AB 50: Medi-Cal: evidence-based home visiting programs.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2015-09-16
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health Care Services, in consultation with specified stakeholders, to develop a feasibility plan on or before January 1, 2017, that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for Medi-Cal providers to offer those services, and would require the department, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health Care Services, in consultation with specified stakeholders, to develop a feasibility plan on or before January 1, 2017, to determine the feasibility of that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for Medi-Cal providers to offer those services, and would require the department, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health Care Services, in consultation with specified stakeholders, to develop a plan on or before January 1, 2017, to ensure that determine the feasibility of offering evidence-based home visiting programs are offered and provided to Medi-Cal eligible pregnant and parenting women, and would require the department, on or before January 1, 2022, and every 5 years thereafter, to report to the Legislature, as specified. women. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for Medi-Cal providers to offer those services, and would require the department, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health Care Services, in consultation with specified stakeholders, to develop and implement a plan on or before January 1, 2017, to ensure that evidence-based home visiting programs are offered and provided to Medi-Cal eligible pregnant and parenting women, and would require the department, on or before January 1, 2022, and every 5 years thereafter, to report to the Legislature, as specified. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for Medi-Cal providers to offer those services. services, and would require the department, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Public Health to additionally develop a grant application and award grants to counties for other evidence-based home visiting programs, and would require the department, Health Care Services, in consultation with stakeholders and the State Department of Health Care Services, stakeholders, to develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to Medi-Cal eligible pregnant women. and parenting women, and would require the department, on or before January 1, 2022, and every 5 years thereafter, to report to the Legislature, as specified. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based home visiting program services and incentives for providers to offer those services.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would require the State Department of Health Care Services, Public Health to additionally develop a grant application and award grants to counties for other evidence-based home visiting programs, and would require the department, in consultation with stakeholders, stakeholders and the State Department of Health Care Services, to develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to Medi-Cal eligible pregnant women, and would require the department, on or before January 1, 2022, and every 5 years thereafter, to report to the Legislature, as specified. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based nurse home visiting program services and incentives for providers to offer those services. women.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would declare the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership in California, in accordance with specified findings. The bill would revise the requirements relating to the award and use of Nurse-Family Partnership grants, including eliminating a requirement for nurse home visitors and supervisors to receive certain training in effective home visitation techniques.
This bill would require the State Department of Health Care Services, in consultation with stakeholders, to develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to Medi-Cal eligible pregnant women, and would require the department, on or before January 1, 2022, and every 5 years thereafter, to report to the Legislature, as specified. The bill would also require the department, in developing the plan, to consider, among other things, establishing Medi-Cal coverage for evidence-based nurse home visiting program services and incentives for providers to offer those services.
Existing law establishes the Nurse-Family Partnership program, which is administered by the State Department of Public Health, to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Under existing law, a county is required to satisfy specified requirements in order to be eligible to receive a grant.
This bill would declare the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership in California, in accordance with specified findings. The bill would revise the requirements relating to the award and use of Nurse-Family Partnership grants, including eliminating a requirement for nurse home visitors and supervisors to receive certain training in effective home visitation techniques.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G. Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states, the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state in order to meet the ambitious goals in the Governors directive.
(g)Voluntary evidence-based home visiting programs, such as Nurse-Family Partnership, Healthy Families America, Early Head Start (Home-Based Program Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters, strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to five years of age. Extensive research has shown that evidence-based home visiting programs serving pregnant and parenting mothers, prenatal to the child turning five years of age, increase family self-sufficiency, positive parenting practices, child literacy and school readiness, and maternal and child health.
(h)Voluntary evidence-based home visiting program models focused on the prenatal period to five years of age range from low to high intensity, reflecting the broad spectrum of family needs that home visiting can impact. Many experts hail home visiting program diversity as essential to providing parents with choices and ensuring that programs are well matched with local needs and strengths, as well as responsive to the diverse needs of Californias children and families.
(i)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(j)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high-cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(k)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(l)With more than three decades of evidence from randomized, controlled trials and rigorous followup evaluation studies, evidence-based home visiting programs have demonstrated sustained improvements in maternal health, child health, positive parenting practices, child development and school readiness, reductions in child maltreatment, family economic self-sufficiency, linkages and referrals, and reductions in family violence.
(m)Evidence-based home visiting programs have specifically demonstrated reductions in preterm births, preventable maternal mortality, smoking during pregnancy, complications of pregnancy, closely spaced subsequent births, childhood injuries resulting in costly emergency department use and hospitalizations, improved childhood immunization rates, compliance with well child visit schedules, lower body mass index rates, higher birth weights, and improved family well-being, including increased family health literacy, and parent self-help development. As a result of families benefiting from evidence-based home visiting, there have been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(n)The strong evidence of effectiveness and predictable return on investment demonstrate that evidence-based home visiting programs should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(o)By supporting families from the start, voluntary evidence-based home visiting programs serving families from prenatal to five years of age provide a foundation for subsequent early childhood programs and family support efforts to build upon, and can help ensure that families are well-equipped to raise Californias next generation of productive, healthy, and successful adults.
(p)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of evidence-based home visiting programs throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 14148.25 is added to the Health and Safety Code, to read:14148.25.(a)The department shall, in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and other governmental entities including local and state law enforcement and corrections agencies, local and state social services agencies, and local and state educational agencies, develop a feasibility plan on or before January 1, 2017, that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. The department shall consult with stakeholders from diverse geographical regions of the state. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based home visiting program services.
(2)Incentives for Medi-Cal providers to offer evidence-based home visiting program services.
(3)Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women.
(4)Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
(b)In developing the plan, the department shall prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Evidence-based home visiting program means a program or initiative that does all of the following:
(A)Meets, on or before April 1, 2015, the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) criteria, as described in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C. Sec. 711).
(B)Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance.
(C)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age.
(D)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G. Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states, the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state in order to meet the ambitious goals in the Governors directive.
(g)Voluntary evidence-based home visiting programs, such as Nurse-Family Partnership, Healthy Families America, Early Head Start (Home-Based Program Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters, strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to five years of age. Extensive research has shown that evidence-based home visiting programs serving pregnant and parenting mothers, prenatal to the child turning five years of age, increase family self-sufficiency, positive parenting practices, child literacy and school readiness, and maternal and child health.
(h)Voluntary evidence-based home visiting program models focused on the prenatal period to five years of age range from low to high intensity, reflecting the broad spectrum of family needs that home visiting can impact. Many experts hail home visiting program diversity as essential to providing parents with choices and ensuring that programs are well matched with local needs and strengths, as well as responsive to the diverse needs of Californias children and families.
(i)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(j)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high-cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(k)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(l)With more than three decades of evidence from randomized, controlled trials and rigorous followup evaluation studies, evidence-based home visiting programs have demonstrated sustained improvements in maternal health, child health, positive parenting practices, child development and school readiness, reductions in child maltreatment, family economic self-sufficiency, linkages and referrals, and reductions in family violence.
