Revision: June 15, 2023, 3:56 p.m.
SB 105-FN - VERSION ADOPTED BY BOTH BODIES
03/23/2023 1037s
8Jun2023... 1728h
2023 SESSION
23-0795
05/08
SENATE BILL 105-FN
SPONSORS: Sen. Rosenwald, Dist 13; Sen. Perkins Kwoka, Dist 21; Sen. Fenton, Dist 10; Rep. T. Lekas, Hills. 38; Rep. Nutter-Upham, Hills. 8; Rep. Edwards, Rock. 31
COMMITTEE: Executive Departments and Administration
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AMENDED ANALYSIS
This bill limits the potential criminal penalty for misinformation on a birth worksheet to that required for the birth certificate; and requires the birth worksheet to be retained for 7 years rather than indefinitely.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/23/2023 1037s
8Jun2023... 1728h 23-0795
05/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Vital Records Administration; Penalties; Live Birth; Mother's Worksheet. Amend RSA 5-C:14 by inserting after paragraph IV the following new paragraph:
V. When a live birth is reported to the division of vital records, subparagraph II(a) and paragraph IV shall apply only to the information on the mother's worksheet that is required for the birth certificate.
2 Record Retention. Amend RSA 5-C:96, II(d) and (e) to read as follows:
(d) Birth worksheet, hospital birth: retained [permanently] for 7 years.
(e) Birth worksheet, home birth: retained [permanently] for 7 years.
3 Effective Date. This act shall take effect upon its passage.
23-0795
Amended 4/20/23
SB 105-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2023-1037s)
FISCAL IMPACT: [ X ] State [ X ] County [ ] Local [ ] None
| Estimated Increase / (Decrease) | |||
STATE: | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | Indeterminable Decrease | Indeterminable Decrease | Indeterminable Decrease |
Expenditures | $0 | Indeterminable Decrease | Indeterminable Decrease | Indeterminable Decrease |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Vital Records Administration Fund and Federal Funds | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill removes the possibility that omission of certain information on a live birth worksheet may result in a violation or criminal penalty; requires that the mother affirmatively consent to the inclusion of certain identifiable health information on the live birth worksheet; and repeals the requirement that the birth worksheet be retained permanently. Lastly, it requires, no later than January 1, 2024, the Division of Vital Records, in consultation with the Division of Public Health Services, hospitals, and freestanding birth centers, to present revised mother and facility worksheet forms and a signature document for the mother's consent for disclosure of identifiable health information contained in the facility worksheet to the oversight committee on health and human services for approval.
The Department of State indicates requiring the Division of Vital Records Administration to update its paper forms will not have an impact as those form changes are regularly recorded by the Division. However, the Department states updating the electronic forms has an estimated cost of $100,000 in FY 2024. The Department also notes currently the Division has a contract with the CDC, the Vital Statistics Cooperative Program Contract, which requires the Division to share vital record information from the birth form. Changing the data reported to the CDC may cause NH to default on the contract resulting in a potential loss in contract revenue going into the Vital Records Administration Fund of $169,000 per a year. This fund is used to pay personnel costs in vital records. Any lost revenue in this fund would need to be supported by the General Funds.
The Department of Health and Human Services (DHHS) states vital records include births, deaths, marriages, divorces, and fetal deaths. The National Vital Statistics System is one of the oldest and most successful examples of data collection and sharing. It is a complex system that incorporates entities at the local, state, and federal level, each with its own role. Federal law mandates uniform collection and publication of this data.
Birth registration is the process of recording a child’s birth. It is a permanent and official record of a child’s existence and provides legal recognition of that child’s identity. In addition to its role in assuring an accurate count of births and creating a legal identity for an individual, birth records are used to identify and quantify health related issues. This foundational information is collected in the same manner by every state. Standardized birth records are used in the prevention of preterm birth, maternal and fetal deaths, birth defects and other labor, delivery and birth related outcomes. Birth records identify health trends at the state, local and national levels including rates of infant mortality, maternal mortality and fetal death. The Standard Certificate of Live Birth collects information on the use of prenatal care, maternal sociodemographic and behavioral data, place of birth, information pertaining to medical and obstetric complications of pregnancy, and Apgar scores. The registration of births is the responsibility of the birth attendant, generally a physician, midwife or hospital, and must be reported promptly.
