Revision: Jan. 9, 2023, 9:58 a.m.
2023 SESSION
23-1034.1
07/05
SENATE BILL [bill number]
AN ACT relative to Medicaid coverage for mothers.
SPONSORS: [sponsors]
COMMITTEE: [committee]
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ANALYSIS
This bill:
1. Mandates that the department of health and human services extend Medicaid coverage for pregnant women to 12 months postpartum, to cover doula services, to cover lactation services, and to cover donor breast milk for eligible infants, and creates appropriations thereof.
2. Establishes minimum workplace supports for nursing mothers.
3. Appropriates money to the department of health and human services to support healthy outcomes for caregivers and children.
4. Establishes a commission to study home visiting programs for all parents of newborns and young children.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-1034.1
07/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to Medicaid coverage for mothers.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Short Title. This act shall be known as the "The New Hampshire Mom-nibus."
2 New Paragraph; The Children's Health Plan; Medicaid Enhancement for Children and Pregnant Women; Postpartum Coverage. Amend RSA RSA 167:68 by inserting after paragraph III the following new paragraph:
IV.(a) Pursuant to the state option under the American Rescue Plan Act of 2021 to expand maternity care under Medicaid and section 1902(e)(16) of the Social Security Act (42 U.S.C. section 1396a(e)), the commissioner of the department of health and human services shall submit, no later than September 30, 2023, a Medicaid state plan amendment to the federal Centers of Medicare and Medicaid Services to establish and implement 12 months of continuous coverage for the entire postpartum period. This benefit shall be available to anyone who received medical assistance under the state plan for all pregnancy-related and postpartum medical assistance available under the state plan.
(b) The purpose of the program shall be, through ensuring continuous coverage for a 12-month postpartum period, to increase identification and mitigation of preventable pregnancy related and pregnancy associated morbidity and mortality, including those related to substance use disorder and mental illness.
(c) The medical assistance provided for a pregnant or postpartum woman under this section shall, consistent with section 1902(e)(16) include all items and services covered under the state plan that are not less in amount, duration, or scope, or are determined by the Secretary to be substantially equivalent, to the medical assistance available for an individual described in subsection (a)(10)(A)(i); and be provided for the individual while pregnant and during the 12-month period that begins on the last day of the individual’s pregnancy and ends on the last day of the month in which such 12-month period ends.
(d) On January 31, 2024, the commissioner shall begin submitting quarterly reports to the oversight committee on Health and Human services, the legislative committees with jurisdiction over Health and Human services, and the governor regarding the department's progress in obtaining and implementing the state plan amendment. The quarterly reports shall include the department's plans for reducing administrative burdens for enrollees and the department’s efforts to expand access and participation to voluntary, evidence-based maternal home visiting programs, pursuant to subparagraph (a). Reports submitted under this paragraph shall also be posted on the department's website.
(e) The department shall include in its biennial request for appropriations under RSA 9:4, not less than $300,000 for each fiscal year, for the purpose of providing the postpartum health care services required under this paragraph.
(f) Working with stakeholder and community organizations, the department shall establish a comprehensive community education and outreach campaign to inform eligible persons and providers of the extended health care coverage in this section.
3 Appropriation. The sum of $300,000 for the biennium ending June 30, 2025 is hereby appropriated to the department of health and human services for the purpose of expanding postpartum health care services under the state Medicaid plan as provided in section 2 of this act. The governor shall determine if any discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-2, or any other federal funds, can be used for this purpose, and the commissioner shall expend such federal funds for this purpose. Any remainder shall be appropriated from the general fund. The governor is authorized to draw a warrant for the general fund portion of said sum out of any money in the treasury not otherwise appropriated. The department of health and human service may accept and expend matching federal funds without prior approval of the fiscal committee of the general court.
4 New Subdivision; Medicaid Coverage of Certain Birthing, Postpartum, and Newborn Services. Amend RSA 126-A by inserting after section 98 the following new subdivision:
Medicaid Coverage of Certain Birthing, Postpartum, and Newborn Services
126-A:99 Medicaid Doula Coverage.
I. Notwithstanding any other provision of this chapter, doula services shall be covered under the medical assistance for eligible Medicaid beneficiaries.
II. As used in this section, “doula services” means services provided by a highly-qualified doula certified by the state pursuant to RSA 310-A:222 and designed to provide physical, emotional, and educational support to pregnant women before, during, and after childbirth. Doula services include the following:
(a) Support and assistance during labor and childbirth.
(b) Prenatal and postpartum support and education.
(c) Breastfeeding assistance and lactation support.
(d) Parenting education.
(e) Support for a birthing person following loss of pregnancy.
III. The department of health and human services is authorized to take any action to include doula services in the medical assistance program, including seeking waivers or amending the Medicaid state plan to provide reimbursement for doulas who provide Medicaid eligible services to eligible Medicaid beneficiaries.