(m)Evidence-based home visiting programs have specifically demonstrated reductions in preterm births, preventable maternal mortality, smoking during pregnancy, complications of pregnancy, closely spaced subsequent births, childhood injuries resulting in costly emergency department use and hospitalizations, improved childhood immunization rates, compliance with well child visit schedules, lower body mass index rates, higher birth weights, and improved family well-being, including increased family health literacy, and parent self-help development. As a result of families benefiting from evidence-based home visiting, there have been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(n)The strong evidence of effectiveness and predictable return on investment demonstrate that evidence-based home visiting programs should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(o)By supporting families from the start, voluntary evidence-based home visiting programs serving families from prenatal to five years of age provide a foundation for subsequent early childhood programs and family support efforts to build upon, and can help ensure that families are well-equipped to raise Californias next generation of productive, healthy, and successful adults.
(p)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of evidence-based home visiting programs throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 14148.25 is added to the Health and Safety Code, to read:14148.25.(a)The department shall, in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and local governments, other governmental entities including local and state law enforcement and corrections agencies, local and state social services agencies, and local and state educational agencies, develop a feasibility plan on or before January 1, 2017, to determine the feasibility of that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. The department shall consult with stakeholders from diverse geographical regions of the state. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based home visiting program services.
(2)Incentives for Medi-Cal providers to offer evidence-based home visiting program services.
(3)Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women.
(4)Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
(b)In developing the plan, the department shall prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Evidence-based home visiting program means a program or initiative that does all of the following:
(A)Meets, on or before April 1, 2015, the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) criteria, as described in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C. Sec. 711).
(B)Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance.
(C)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age.
(D)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G. Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states states, the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, state in order to meet the ambitious goals in the Governors directive.
(g)Voluntary evidence-based home visiting programs, such as Nurse-Family Partnership, Healthy Families America, Early Head Start (Home-Based Program Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters, strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to five years of age. Extensive research has shown that evidence-based home visiting programs serving pregnant and parenting mothers, prenatal to the child turning five years of age, increase family self-sufficiency, positive parenting practices, child literacy and school readiness, and maternal and child health.
(h)Voluntary evidence-based home visiting program models the prenatal to five years of age range from low to high intensity, reflecting the broad spectrum of family needs that home visiting can impact. Many experts hail home visiting program diversity as essential to providing parents with choices and ensuring that programs are well matched with local needs and strengths, as well as responsive to the diverse needs of Californias children and families.
(i)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(j)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high-cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(k)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(l)With more than three decades of evidence from randomized, controlled trials and rigorous followup evaluation studies, evidence-based home visiting programs have demonstrated sustained improvements in maternal health, child health, positive parenting practices, child development and school readiness, reductions in child maltreatment, family economic self-sufficiency, linkages and referrals, and reductions in family violence.
(m)Evidence-based home visiting programs have specifically demonstrated reductions in preterm births, preventable maternal mortality, smoking during pregnancy, complications of pregnancy, closely spaced subsequent births, childhood injuries resulting in costly emergency department use and hospitalizations, improved childhood immunization rates, compliance with well child visit schedules, lower body mass index rates, higher birth weights, and improved family well-being, including increased family health literacy, and parent self-help development. As a result of families benefiting from evidence-based home visiting, there have been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(n)The strong evidence of effectiveness and predictable return on investment demonstrate that evidence-based home visiting programs should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(o)By supporting families from the start, voluntary evidence-based home visiting programs serving families from prenatal to five years of age provide a foundation for subsequent early childhood programs and family support efforts to build upon, and can help ensure that families are well-equipped to raise Californias next generation of productive, healthy, and successful adults.
(p)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of evidence-based home visiting programs throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 14148.25 is added to the Health and Safety Code, to read:14148.25.(a)The department shall, in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and local governments, develop a plan on or before January 1, 2017, to ensure that determine the feasibility of offering evidence-based home visiting programs are offered and provided to Medi-Cal eligible pregnant and parenting women. The department shall consult with stakeholders from diverse geographical regions of the state. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based home visiting program services.
(2)Incentives for Medi-Cal providers to offer evidence-based home visiting program services.
(3)Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women.
(4)Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
(b)In developing the plan, the department shall prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
(c)(1)Notwithstanding Section 10231.5 of the Government Code, the department shall, on or before January 1, 2022, and every five years thereafter, report to the Legislature on implementation progress and the effectiveness of evidence-based home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
(2)A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(d)
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Evidence-based home visiting program means a program or initiative that does all of the following:
(A)Meets, on or before April 1, 2015, the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) criteria, as described in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C. Sec. 711).
(B)Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance.
(C)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age.
(D)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G, G. Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity. equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, in order to meet the ambitious goals in the Governors directive.
(g)Voluntary evidence-based home visiting programs, such as Nurse-Family Partnership, Healthy Families America, Early Head Start (Home-Based Program Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters, strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to five years of age. Extensive research has shown that evidence-based home visiting programs serving pregnant and parenting mothers, prenatal to the child turning five years of age, increase family self-sufficiency, positive parenting practices, child literacy and school readiness, and maternal and child health.
(h)Voluntary evidence-based home visiting program models the prenatal to five years of age range from low to high intensity, reflecting the broad spectrum of family needs that home visiting can impact. Many experts hail home visiting program diversity as essential to providing parents with choices and ensuring that programs are well matched with local needs and strengths, as well as responsive to the diverse needs of Californias children and families.
(i)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(j)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high-cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(k)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(l)With more than three decades of evidence from randomized, controlled trials and rigorous followup evaluation studies, evidence-based home visiting programs have demonstrated sustained improvements in maternal health, child health, positive parenting practices, child development and school readiness, reductions in child maltreatment, family economic self-sufficiency, linkages and referrals, and reductions in family violence.
(m)Evidence-based home visiting programs have specifically demonstrated reductions in preterm births, preventable maternal mortality, smoking during pregnancy, complications of pregnancy, closely spaced subsequent births, childhood injuries resulting in costly emergency department use and hospitalizations, improved childhood immunization rates, compliance with well child visit schedules, lower body mass index rates, higher birth weights, and improved family well-being, including increased family health literacy, and parent self-help development. As a result of families benefiting from evidence-based home visiting, there has have been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(n)The strong evidence of effectiveness and predictable return on investment demonstrate that evidence-based home visiting programs should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(o)By supporting families from the start, voluntary evidence-based home visiting programs serving families from prenatal to five years of age provide a foundation for subsequent early childhood programs and family support efforts to build upon, and can help ensure that families are well-equipped to raise Californias next generation of productive, healthy, and successful adults.
(p)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of evidence-based home visiting programs throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 14148.25 is added to the Health and Safety Code, to read:14148.25.(a)The department shall, in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and local governments, develop and implement a plan on or before January 1, 2017, to ensure that evidence-based home visiting programs are offered and provided to all Medi-Cal eligible pregnant and parenting women. The department shall consult with stakeholders from diverse geographical regions of the state. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based home visiting program services.
(2)Incentives for Medi-Cal providers to offer evidence-based home visiting program services.
(3)Other mechanisms to fund evidence-based home visiting program services. services for Medi-Cal eligible pregnant and parenting women.
(4)Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
(b)In developing the plan, the department shall prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
(b)
(c)(1)The Notwithstanding Section 10231.5 of the Government Code, the department shall, on or before January 1, 2022, and every five years thereafter, report to the Legislature on implementation progress and the effectiveness of evidence-based home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
(2)A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(c)
(d)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Evidence-based home visiting program means a program or initiative that does all of the following:
(A)Meets, on or before April 1, 2015, the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) criteria, as described in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C. Sec. 711).