The DHHS states hospitals, birthing centers, towns and cities enter birth records into the New Hampshire Division of Vital Records Administration (NHDVRA) electronic system. In accordance with RSA 126:24-c and a Memorandum of Understanding between the DHHS and the NH Secretary of State, a file transfer of the entire contents of birth records is shared with the DHHS 4 times a day on a 24-hour, 7-day per week basis, via a remote data download so that DHHS can administer a wide range of authorized services and activities. The DHHS also states the Office of Secretary of State is not a covered entity by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). However, the DHHS is covered by HIPAA.
The DHHS states this bill amends RSA 5-C:19, II(a) to require the removal of the all personally identifiable information for the mother, father and infant on the birth work sheet for institutional births by the hospital or institution’s birth registrar or designee prior to submission to the NHDVRA. The bill also prohibits any hospital, birthing center, or institution from disclosing on the facility worksheet the mother’s medical record number or the infant’s medical record number.
This bill also requires that no later than January 1, 2024, the NHDVRA in consultation with the DHHS, hospitals, and freestanding birth centers present a revised draft of the mother and facility worksheet form for review to the Committee on Health and Human Services Oversight for approval. The revised and approved birth worksheet (written or electronic copy) will be required to be in use no later than one year after approval. The DHHS states the changes required by this bill are in conflict with reporting requirements of the National Center for Health Statistics. (RSA 5-C:5)
The bill removes the criminal penalty for not providing the information requested on the mother's birth worksheet (health information) that is not required for the birth certificate. This bill also repeals RSA 5-C:96, II(d) and (e), relative to permanent retention of the birth worksheet.
The DHHS estimates that a significant unintended consequence of this bill could be the loss of critical and timely data from the information provided by the Live Birth Worksheet as described below. It is anticipated that without this data, the programs that depend on this information to plan access to prenatal care, health screenings for life saving treatment, fraud and program integrity protection for state and federal entitlements, health promotion planning and required evaluation efforts of the health and safety of New Hampshire mothers and infants could be at risk of losing critical federal funding.
Additionally, the DHHS understands that some of the information within this bill would prohibit collection of is needed by the Secretary of State’s office and Social Security Administration (SSA) in order to issue a birth certificate and social security number (SSN) for a newborn. Information needed for this process includes the child’s name, mailing address, mother’s name, father’s name, mother’s SSN and father’s SSN. This information is currently collected as part of the birth registration process as a convenience for parents, and the information is sent directly to the SSA by the state. It is unclear how the SSA will confirm the birth information and the parent requesting the SSN at the time of application. The DHHS states there is a chance this may lead to the need for the parents of approximately 12,000 New Hampshire infants per year to physically take their child’s birth certificate to a Social Security Office to complete a process that is now done electronically and seamlessly.
The DHHS notes this bill will impact its Division of Public Health Services newborn screening program; hearing screening; birth conditions program; maternal mortality review; identification of emerging or known infectious threats during pregnancy; pregnancy risk assessment monitoring system; rural health and primary care; and certain data analysis and needs assessments for various grants or the data portal. It will also impact the Division of Economic Supports Child Support Services, Medicaid (DMS) Integrated Eligibility Services, Division for Children, Youth and Families, and the Estate Recovery Unit - Division of Legal Services.
The DHHS anticipates the fiscal impact from this bill will begin in FY 2024. The DHHS states in extreme instances this bill could have an impact in excess of $26 million in federal funds due to becoming ineligible for a variety of programmatic grants, with costs for data system, quality assurance and fraud prevention being indeterminable at this time and may result in the need to eliminate in excess of 13 full-time positions, mainly in the Division of Public Health Services.
The Division of Legal Services, Estate Recovery Unit (ERU) estimates the bill could have a negative impact on the general fund as this bill could decrease the State General Fund by an indeterminable amount because it is impossible to predict who will pass away with what surviving heirs. The ERU would be unable to confirm the relationship between a deceased Medicaid recipient and survivors. Without this information, the ERU will be unable to enforce recovery properly and could have a negative impact on the State General Fund because it will unnecessarily subject the State to liability should recovery be made where it is inappropriate.
Also, there may be an indeterminable impact to community-based, safety-net health organizations including Federally Qualified Health Centers. Without federal designations of need based in part on local birth data, critical federal funds for Federally Qualified Health Centers and workforce loan repayment programs for healthcare workforce are in jeopardy.
The overall fiscal impact is indeterminable at this time because no other state has enacted similar restrictions in access to Birth Data and there may be additional unintended consequences.
