fiscal year, to be used to establish and administer 40 the implicit bias training program for health care professionals engaged in perinatal care 41 authorized by subsection (a) of this section. 42 43 PART III. SUPPORTING AND DIVERSIFYING LACTATION CONSULTANT 44 TRAINING PROGRAMS 45 SECTION 3.1.(a) The following definitions apply in this section: 46 (1) Historically Black Colleges and Universities or HBCUs. – Institutions of 47 higher education that were founded to educate black citizens who were 48 historically restricted from attending predominantly white institutions of 49 higher education. 50 General Assembly Of North Carolina Session 2023 DRS15440-MGa-153 Page 7 (2) Lactation consultants. – Educators or counselors trained in breast feeding or 1 chest feeding practices, lactation care, and lactation services. 2 (3) Lactation services. – The clinical application of scientific principles and a 3 multidisciplinary body of evidence for evaluation, problem identification, 4 treatment, education, and consultation to childbearing families regarding 5 lactation care and services. 6 (4) Maternity care services. – Health care related to an individual's pregnancy, 7 childbirth, or postpartum recovery. 8 (5) Preceptor. – A person who is a certified lactation consultant and meets the 9 requirements of the International Board of Lactation Consultant Examiners to 10 supervise lactation consultants-in-training during the training period. 11 SECTION 3.1.(b) There is appropriated from the General Fund to the Board of 12 Governors of The University of North Carolina the sum of five hundred fifty thousand dollars 13 ($550,000) in nonrecurring funds for the 2024-2025 fiscal year for the purposes of recruiting, 14 training, and retaining a diverse workforce of lactation consultants in North Carolina by 15 supporting the infrastructure and sustainability of lactation consultant training programs at 16 Historically Black Colleges and Universities located within the State. These funds shall be 17 distributed equally between North Carolina Agricultural & Technical State University and 18 Johnson C. Smith University to cover costs incurred by each university for administering a 19 lactation training program, including, but not limited to: 20 (1) Leasing or other costs for teaching facilities or approved clinical training sites. 21 (2) Student aid or scholarships. 22 (3) Compensation for lactation consultant training program teachers and 23 preceptors. 24 SECTION 3.1.(c) The Department of Health and Human Services, Office of 25 Minority Health and Health Disparities, shall provide technical assistance to North Carolina 26 Agricultural & Technical State University and Johnson C. Smith University with respect to the 27 following: 28 (1) Developing culturally appropriate training content for the lactation consultant 29 training programs funded by State appropriations. 30 (2) Recruiting persons from historically marginalized populations to enroll in the 31 lactation consultant training programs offered at these universities. 32 (3) Recruiting historically underutilized providers to serve as teachers and 33 preceptors in the lactation consultant training programs offered at these 34 universities. 35 (4) Identifying rural and medically underserved areas of the State experiencing a 36 shortage of lactation consultants in order to recruit program graduates to work 37 in these areas. 38 SECTION 3.1.(d) By May 1, 2027, the Department of Health and Human Services, 39 Office of Minority Health and Health Disparities, shall evaluate and submit a report to the Joint 40 Legislative Oversight Committee on Health and Human Services and the Joint Legislative 41 Education Oversight Committee on the benefits received by the State as a result of funding the 42 lactation consultant training programs at North Carolina Agricultural & Technical State 43 University and Johnson C. Smith University. The report shall include at least all of the following 44 information and recommendations: 45 (1) The total number of lactation consultants who received training at one of the 46 State-funded HBCU lactation programs, broken down by (i) race and ethnicity 47 and (ii) chosen work site, such as hospital, provider office, or 48 community-based organization. 49 (2) A review of the prenatal and postpartum experiences of patients who received 50 lactation consultant services from a health care professional who graduated 51 General Assembly Of North Carolina Session 2023 Page 8 DRS15440-MGa-153 from one of the State-funded HBCU lactation consultant programs. The 1 review shall address patients' experiences relative to the following: 2 a. Health insurance coverage for maternity care services, including 3 telehealth lactation consultant services. 4 b. Contributing factors to population-based disparities in breast feeding 5 and chest feeding outcomes, including bias and discrimination toward 6 patients who are members of racial and ethnic minority groups. 7 c. Patient satisfaction with the services received from these lactation 8 consultants. 9 d. Breastfeeding or chest-feeding initiation and duration rates of patients 10 who received services from these lactation consultants. 11 SECTION 3.2. This Part becomes effective July 1, 2024. 12 13 PART IV. ESTABLISHMENT AND FUNDING OF COUNT THE KICKS PROGRAM 14 SECTION 4.1.(a) The Department of Health and Human Services, Division of 15 Public Health (DPH), shall establish and administer a statewide, evidence-based stillbirth 16 prevention program known as Count the Kicks that provides educational resources to healthcare 17 providers, community health workers, and expectant parents on the importance of, and methods 18 for, tracking fetal movement. 19 SECTION 4.1.(b) Effective July 1, 2024, there is appropriated from the General 20 Fund to the Department of Health and Human Services, Division of Public Health, the sum of 21 two million dollars ($2,000,000) in recurring funds for the 2024-2025 fiscal year to be allocated 22 to the Count the Kicks program authorized by subsection (a) of this section. The DPH may use 23 these allocated funds for all of the following purposes: 24 (1) To produce and distribute educational materials for expectant mothers about 25 the Count the Kicks program and the importance of fetal movement 26 monitoring. 27 (2) To train healthcare providers and community health workers on the 28 importance of, and methods for, tracking fetal movement. 29 (3) To fund public awareness campaigns to promote fetal movement monitoring. 30 (4) To provide support for data collection and program evaluation to monitor and 31 improve program effectiveness. 32 (5) To cover up to ten percent (10%) of the administrative costs associated with 33 establishing and administering the program. 34 SECTION 4.1.(c) The DPH shall report to the Joint Legislative Oversight 35 Committee on Health and Human Services and the Fiscal Research Division on the Count the 36 Kicks program authorized by subsection (a) of this section as follows: 37 (1) By September 1, 2025, the DPH shall report on the implementation status of 38 the program. The report shall include a detailed breakdown of program 39 expenditures and an explanation of any obstacles to full program 40 implementation. 41 (2) Annually on September 1, beginning September 1, 2026, the DPH shall report 42 on the status and operation of the program. The annual report shall include a 43 detailed breakdown of program expenditures and an evaluation of the impact 44 of the program on maternal and infant health outcomes in North Carolina for 45 the one-year period preceding the report. 46 47 PART V. EFFECTIVE DATE 48 SECTION 5.1. Except as otherwise provided, this act is effective when it becomes 49 law. 50