(B)Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance.
(C)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age.
(D)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G, Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, in order to meet the ambitious goals in the Governors directive.
(g)Voluntary evidence-based home visiting programs, such as Nurse-Family Partnership, Healthy Families America, Early Head Start (Home-Based Program Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters, strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to five years of age. Extensive research has shown that evidence-based home visiting programs serving pregnant and parenting mothers, prenatal to the child turning five years of age, increase family self-sufficiency, positive parenting practices, child literacy and school readiness, and maternal and child health.
(h)Voluntary evidence-based home visiting program models the prenatal to five years of age range from low to high intensity, reflecting the broad spectrum of family needs that home visiting can impact. Many experts hail home visiting program diversity as essential to providing parents with choices and ensuring that programs are well matched with local needs and strengths, as well as responsive to the diverse needs of Californias children and families.
(g)
(i)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(h)
(j)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high cost high-cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(i)
(k)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(j)The Nurse-Family Partnership is a voluntary, evidence-based, prevention program that partners low-income, pregnant women having their first child with a registered nurse who provides home visits from early in pregnancy until the childs second birthday.
(k)With more than 37 years of evidence from randomized, controlled trials, the Nurse-Family Partnership has demonstrated sustained improvements in maternal health, child health and development, and the economic stability of families.
(l)The Nurse-Family Partnership has consistently demonstrated reductions in preterm births and preventable maternal mortality via controlled trial and longitudinal follow-ups over two decades.
(m)Randomized, controlled trials have also demonstrated that the use of Nurse-Family Partnership nurse home visitors increases positive outcomes during the prenatal period and the first two years of life compared to the use of paraprofessionals.
(n)Research has shown that the Nurse-Family Partnership can reduce smoking during pregnancy, complications of pregnancy, preterm births, closely spaced subsequent births, and childhood injuries resulting in costly emergency department use and hospitalizations. The Nurse-Family Partnership also can improve childhood immunization rates and compliance with well child visit schedules. As a result of families benefiting from Nurse-Family Partnership, there has been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(o)By enrolling recipients no later than 28 weeks of gestation, the Nurse-Family Partnership maximizes the impact on prenatal care, birth outcomes, and critical early brain development of infants.
(p)The Nurse-Family Partnerships evidence base and benefits to society are well documented and validated by independent analyses.
(l)With more than three decades of evidence from randomized, controlled trials and rigorous followup evaluation studies, evidence-based home visiting programs have demonstrated sustained improvements in maternal health, child health, positive parenting practices, child development and school readiness, reductions in child maltreatment, family economic self-sufficiency, linkages and referrals, and reductions in family violence.
(m)Evidence-based home visiting programs have specifically demonstrated reductions in preterm births, preventable maternal mortality, smoking during pregnancy, complications of pregnancy, closely spaced subsequent births, childhood injuries resulting in costly emergency department use and hospitalizations, improved childhood immunization rates, compliance with well child visit schedules, lower body mass index rates, higher birth weights, and improved family well-being, including increased family health literacy, and parent self-help development. As a result of families benefiting from evidence-based home visiting, there has been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(q)
(n)The Nurse-Family Partnerships strong evidence of effectiveness and predictable return on investment demonstrate that this evidence-based intervention home visiting programs should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(r)Twenty-one California counties currently operate a Nurse-Family Partnership program providing services to 4,000 residents. Only a fraction of the 100,000 potentially eligible recipients annually are receiving these highly beneficial and cost-effective services.
(s)However, if California were to provide these services to significantly more eligible first-time mothers, the state could see population-wide health and economic benefits that would carry over to future generations.
(o)By supporting families from the start, voluntary evidence-based home visiting programs serving families from prenatal to five years of age provide a foundation for subsequent early childhood programs and family support efforts to build upon, and can help ensure that families are well-equipped to raise Californias next generation of productive, healthy, and successful adults.
(t)
(p)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership and other evidence-based nurse home visiting programs throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 123492 of the Health and Safety Code is amended to read:123492.(a)The department shall develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of the Nurse-Family Partnership program established pursuant to Section 123491 and other evidence-based home visiting programs. To be eligible to receive a grant for purposes of that section, a county shall agree to do all of the following:
(1)Serve through the program only pregnant, low-income women who have had no previous live births. Notwithstanding subdivision (b) of Section 123485, women who are juvenile offenders or who are clients of the juvenile system shall be deemed eligible for services under the program.
(2)Enroll women in the program while they are still pregnant, before the 28th week of gestation, and preferably before the 16th week of gestation, and continue those women in the program through the first two years of the childs life.
(3)Use as home visitors only registered nurses who have been licensed in the state.
(4)Have nurse home visitors undergo training according to the program and follow the home visit guidelines developed by the Nurse-Family Partnership program.
(5)Have nurse home visitors specially trained in prenatal care and early child development.
(6)Have nurse home visitors follow a visit schedule keyed to the developmental stages of pregnancy and early childhood.
(7)Ensure that, to the extent possible, services shall be rendered in a culturally and linguistically competent manner.
(8)Limit a nurse home visitors caseload to no more than 25 active families at any given time.
(9)Provide for every eight nurse home visitors a full-time nurse supervisor who holds at least a bachelors degree in nursing and has substantial experience in community health nursing.
(10)Have nurse home visitors and nurse supervisors trained in effective home visitation techniques by qualified trainers.
(11)Have nurse home visitors and nurse supervisors trained in the method of assessing early infant development and parent-child interaction in a manner consistent with the program.
(12)Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(13)Collaborate with other home visiting and family support programs in the community to avoid duplication of services and complement and integrate with existing services to the extent practicable.
(14)Demonstrate that adoption of the Nurse-Family Partnership program is supported by a local governmental or government-affiliated community planning board, decisionmaking board, or advisory body responsible for assuring the availability of effective, coordinated services for families and children in the community.
(15)Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(16)Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
(b)The department shall, in consultation with stakeholders and the State Department of Health Care Services, develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to all Medi-Cal eligible pregnant women.
SEC. 2.Section 14148.25 is added to the Health and Safety Code, to read:14148.25.(a)The department shall, in consultation with stakeholders, develop and implement a plan on or before January 1, 2017, to ensure that evidence-based home visiting programs are offered and provided to all Medi-Cal eligible pregnant and parenting women. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based home visiting program services.
(2)Incentives for providers to offer evidence-based home visiting program services.
(3)Other mechanisms to fund evidence-based home visiting program services.
(4)Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
(b)(1)The department shall, on or before January 1, 2022, and every five years thereafter, report to the Legislature on implementation progress and the effectiveness of evidence-based home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
(2)A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Evidence-based home visiting program means a program or initiative that does all of the following:
(A)Meets, on or before April 1, 2015, the United States Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting (MIECHV) criteria, as described in Section 511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C. Sec. 711).
(B)Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance.
(C)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age.
(D)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body that, in turn, influence the persons physical and mental health over his or her lifetime.