IV. Not later than January 31, 2025, the commissioner shall report to the oversight committee on health and human services, the legislative committees with jurisdiction over health and human services, and the governor, a set of metrics determined by the department of health and human services in consultation with the doula advisory board established in RSA 310-A:223.
V. The department shall adopt rules pursuant to RSA 541-A to implement the provisions of this section. The rules shall address the requirements and expertise of practicing doulas, doula training providers, and home visiting experts. Every 2 years, the department shall assess the rates of reimbursement for doula services and adjust rates accordingly.
126-A:100 Medicaid Coverage of Lactation Services; Reimbursement Required.
I. The department of health of health and human services shall cover lactation services for Medicaid recipients as a pregnancy-related service under New Hampshire’s Medicaid program.
II. The department is authorized to use the following Medicaid coverage categories to reimburse lactation services:
(a) Inpatient hospital services, other than services in an institution for mental disease, per Social Security Act (SSA) section 1905(a)(1);
(b) Outpatient hospital services, per SSA section 1905(a)(2)(A) and 42 C.F.R. section 440.10;
(c) Early and periodic screening, diagnostic, and treatment services for individuals who are eligible under the plan and are under the age of 21, per SSA section 1905(a)(4)(B);
(d) Physicians’ services furnished by a physician under the physician’s supervision, whether furnished in the office, the patient’s home, a hospital, or a nursing facility, or elsewhere, per SSA section 1905(a)(5)(A);
(e) Services furnished by a nurse-midwife, which the nurse-midwife is legally authorized to perform under State law, per SSA section 1905(a)(17);
(f) Freestanding birth center services, per SSA section 1905(a)(28); and
(g) Services furnished by nurse practitioners per 42 C.F.R. section 440.166 and other licensed practitioners per 42 C.F.R. section 440.60.
III. Reimbursable lactation services shall include:
(a) Breastfeeding education;
(b) Individual lactation consultation; and
(c) Equipment rentals.
126-A:101 Medicaid Coverage of Donor Breast Milk; Reimbursement Required.
I. The department of health and human services shall provide reimbursement under the medical assistance program for donor breast milk provided to an infant receiving benefits under this chapter by organizations approved by the department if a physician or physician assistant licensed in this state or an advanced practice registered nurse licensed in this state signs an order state the following:
(a) The infant is medically or physically unable to receive maternal breast milk or participate in breastfeeding or the infant's mother is medically or physically unable to produce maternal breast milk in quantities sufficient for the infant; and
(b) The infant:
(1) Was born at a birth weight of less than 1,500 grams;
(2) Has a gastrointestinal anomaly or metabolic or digestive disorder or is recovering from intestinal surgery and the infant's digestive needs require additional support;
(3) Is not appropriately gaining weight or growing;
(4) Has formula intolerance and is experiencing weight loss or difficulty feeding;
(5) Has low blood sugar;
(6) Has congenital heart disease;
(7) Has received or will receive an organ transplant; or
(8) Has another medical condition for which donor breast milk is medically necessary.
II. The department shall adopt rules pursuant to RSA 541-A to implement the program described in this section.
5 Medicaid State Plan; Requiring Coverage of Donor Breast Milk. The department of health and human services shall prepare and submit a Medicaid state plan amendment or waiver as necessary to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services no later than September 30, 2023 that provides or requests, as appropriate, Medicaid coverage consistent with RSA 126-A:101 for the coverage of donor breast milk for eligible infants.
6 Appropriation; Reimbursement for Donor Breast Milk under the Medicaid Program. The sum of $250,000 for the biennium ending June 30, 2025 is hereby appropriated to the department of health and human services for the purpose of providing reimbursement for donor breast milk for eligible infants under the state Medicaid plan as provided in sections 4 and 5 of this act. The governor shall determine if any discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-3, or any other federal funds, can be used for this purpose, and the commissioner shall expend such federal funds for this Crusoe Any remainder shall be appropriated from the general fund. The governor is authorized to draw a warrant for the general fund portion of such sum from any money in the treasury not otherwise appropriated. The department of health and human services may accept and expend matching federal funds without prior approval of the fiscal committee of the general court.
7 Appropriation; Reimbursement for Doulas under the Medicaid Program. The sum of $300,000 for the biennium ending June 30, 2025 is hereby appropriated to the department of health and human services for the purpose of providing reimbursement for state-certified doulas under the state Medicaid plan as provided in section 4 of this act. The governor shall determine if any discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-2, or any other federal funds, can be used for this purpose, and the commissioner shall expend such federal funds for this purpose. Any remainder shall be appropriated from the general fund. The governor is authorized to draw a warrant for the general fund portion of such sum from any money in the treasury not otherwise appropriated. The department of health and human services may accept and expend matching federal funds without prior approval of the fiscal committee of the general court.