This bill contains penalties that may have an impact on the New Hampshire judicial and correctional systems. There is no method to determine how many charges would not be brought as a result of the changes contained in this bill to determine the fiscal impact on expenditures. However, the entities impacted have provided the potential costs associated with these penalties below.
Judicial Branch | FY 2023 | FY 2024 through 12/31/23 | FY 2024 (Starting 1/1/24 with repeal of Felonies First) | ||||||||
Violation and Misdemeanor Level Offense | $119 | $122 | $122 | ||||||||
Complex Felony Case | $3,195 | $3,244 | $3,366 | ||||||||
Routine Criminal Case | $644 | $657 | $779 | ||||||||
Appeals | Varies | Varies | Varies | ||||||||
Judicial Council | FY 2023 | FY 2024 | |||||||||
Public Defender Program | Has contract with State to provide services. | Has contract with State to provide services. | |||||||||
Contract Attorney - Felony | $825/Case $105 administrative fee $200 incarceration fee (If applicable) | $825/Case $105 administrative fee $200 incarceration fee (If applicable) | |||||||||
Contract Attorney – Misdemeanor | $300/Case $70 administrative fee $100 incarceration fee (If applicable) | $300/Case $70 administrative fee $100 incarceration fee (If applicable) | |||||||||
Contract Attorney - Major Crimes (aggravated felonious sexual assault, felonious sexual assault and first degree assault) | $2,490/Case $140 administrative fee $200 incarceration fee (If applicable) | $2,490/Case $140 administrative fee $200 incarceration fee (If applicable) | |||||||||
Assigned Counsel - Felony. Homicide including capital cases. Travel time to court does not count toward the cap. | $125/Hour up to $20,000 | $125/Hour up to $20,000 | |||||||||
Assigned Counsel - Major Crimes. Aggravated felonious sexual assault, felonious sexual assault, first degree assault, class A felony robbery and felony arson. Travel time to court does not count toward the cap. | $125/Hour up to $12,500 | $125/Hour up to $12,500 | |||||||||
Assigned Counsel - Felony. Travel time to court does not count toward the cap. | $90/Hour up to $5,500 | $90/Hour up to $5,500 | |||||||||
Assigned Counsel- Misdemeanor. Travel time to court does not count toward the cap. | $90/Hour up to $2,000 | $90/Hour up to $2,000 | |||||||||
Assigned Counsel - Supreme Court Appeal | $125/Hour up to $10,000 | $125/Hour up to $10,000 | |||||||||
It should be noted that a person needs to be found indigent and have the potential of being incarcerated to be eligible for indigent defense services. Historically, approximately 85% of the indigent defense caseload has been handled by the public defender program, with the remaining cases going to contract attorneys (14%) or assigned counsel (1%). Beginning in March of 2021, the public defender program has had to close intake of new cases due to excessive caseloads. Due to these closures, the contract and assigned counsel program have had to absorb significantly more cases. The system is experiencing significant delays in appointing counsel and the costs of representation have increased due to travel time and multiple appointments. | |||||||||||
Department of Corrections | FY 2023 | FY 2024 | |||||||||
FY 2022 Average Cost of Incarcerating an Individual | $64,223 | $64,223 | |||||||||
FY 2022 Annual Marginal Cost of a General Population Inmate | $6,123 | $6,123 | |||||||||
FY 2022 Average Cost of Supervising an Individual on Parole/Probation | $688 | $688 | |||||||||
The Department notes any increase in the incarcerated population will have a direct impact on overtime costs given the Department’s history of challenges associated with recruitment. In addition, the NH State Prison for Men has a degrading infrastructure which will only be exacerbated if an increase in the incarcerated population were to occur. | |||||||||||
NH Association of Counties | FY 2023 | FY 2024 | |||||||||
County Prosecution Costs | Indeterminable | Indeterminable | |||||||||
Estimated Average Daily Cost of Incarcerating an Individual | $105 to $125 | $105 to $125 | |||||||||
Many offenses are prosecuted by local and county prosecutors. When the Department of Justice has investigative and prosecutorial responsibility or is involved in an appeal, the Department may be able to absorb the cost within its existing budget. However, if the Department needs to prosecute significantly fewer cases or handle less appeals, then costs will decrease by an indeterminable amount.
AGENCIES CONTACTED:
Department of State, Department of Health and Human Services, Judicial Branch, Departments of Corrections and Justice, Judicial Council, and New Hampshire Association of Counties