(d)On May 3, 2012, Governor Edmund G, Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(f)The final report of the task force states the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, in order to meet the ambitious goals in the Governors directive.
(g)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is expected to exceed 12 million in 2015.
(h)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the federal Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(i)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(j)The Nurse-Family Partnership is a voluntary, evidence-based, prevention program that partners low-income, pregnant women having their first child with a registered nurse who provides home visits from early in pregnancy until the childs second birthday.
(k)With more than 37 years of evidence from randomized, controlled trials, the Nurse-Family Partnership has demonstrated sustained improvements in maternal health, child health and development, and the economic stability of families.
(l)The Nurse-Family Partnership has consistently demonstrated reductions in preterm births and preventable maternal mortality via controlled trial and longitudinal follow-ups over two decades.
(m)Randomized, controlled trials have also demonstrated that the use of Nurse-Family Partnership nurse home visitors increases positive outcomes during the prenatal period and the first two years of life compared to the use of paraprofessionals.
(n)Research has shown that the Nurse-Family Partnership can reduce smoking during pregnancy, complications of pregnancy, preterm births, closely spaced subsequent births, and childhood injuries resulting in costly emergency department use and hospitalizations. The Nurse-Family Partnership also can improve childhood immunization rates and compliance with well child visit schedules. As a result of families benefiting from Nurse-Family Partnership, there has been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(o)By enrolling recipients no later than 28 weeks of gestation, the Nurse-Family Partnership maximizes the impact on prenatal care, birth outcomes, and critical early brain development of infants.
(p)The Nurse-Family Partnerships evidence base and benefits to society are well documented and validated by independent analyses.
(q)The Nurse-Family Partnerships strong evidence of effectiveness and predictable return on investment demonstrate that this evidence-based intervention should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(r)Twenty-one California counties currently operate a Nurse-Family Partnership program providing services to 4,000 residents. Only a fraction of the 100,000 potentially eligible recipients annually are receiving these highly beneficial and cost-effective services.
(s)However, if California were to provide these services to significantly more eligible first-time mothers, the state could see population-wide health and economic benefits that would carry over to future generations.
(t)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership and other evidence-based nurse home visiting throughout California, beginning with communities and populations with the greatest need.
SEC. 2.Section 14148.25 is added to the Welfare and Institutions Code, immediately following Section 14148.2, to read:14148.25.(a)The department shall, in consultation with stakeholders, develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to all Medi-Cal eligible pregnant women. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based nurse home visiting program services.
(2)Incentives for providers to offer evidence-based nurse home visiting program services.
(3)Other mechanisms to fund evidence-based nurse home visiting program services.
(b)(1) The department shall, on or before January 1, 2022, and every five years thereafter, report to the Legislature on implementation progress and the effectiveness of evidence-based nurse home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
(2)A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Nurse home visiting program means a program or initiative that does all of the following:
(A)Contains home visiting as a primary service delivery strategy by registered nurses to families with a pregnant woman who is eligible for medical assistance.
(B)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to two years old; and
(C)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
SEC. 2.Section 123492 of the Health and Safety Code is amended to read:123492.(a)The department shall develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of the Nurse-Family Partnership program established pursuant to Section 123491. 123491 and other evidence-based home visiting programs. To be eligible to receive a grant for purposes of that section, a county shall agree to do all of the following:
(a)
(1)Serve through the program only pregnant, low-income women who have had no previous live births. Notwithstanding subdivision (b) of Section 123485, women who are juvenile offenders or who are clients of the juvenile system shall be deemed eligible for services under the program.
(b)
(2)Enroll women in the program while they are still pregnant, before the 28th week of gestation, and preferably before the 16th week of gestation, and continue those women in the program through the first two years of the childs life.
(c)
(3)Use as home visitors only registered nurses who have been licensed in the state.
(d)
(4)Have nurse home visitors undergo training according to the program and follow the home visit guidelines developed by the Nurse-Family Partnership program.
(e)
(5)Have nurse home visitors specially trained in prenatal care and early child development.
(f)
(6)Have nurse home visitors follow a visit schedule keyed to the developmental stages of pregnancy and early childhood.
(g)
(7)Ensure that, to the extent possible, services shall be rendered in a culturally and linguistically competent manner.
(h)
(8)Limit a nurse home visitors caseload to no more than 25 active families at any given time.
(i)
(9)Provide for every eight nurse home visitors a full-time nurse supervisor who holds at least a bachelors degree in nursing and has substantial experience in community health nursing.
(j)
(10)Have nurse home visitors and nurse supervisors trained in effective home visitation techniques by qualified trainers.
(k)
(11)Have nurse home visitors and nurse supervisors trained in the method of assessing early infant development and parent-child interaction in a manner consistent with the program.
(l)
(12)Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(m)
(13)Collaborate with other home visiting and family support programs in the community to avoid duplication of services and complement and integrate with existing services to the extent practicable.
(n)
(14)Demonstrate that adoption of the Nurse-Family Partnership program is supported by a local governmental or government-affiliated community planning board, decisionmaking board, or advisory body responsible for assuring the availability of effective, coordinated services for families and children in the community.
(o)
(15)Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(p)
(16)Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
(b)The department shall, in consultation with stakeholders and the State Department of Health Care Services, develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to all Medi-Cal eligible pregnant women.
The Legislature finds and declares all of the following:
(a)According to United States Census Bureau, California has a poverty rate of 23.5 percent, the highest rate of any state in the country.
(b)Children born into poverty are at higher risk of health and developmental disparities, including, but not limited to, premature birth, low birth weight, infant mortality, crime, domestic violence, developmental delays, dropping out of high school, substance abuse, unemployment, and child abuse and neglect.
(a)
(c)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body which that, in turn, influence the persons physical and mental health over his or her lifetime.
(b)
(d)On May 3, 2012, Governor Edmund G, Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(c)
(e)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(d)
(f)The final report of the task force states the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, in order to meet the ambitious goals in the Governors directive.
(e)In addition to reducing healthcare costs, the Nurse-Family Partnership has demonstrated proven outcomes addressing factors that contribute to toxic stress and made measurable progress towards many of the goals identified by the task force.
(f)The Nurse-Family Partnership is an evidence-based, community health program that improves pregnancy outcomes, improves child health and development, and improves economic self-sufficiency.
(g)Multiple peer-reviewed, randomized, controlled trials and longitudinal followup studies have clearly demonstrated the efficacy of the Nurse-Family Partnership programs, through significant sustained results, in achieving these goals.
(h)The Nurse-Family Partnership provides lifelong health and economic benefits to both mothers and children served by the program.
(i)These lifelong benefits have the potential to achieve substantial savings to federal, state, and local governments with respect to programs and services, including Medicaid, Child Protective Services, law enforcement, special education, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) program, among others. These savings far exceed the costs of implementing the Nurse-Family Partnership program.
(g)In 2013, more than 248,000 Medi-Cal beneficiaries gave birth to a child. Because Medi-Cal covers half of all births in the state, this has increased costs for taxpayers. Medi-Cal expansion has resulted in an 18 percent increase in Medi-Cal enrollment to a total of 11.3 million, and enrollment is to exceed 12 million in 2015.