8 Appropriation; Reimbursement for Lactation Services under the Medicaid Program. The sum of $300,000 for the biennium ending June 30, 2025 is hereby appropriated to the department of health and human services for the purpose of providing reimbursement for lactation services under the state Medicaid plan as provided in section 4 of this act. The governor shall determine if any discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-2, or any other federal funds, can be used for this purpose, and the commissioner shall expend such federal funds for this purpose. Any remainder shall be appropriated from the general fund. The governor is authorized to draw a warrant for the general fund portion of such sum from any money in the treasury not otherwise appropriated. The department of health and human services may accept and expend matching federal funds without prior approval of the fiscal committee of the general court.
9 New Subdivision; Labor; Protective Legislation; Policies Relating to Nursing Mothers. Amend RSA 275 by inserting after section 77 the following new subdivision:
Policies Relating to Nursing Mothers
275:78 Definitions. In this subdivision:
I. "Employee" shall mean a person who may be permitted, required, or directed by an employer in consideration of direct or indirect gain or profit but shall not include any individual who volunteers services for a public, charitable, or religious facility without expectation or promise of pay.
II. "Employer" shall mean a person, partnership, association, corporation, or legal representative of a person, partnership, association, or corporation, or the state or any of its political subdivisions, which has 6 or more employees working in the state.
III. "Expression of milk" means the initiation of lactation by manual or mechanical means but shall not include breastfeeding.
IV. "Reasonable break period" shall mean an unpaid break of approximately 30 minutes for every 3 hours of work performed by a nursing employee for the purpose of expressing milk.
V. "Undue hardship" shall mean any action that requires significant difficulty or expense when considered in relation to factors such as the size of the business, its financial resources and the nature and structure of its operation.
275:79 Notification of Policies.
I. Every employer shall adopt a policy to address the provision of sufficient space and reasonable break periods for nursing employees that need to express milk during working hours.
II. Every employer shall, at the time of hire, make available to its employees the employer's policy related to expression of milk during working hours.
III. A nursing employee shall notify its employer at least 2 weeks prior to needing reasonable break periods and sufficient space for expression of milk during work hours.
275:80 Sufficient Space.
I. Every employer shall provide access to reasonable, sufficient space, either temporary or permanent in nature, for the use of an employee to express milk for a nursing child for a period of one year from the date of birth of the child.
II. The location of the space provided shall be within a reasonable walk of the employee’s worksite, unless otherwise mutually agreed to by the employer and employee.
III. Sufficient space provided in accordance with this section shall not be a bathroom, and shall be a clean space shielded from view and free from intrusion from coworkers and the public.
(a) If the space is not solely for the use of employees expressing milk it shall be made available when requested to comply with the requirements set forth in this subdivision.
(b) If feasible, the room shall have, at a minimum, an electrical outlet and a chair.
275:81 Reasonable Break Period.
I. Every employer shall provide reasonable break periods to employees who need to express milk for a child for a period of one year from the date of birth of the child. Nothing in this section shall preclude an employer from negotiating with an employee reasonable break periods to express milk that are different from the requirements in this subdivision.
II. Nothing under this subdivision shall preclude an employee from taking a reasonable break period contemporaneously with break or meal periods already provided to the employee by the employer.
III. An employer shall not require an employee to make up time related to use of unpaid reasonable break periods.
275:82 Penalties. Any employer who violates any provision of this subdivision shall be subject to a civil penalty pursuant to RSA 273:11-a.
275:83 Hardship Exemption. An employer may be exempted from this subdivision if providing reasonable break time and sufficient space for expressing milk would impose an undue hardship to the employer's operations.
10 Appropriation; Maternal and Child Support. The sum of $2,000,000 for fiscal year ending June 30, 2024, and the sum of $2,000,000 for the fiscal year ending June 30, 2025, is hereby appropriated to the department of health and human services to support healthy outcomes for caregivers and children and shall be allocated to the family resource center facilitating organization, New Hampshire Children's Trust, for distribution to family resource centers. The use of the funds shall include, but not be limited to, better serving families, preparing for FRC-Q designation, enhancing coordination with other early childhood systems, and supporting evidence-based programs such as home visiting programs and perinatal doula services, ACERT, and community collaboration. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.
11 New Subdivision; Commission to Study Home Visiting. Amend RSA 125 by inserting after section 95 the following new subdivision:
Commission to Study Home Visiting
125:96 Commission to Study Home Visiting Established.
I. There is established a commission to study home visiting in New Hampshire. The membership of the commission shall be as follows:
(a) Two members of the senate, appointed by the senate president, one of whom serves on the senate health and human services committee.
(b) Two members of the house of representatives, who serve on the house health and human services and elderly affairs committee, appointed by the speaker of the house of representatives.
(c) The director of the division of public health services of the department of health and human services, or designee.