(h)The California Health and Human Services Agency recently submitted its State Health Care Innovation Plan, including the Maternity Care initiative, which addresses issues of high costs in maternity care, to the Center for Medicare and Medicaid Innovation. Child deliveries and related expenses, including high-risk births, rank among the top 10 high cost episodes of health care, and in the last 15 years, California has seen a continual rise in maternal mortality.
(i)The cost of health care specifically related to high-risk pregnancies, neonatal intensive-care unit (NICU) services, toxic stress, and emergency room visits has increased and is projected to continue to rise. Average health care costs for women were 25 percent more than men primarily due to higher costs of health care during childbearing years.
(j)The Nurse-Family Partnership is a voluntary, evidence-based, prevention program that partners low-income, pregnant women having their first child with a registered nurse who provides home visits from early in pregnancy until the childs second birthday.
(k)With more than 37 years of evidence from randomized, controlled trials, the Nurse-Family Partnership has demonstrated sustained improvements in maternal health, child health and development, and the economic stability of families.
(l)The Nurse-Family Partnership has consistently demonstrated reductions in preterm births and preventable maternal mortality via controlled trial and longitudinal follow-ups over two decades.
(m)Randomized, controlled trials have also demonstrated that the use of Nurse-Family Partnership nurse home visitors increases positive outcomes during the prenatal period and the first two years of life compared to the use of paraprofessionals.
(n)Research has shown that the Nurse-Family Partnership can reduce smoking during pregnancy, complications of pregnancy, preterm births, closely spaced subsequent births, and childhood injuries resulting in costly emergency department use and hospitalizations. The Nurse-Family Partnership also can improve childhood immunization rates and compliance with well child visit schedules. As a result of families benefiting from Nurse-Family Partnership , there has been cost savings to federal, state, and local governments with respect to programs and services, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families (TANF) program.
(o)By enrolling recipients no later than 28 weeks of gestation, the Nurse-Family Partnership maximizes the impact on prenatal care, birth outcomes, and critical early brain development of infants.
(p)The Nurse-Family Partnerships evidence base and benefits to society are well documented and validated by independent analyses.
(q)The Nurse-Family Partnerships strong evidence of effectiveness and predictable return on investment demonstrate that this evidence-based intervention should be brought to scale in California to improve maternal and child health outcomes and help reduce health care costs for generations to come.
(j)
(r)Twenty-one California counties currently operate a Nurse-Family Partnership program. program providing services to 4,000 residents. Only a fraction of the 100,000 potentially eligible recipients annually are receiving these highly beneficial and cost-effective services.
(k)
(s)However, if California were to provide these services to significantly more eligible first-time mothers, the state could see population-wide health and economic benefits that would carry over to future generations.
(l)
(t)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership in and other evidence-based nurse home visiting throughout California, beginning with regions communities and populations with the greatest need.
SEC. 2.Section 123492 of the Health and Safety Code is amended to read:123492.The department shall develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of the program established pursuant to Section 123491. To be eligible to receive a grant for purposes of that section, a county shall agree to do all of the following:
(a)Serve through the program only pregnant, low-income women who have had no previous live births. Notwithstanding subdivision (b) of Section 123485, women who are juvenile offenders or who are clients of the juvenile system, with no history of prior live births, shall be deemed eligible for services under the program.
(b)Enroll women in the program while they are still pregnant, before the 28th week of gestation, and preferably before the 16th week of gestation, and continue those women in the program through the first two years of the childs life.
(c)Use as home visitors only registered nurses who have been licensed in the state.
(d)Have nurse home visitors undergo training according to the program and follow the home visit guidelines developed by the Nurse-Family Partnership program.
(e)Have nurse home visitors specially trained in the Nurse-Family Partnership guidelines for prenatal care and early child development.
(f)Have nurse home visitors follow a visit schedule keyed to the developmental stages of pregnancy and early childhood.
(g)Ensure that, to the extent possible, services shall be rendered in a culturally and linguistically competent manner.
(h)Limit a nurse home visitors caseload to no more than 25 active families at any given time.
(i)For every eight nurse home visitors, provide a full-time nurse supervisor who holds at least a bachelors degree in nursing and has substantial experience in community health nursing.
(j)Have nurse home visitors and nurse supervisors trained in the method of assessing early infant development and parent-child interaction in a manner consistent with the program.
(k)Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(l)Collaborate with other home visiting and family support programs in the community to avoid duplication of services and complement and integrate with existing services to the extent practicable.
(m)Demonstrate that adoption of the Nurse-Family Partnership program is supported by a local governmental or government-affiliated community planning board, decisionmaking board, or advisory body responsible for assuring the availability of effective, coordinated services for families and children in the community.
(n)Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(o)Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
SEC. 2.Section 14148.25 is added to the Welfare and Institutions Code, immediately following Section 14148.2, to read:14148.25.(a)The department shall, in consultation with stakeholders, develop and implement a plan on or before January 1, 2017, to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered and provided to all Medi-Cal eligible pregnant women. The department shall consider all of the following in developing the plan:
(1)Establishing Medi-Cal coverage for evidence-based nurse home visiting program services.
(2)Incentives for providers to offer evidence-based nurse home visiting program services.
(3)Other mechanisms to fund evidence-based nurse home visiting program services.
(b)(1) The department shall, on or before January 1, 2022, and every five years thereafter, report to the Legislature on implementation progress and the effectiveness of evidence-based nurse home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
(2)A report to be submitted pursuant to paragraph (1) shall be submitted in compliance with Section 9795 of the Government Code.
(c)For the purposes of this section, the following definitions shall apply:
(1)Evidence-based program means a program that is based on scientific evidence demonstrating that the program model is effective. An evidence-based program shall be reviewed on site and compared to program model standards by the model developer or the developers designee at least every five years to ensure that the program continues to maintain fidelity with the program model. The program model shall have had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and the evaluation results shall have been published in a peer-reviewed journal.
(2)Nurse home visiting program means a program or initiative that does all of the following:
(A)Contains home visiting as a primary service delivery strategy by registered nurses to families with a pregnant woman who is eligible for medical assistance.
(B)Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to two years old; and
(C)Targets participant outcomes that include all of the following:
(i)Improved maternal and child health.
(ii)Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
(iii)Improvements in school readiness and achievement.
(iv)Reduction in crime or domestic violence.
(v)Improvements in family economic self-sufficiency.
(vi)Improvements in coordination of, and referrals to, other community resources and support.
(vii)Improvements in parenting skills related to child development.
The Legislature finds and declares all of the following:
(a)In 2014, the Legislature passed Assembly Concurrent Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing that research over the last two decades in the evolving fields of neuroscience, molecular biology, public health, genomics, and epigenetics reveals that experiences in the first few years of life build changes into the biology of the human body which, in turn, influence the persons physical and mental health over his or her lifetime.
(b)On May 3, 2012, Governor Edmund G, Brown Jr. issued Executive Order B-19-12, establishing the Lets Get Healthy California Task Force to develop a 10-year plan for improving the health of Californians, controlling health care costs, promoting personal responsibility for individual health, and advancing health equity.
(c)The task force identified several priorities, including a subset for Healthy Beginnings, which include reducing infant deaths, increasing vaccination rates, reducing childhood trauma, and reducing adolescent tobacco use.
(d)The final report of the task force states the challenge going forward is to identify evidence-based interventions and quicken the pace of uptake across the state, in order to meet the ambitious goals in the Governors directive.
(e)In addition to reducing healthcare costs, the Nurse-Family Partnership has demonstrated proven outcomes addressing factors that contribute to toxic stress and made measurable progress towards many of the goals identified by the task force.
(f)The Nurse-Family Partnership is an evidence-based, community health program that improves pregnancy outcomes, improves child health and development, and improves economic self-sufficiency.
(g)Multiple peer-reviewed, randomized, controlled trials and longitudinal followup studies have clearly demonstrated the efficacy of the Nurse-Family Partnership programs, through significant sustained results, in achieving these goals.
(h)The Nurse-Family Partnership provides lifelong health and economic benefits to both mothers and children served by the program.
(i)These lifelong benefits have the potential to achieve substantial savings to federal, state, and local governments with respect to programs and services, including Medicaid, Child Protective Services, law enforcement, special education, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) program, among others. These savings far exceed the costs of implementing the Nurse-Family Partnership program.
(j)Twenty-one California counties currently operate a Nurse-Family Partnership program. Only a fraction of potentially eligible recipients are receiving these highly beneficial and cost-effective services.
(k)However, if California were to provide these services to significantly more eligible first-time mothers, the state could see population-wide health and economic benefits that would carry over to future generations.
(l)Therefore, it is the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership in California, beginning with regions and populations with the greatest need.
SEC. 2.Section 123492 of the Health and Safety Code is amended to read:123492.The department shall develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of the program established pursuant to Section 123491. To be eligible to receive a grant for purposes of that section, a county shall agree to do all of the following:
(a)Serve through the program only pregnant, low-income women who have had no previous live births. Notwithstanding subdivision (b) of Section 123485, women who are juvenile offenders or who are clients of the juvenile system, with no history of prior live births, shall be deemed eligible for services under the program.
(b)Enroll women in the program while they are still pregnant, before the 28th week of gestation, and preferably before the 16th week of gestation, and continue those women in the program through the first two years of the childs life.
(c)Use as home visitors only registered nurses who have been licensed in the state.
(d)Have nurse home visitors undergo training according to the program and follow the home visit guidelines developed by the Nurse-Family Partnership program.
(e)Have nurse home visitors specially trained in the Nurse-Family Partnership guidelines for prenatal care and early child development.
(f)Have nurse home visitors follow a visit schedule keyed to the developmental stages of pregnancy and early childhood.
(g)Ensure that, to the extent possible, services shall be rendered in a culturally and linguistically competent manner.
(h)Limit a nurse home visitors caseload to no more than 25 active families at any given time.
(i)Provide for For every eight nurse home visitors, provide a full-time nurse supervisor who holds at least a bachelors degree in nursing and has substantial experience in community health nursing.
(j)Have nurse home visitors and nurse supervisors trained in effective home visitation techniques by qualified trainers.
(k)
(j)Have nurse home visitors and nurse supervisors trained in the method of assessing early infant development and parent-child interaction in a manner consistent with the program.
(l)
(k)Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(m)
(l)Collaborate with other home visiting and family support programs in the community to avoid duplication of services and complement and integrate with existing services to the extent practicable.
(n)
(m)Demonstrate that adoption of the Nurse-Family Partnership program is supported by a local governmental or government-affiliated community planning board, decisionmaking board, or advisory body responsible for assuring the availability of effective, coordinated services for families and children in the community.
(o)
(n)Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(p)
(o)Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
|
Date
|
Status
|
|---|---|
| Sep 10, 2015 | In Assembly. Concurrence in Senate amendments pending. |
| Jun 2, 2015 | Read third time. Passed. Ordered to the Senate. (Ayes 79. Noes 0. Page 1767.) |
| Jun 11, 2015 | Referred to Com. on RLS. |
| Jun 18, 2015 | Re-referred to Com. on HEALTH. |
| Jul 9, 2015 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 8. Noes 0.) (July 8). Re-referred to Com. on APPR. |
| Aug 17, 2015 | In committee: Referred to APPR. suspense file. |
| Aug 31, 2015 | From committee: Amend, and do pass as amended. (Ayes 7. Noes 0.) (August 27). |
| Sep 1, 2015 | Read second time and amended. Ordered to third reading. |
| Sep 4, 2015 | Read third time and amended. Ordered to second reading. |
| Sep 8, 2015 | Read second time. Ordered to third reading. |
| Jun 2, 2015 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Sep 10, 2015 | Read third time. Passed. Ordered to the Assembly. |
| Sep 10, 2015 | Read third time. Passed. Ordered to the Assembly. (Ayes 40. Noes 0. Page 2694.). |
| Sep 11, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Sep 11, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 3152.). |
| Sep 11, 2015 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0.). |
| Sep 23, 2015 | Enrolled and presented to the Governor at 4 p.m. |
| Oct 10, 2015 | Vetoed by Governor. |
| Jan 15, 2016 | Consideration of Governor's veto stricken from file. |
| May 13, 2015 | From committee chair, with author's amendments: Amend, and re-refer to Com. on APPR. Read second time and amended. |
| Dec 2, 2014 | From printer. May be heard in committee January 1. |
| Jan 22, 2015 | Referred to Com. on HEALTH. |
| Apr 6, 2015 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Apr 7, 2015 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Apr 7, 2015 | Re-referred to Com. on HEALTH. |
| Apr 20, 2015 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 14). |
| Apr 21, 2015 | Read second time and amended. |
| Apr 22, 2015 | Re-referred to Com. on APPR. |
| Dec 1, 2014 | Read first time. To print. |
| May 14, 2015 | Re-referred to Com. on APPR. |
| May 21, 2015 | From committee chair, with author's amendments: Amend, and re-refer to Com. on APPR. Read second time and amended. |
| May 22, 2015 | Re-referred to Com. on APPR. |
| May 27, 2015 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| May 28, 2015 | From committee: Do pass. (Ayes 17. Noes 0.) (May 28). |
| May 28, 2015 | Joint Rule 62(a), file notice suspended. |
| May 28, 2015 | Joint Rule 62(a), file notice suspended. (Page 1613.) |
| May 28, 2015 | Read second time. Ordered to third reading. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 11, 2015 | AB 50 MULLIN Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 10, 2015 | Assembly 3rd Reading AB50 Mullin By Monning | Senate Floor |
Passed |
|
| Aug 27, 2015 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| Aug 17, 2015 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 8, 2015 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Jun 2, 2015 | AB 50 MULLIN Assembly Third Reading | Assembly Floor |
Passed |
|
| May 28, 2015 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 14, 2015 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Academy of Pediatrics | * Support | Jul 8, 2015 |
| Apollo Ceiling | * Support | Jul 8, 2015 |
| Asian Americans Advancing Sacramento | * Support | Jul 8, 2015 |
| Board of the Southeast Asia Resource Action Center | * Support | Jul 8, 2015 |
| California Asian Pacific Chamber Of Commerce | * Support | Jul 8, 2015 |