(d) The commissioner of the department of education, or designee.
(e) The chair of the wellness and primary prevention council, established under RSA 126-M:3, or designee.
II. The commission shall study how New Hampshire can reduce barriers, improve access, and create a system of universal access to voluntary home visiting programs available to all parents of newborns and young children designed to support families, bridge gaps between caretakers and community resources, and improve maternal and child health wellness. The commission's duties shall include, but not be limited to:
(a) Review of current data regarding home visiting programs, services, and family needs in New Hampshire.
(b) Review of current barriers in both provision of home visiting services and participation in programs by families.
(c) Review of national, state, and other resources on building a strong system of universal home visiting.
(d) Identify a set of recommendations, including legislative, administrative, financial, and other policies, that should be made to reduce barriers and improve access to voluntary home visiting services statewide.
(e) As part of this study and to ensure cross-agency collaboration, the commission shall include, but not be limited to, in meetings the following individuals and organizations:
(1) The director of the division of children, youth, and family of the department of health and human services, or designee.
(2) The director of the council for thriving children, or designee.
(3) One representative of the New Hampshire Children’s Trust, designated by that organization.
(4) A representative of a family resource center which provides home visiting programming to families, designated by Family Support New Hampshire.
(5) A representative of Waypoint, designated by that organization.
(6) A representative of the New Hampshire School Administrators Association, appointed by that organization.
(7) A parent or caretaker that has participated in home visiting programs, as designated by the Council for Thriving Children Parent Advisors.
III. Members of the commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named senate member. The first meeting of the commission shall be held within 30 days of the effective date of this section. Four members of the commission shall constitute a quorum. The senate health and human services committee staff shall provide clerical, administrative, and research services to the commission as may be needed.
IV. Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.
V. The commission shall submit a final report of its findings and any recommendations for proposed legislation to the president of the senate, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library on or before October 15, 2024.
12 Repeal. RSA 125:96, relative to the commission to study home visiting, is repealed.
13 New Subdivisions; Medicaid Reimbursement-Eligible Doulas and Lactation Service Providers. Amend RSA 310-A by inserting after section 221 the following new subdivisions:
Medicaid Reimbursement-Eligible Doulas and Lactation Service Providers
310-A:222 Doula Certification.
I. For the purposes of Medicaid billing pursuant to RSA 126-A:99, the office of professional licensure and certification shall, in conjunction with the doula advisory board, establish a doula certification process.
II. The office of professional licensure and certification shall make rules pursuant to RSA 541-A relative to the authority set out in paragraph I of this section.
III. Nothing in this section shall prevent a person certified by this state pursuant to any other provision of law from performing the occupation for which he or she is certified.
310-A:223 Doula Advisory Board Established.
I. The office of professional licensure and certification shall establish a doula advisory board to oversee the implementation of the doula certification process.
II. The board members shall:
(a) Consist of 3 doulas who reside in the state and one parent to represent the patient and consumer perspective.
(b) Make an effort to include racially and geographically diverse community members;
(c) Be appointed for 3 years and staggered in such a way that the term of one member expires each year;
(d) Hold office until successors are appointed;
(e) Serve no more than 2 full consecutive terms; and
(f) Serve on the board without any compensation.
III. The board shall advise the executive director of the office of professional licensure and certification regarding the implementation of this section.
310-A:224 Lactation Service Provider Certification.
I. For the purposes of Medicaid billing pursuant to RSA 126-A:100, the office of professional licensure and certification shall, in conjunction with the lactation service provider advisory board, establish a process to certify lactation service providers that are credentialed by the International Board of Lactation Examiners.
II. The office of professional licensure and certification shall make rules pursuant to RSA 541-A relative to the authority set out in paragraph I of this section.
III. Nothing in this section shall prevent a person certified by this state pursuant to any other provision of law from performing the occupation for which he or she is certified.
310-A:225 Lactation Service Provider Advisory Board Established.
I. The office of professional licensure and certification shall establish a lactation service provider advisory board to oversee the implementation of the lactation service provider certification process as set out in RSA 310-A:224.
II. The board members shall:
(a) Consist of 3 lactation consultants who reside in the state and one parent to represent the patient and consumer perspective.
(b) Make an effort to include racially and geographically diverse community members;
(c) Be appointed for 3 years and staggered in such a way that the term of one member expires each year;
(d) Hold office until successors are appointed;
(e) Serve no more than 2 full consecutive terms; and
(f) Serve on the board without any compensation.
III. The board shall advise the executive director of the office of professional licensure and certification regarding the implementation of this section.
I. Sections 3, 6, 7, 8, and 10 of this act shall take effect July 1, 2023.
II. Section 12 of this act shall take effect October 15, 2024.
III. Sections 4 and 13 of this act shall take effect one year after its passage.
IV. The remainder of this act shall take effect upon its passage.