| California Black Health Network | ** Support | Sep 11, 2015 |
| California Dental Association | * Support | Jul 8, 2015 |
| California Disability Rights | * Support | Jul 8, 2015 |
| California Faculty Association | * Support | Jul 8, 2015 |
| California March Of Dimes Birth Defects Foundation | * Support | Jul 8, 2015 |
| California Medical Association, Inc. | * Support | Jul 8, 2015 |
| California Nurses Association | ** Support | Sep 11, 2015 |
| California Rural Legal Assistance Foundation, Inc. | * Support | Jul 8, 2015 |
| Children Now | ** Support | Sep 11, 2015 |
| Children'S Specialty Care Coalition | * Support | Jul 8, 2015 |
| Davis Christian Assembly | * Support | Apr 14, 2015 |
| Department Of Finance | ** Against | Sep 11, 2015 |
| Family Voices | * Support | Jul 8, 2015 |
| Fight Crime and Invest in Kids | * Support | Apr 14, 2015 |
| Fight Crime Invest in Kids | * Indeterminate | Jul 8, 2015 |
| First 5 Alameda County | ** Support | Sep 11, 2015 |
| First 5 Association Of California | ** Support | Sep 11, 2015 |
| First 5 California | ** Support | Sep 11, 2015 |
| First 5 Monterey County | ** Support | Sep 11, 2015 |
| First 5 Solano Children and Families Commission | ** Support | Sep 11, 2015 |
| First 5 Sonoma County Commission | ** Support | Sep 11, 2015 |
| First 5 Tehama | ** Support | Sep 11, 2015 |
| March of Dimes California Chapter | ** Support | Sep 11, 2015 |
| Monterey County Board of Supervisors | ** Support | Sep 11, 2015 |
| Next Generation, Think Tank | * Support | Apr 14, 2015 |
| Nurse Family Partnership | * Indeterminate | Jul 8, 2015 |
| Pacific Institute for Research and Evaluation | * Support | Apr 14, 2015 |
| Parents as Teachers | ** Support | Sep 11, 2015 |
| Prevent Child Abuse America | ** Support | Sep 11, 2015 |
| Sacramento County | * Support | Apr 14, 2015 |
| San Mateo County Board of Supervisors | ** Support | Sep 11, 2015 |
| Santa Clara County Board of Supervisors | ** Support | Sep 11, 2015 |
| Solano County Board of Supervisors | ** Support | Sep 11, 2015 |
| The Children's Partnership | * Support | Jul 8, 2015 |
GOVERNOR'S VETO
AB 50
(Mullin)
As Enrolled September 16, 2015
2/3 vote
ASSEMBLY: |
79-0 |
(June 2, 2015) |
SENATE: |
40-0 |
(September 10, 2015) |
ASSEMBLY: |
80-0 |
(September 11, 2015) |
|
|
|
Original Committee Reference: HEALTH
SUMMARY: Requires the Department of Health Care Services (DHCS) to develop a plan, in consultation with stakeholders, on or before January 1, 2017, to ensure that evidence-based home visiting programs, as defined, are offered and provided to Medi-Cal eligible pregnant and parenting women, as specified. It also requires DHCS, in developing the plan, to prioritize the identification of funding sources for home visiting services other than state General Fund, including local, federal, private, or other funds.
The Senate amendments clarify that this bill only requires DHCS to develop a plan to determine the feasibility of offering home visitation services.
EXISTING LAW:
Establishes the Nurse Family Partnership (NFP) as a voluntary nurse home visiting grant program for expectant first-time mothers, their children, and their families, administered by the Department of Public Health (DPH).
Requires DPH to develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of NFP and requires a county, to be eligible to receive an NFP grant, to agree to specific staffing and service-related provisions.
Permits DPH to accept voluntary contributions, in cash or in-kind, to pay for the costs in the implementation of the NFP and requires private donations to be deposited into the California Families and Children Account, which is created and continuously appropriated to DHCS under this bill.
Prohibits state funds from being used to implement this bill.
Allows DPH to distribute grants if the Director of the Department of Finance determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the NFP. Prohibits DPHs' administration costs from exceeding 5% of the moneys in the account.
Permits DPH, in consultation with the NFP administrators, to contract with one or more qualified organizations to assist DPH in ensuring that grantees implement the program as established under this bill and to conduct an annual evaluation of the implementation of the grant program on a statewide basis. Requires the first evaluation to be due 12 months after the award of grants.
FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by DHCS.
COMMENTS: According to the author, this bill is necessary to increase accessibility for nurse led home visiting and help improve efficiency on this piece of our system of care. This bill helps to address the rising costs of Medi-Cal and potential burdens of rising Medi-Cal enrollment. With increased Medi-Cal enrollments come the societal savings, care coordination, case management, and healthcare outcomes that NFP and other evidence-based nurse home visiting programs, provide for the consistent solutions resonating among stakeholders. These measures will help improve Healthcare Effectiveness Data and Information Set measures, access to services, and reduce costs while further increasing savings. It is the responsibility of the Legislature and in the best interest of all California citizens to prioritize efficiency and effectiveness in the consideration of fiscal expenditures.
The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using Federal Department of Justice funding. The successful implementation of these initial NFP pilot sites demonstrated to other California communities that it was possible to replicate a scientific-based health strategy while also tailoring the program to meet the needs of each community. NFP seeks to continue to build new partnerships with medical managed care entities, school districts, military bases, clinics and hospitals in order to serve the thousands more eligible families in California that could benefit from NFP's evidenced-based outcomes model.
The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500. The California NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school, by the time their infants were 24 months old.
Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now notes that nationally, as well as in California, there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities.
This bill has no known opposition.
These bills unnecessarily codify certain existing health care benefits or require the expansion or development of new benefits and procedures in the Medi-Cal program.
Taken together, these bills would require new spending at a time when there is considerable uncertainty in the funding of this program. Until the fiscal outlook for Medi-Cal is stabilized, I cannot support any of these measures.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0002501
AB 50
Page 2
CONCURRENCE IN SENATE AMENDMENTS
AB 50
(Mullin)
As Amended September 4, 2015
Majority vote
ASSEMBLY: |
79-0 |
(June 2, 2015) |
SENATE: |
40-0 |
(September 10, 2015) |
Original Committee Reference: HEALTH
SUMMARY: Requires the Department of Health Care Services (DHCS) to develop a plan, in consultation with stakeholders, on or before January 1, 2017, to ensure that evidence-based home visiting programs, as defined, are offered and provided to Medi-Cal eligible pregnant and parenting women, as specified. It also requires DHCS, in developing the plan, to prioritize the identification of funding sources for home visiting services other than state General Fund, including local, federal, private, or other funds.
The Senate amendments clarify that this bill only requires DHCS to develop a plan to determine the feasibility of offering home visitation services.
EXISTING LAW:
Establishes the Nurse Family Partnership (NFP) as a voluntary nurse home visiting grant program for expectant first-time mothers, their children, and their families, administered by the Department of Public Health (DPH).
Requires DPH to develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of NFP and requires a county, to be eligible to receive an NFP grant, to agree to specific staffing and service-related provisions.
Permits DPH to accept voluntary contributions, in cash or in-kind, to pay for the costs in the implementation of the NFP and requires private donations to be deposited into the California Families and Children Account, which is created and continuously appropriated to DHCS under this bill.
Prohibits state funds from being used to implement this bill.
Allows DPH to distribute grants if the Director of the Department of Finance determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the NFP. Prohibits DPHs' administration costs from exceeding 5% of the moneys in the account.
Permits DPH, in consultation with the NFP administrators, to contract with one or more qualified organizations to assist DPH in ensuring that grantees implement the program as established under this bill and to conduct an annual evaluation of the implementation of the grant program on a statewide basis. Requires the first evaluation to be due 12 months after the award of grants.
FISCAL EFFECT: According to the Senate Appropriations Committee, one-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by DHCS.
COMMENTS: According to the author, this bill is necessary to increase accessibility for nurse led home visiting and help improve efficiency on this piece of our system of care. This bill helps to address the rising costs of Medi-Cal and potential burdens of rising Medi-Cal enrollment. With increased Medi-Cal enrollments come the societal savings, care coordination, case management, and healthcare outcomes that NFP and other evidence-based nurse home visiting programs, provide for the consistent solutions resonating among stakeholders. These measures will help improve Healthcare Effectiveness Data and Information Set measures, access to services, and reduce costs while further increasing savings. It is the responsibility of the Legislature and in the best interest of all California citizens to prioritize efficiency and effectiveness in the consideration of fiscal expenditures.
The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using Federal Department of Justice funding. The successful implementation of these initial NFP pilot sites demonstrated to other California communities that it was possible to replicate a scientific-based health strategy while also tailoring the program to meet the needs of each community. NFP seeks to continue to build new partnerships with medical managed care entities, school districts, military bases, clinics and hospitals in order to serve the thousands more eligible families in California that could benefit from NFP's evidenced-based outcomes model.
The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500. The California NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school, by the time their infants were 24 months old.
Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now notes that nationally, as well as in California, there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities.
This bill has no known opposition.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0002301
AB 50
Page 7
|
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 |
THIRD READING
Bill No: AB 50
Amended: 9/4/15 in Senate
SENATE HEALTH COMMITTEE: 8-0, 7/8/15
AYES: Hernandez, Nguyen, Hall, Monning, Nielsen, Pan, Roth, Wolk
NO VOTE RECORDED: Mitchell
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/2/15 - See last page for vote
SUBJECT: Medi-Cal: evidence-based home visiting programs
DIGEST: This bill requires the Department of Health Care Services (DHCS) to develop a feasibility plan on or before January 1, 2017, that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women.
Senate Floor Amendments of 9/4/15 broaden and make more specific the list of local and state agencies DHCS is required to consult with in developing a feasibility plan for evidence-based home visiting programs.
Existing law:
Establishes the Medi-Cal program, which is administered by DHCS, under which qualified low-income individuals receive health care services. Children up to age 19 are eligible for Medi-Cal in families with incomes up to 266% of the federal poverty level (FPL) (266% of the FPL is at or below $52,641 annually for a family of three in 2015) and pregnant women are eligible with family incomes up to 322% of the FPL.
Establishes the Nurse-Family Partnership (NFP) program, which is administered by the Department of Public Health (DPH), to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Requires a county to satisfy specified requirements in order to be eligible to receive a grant. The provisions of the NFP program are subject to the normal Budget Act process and are operative to the extent funds are appropriated.
This bill:
Requires DHCS to develop a feasibility plan on or before January 1, 2017, that describes the costs, benefits, and any potential barriers related to offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. Requires DHCS to develop the feasibility plan in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and other governmental entities, including local and state law enforcement and corrections, local and state social service agencies, and local and state educational agencies, from diverse geographical regions of the state.
Requires DHCS to consider all of the following in developing the plan:
Establishing Medi-Cal coverage for evidence-based home visiting program services;
Incentives for Medi-Cal providers to offer evidence-based home visiting program services;
Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women; and,
Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
Requires DHCS, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
Defines an “evidence-based program” as a program that is based on scientific evidence demonstrating that the program model is effective, that is reviewed on site and compared to program model standards by the model developer or the developer’s designee at least every five years to ensure that the program continues to maintain fidelity with the program model, and that has had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and where the evaluation results have been published in a peer-reviewed journal.
Defines an “evidence-based home visiting program” as a program or initiative that does all of the following:
Meets, on or before April 1, 2015, the U.S. Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting criteria, as specified;
Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance;
Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age; and,
Targets participant outcomes that include all of the following:
Improved maternal and child health.
Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
Improvements in school readiness and achievement.
Reduction in crime or domestic violence.
Improvements in family economic self-sufficiency.
Improvements in coordination of, and referrals to, other community resources and support.
Improvements in parenting skills related to child development.
Comments
Author’s statement. According to the author, with rising health care costs and an increasing Medi-Cal eligible population across California, there is a need to strengthen the capacity of our current healthcare system to address the health needs of our most vulnerable populations at lower costs. Evidence-based home visiting programs are proven health-based interventions that can improve the health of low-income families in the state, while helping reduce overall costs to our system and improving system outcomes for the state. Voluntary evidence-based home visiting programs - such as NFP, Healthy Families America, Early Head Start (Home Based Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters - strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. With more than 37 years of evidence from randomized, controlled trials and longitudinal follow-up studies, evidence based home visiting programs have demonstrated sizeable, sustained improvements in maternal health, child health and development, economic stability of families, and helping break intergenerational poverty. By establishing mechanisms for Medi-Cal to increase the reach of home visiting programs, this bill substantially expands the scale of evidence-based home visiting programs in California.
Background. The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using federal Department of Justice funding. NFP provides first-time, low-income mothers with home visitation services by public health nurses. Typically beginning 18 to 28 weeks into their pregnancy, nurses work intensively with mothers to improve prenatal, maternal, and early childhood health and well-being, focusing on therapeutic relationships with the family designed to improve family functioning in health, home and neighborhood environment, family and friend support, parental roles, and major life events. The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500.
NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school by the time their infants were 24 months old. A 1997 RAND study examined the benefits for children and their families enrolled in early childhood intervention programs. The study found that the NFP generated increased tax revenues from increased employment and earnings, decreased enrollment in public assistance programs, reduced expenditures for education, health, and other services, including special education, emergency room visits, and stays in homeless shelters, and lowered criminal justice system costs.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee, one-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by DHCS (General Fund and federal funds).
California Black Health Network
California Nurses Association
Children Now
First 5 Alameda County
First 5 Association of California
First 5 California
First 5 Monterey County
First 5 Solano Children and Families Commission
First 5 Sonoma County Commission
First 5 Tehama
March of Dimes California Chapter
Monterey County Board of Supervisors
Parents as Teachers
Prevent Child Abuse America
San Mateo County Board of Supervisors
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
California Right to Life Committee
Department of Finance
ARGUMENTS IN SUPPORT: Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now states there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities. Many experts hail home visiting program diversity as essential to providing parents with choices, and ensuring that programs are well matched with local needs and strengths. Children Now concludes that it believes this bill can help promote a broad range of home visiting models, reflective of the diverse needs of families and young children in our state.
ARGUMENTS IN OPPOSITION: The California Right to Life Committee, Inc. (CRLC) writes in opposition that the language in this bill presumes to know better than families how to beget and raise children. CRLC writes the mingling of public and private funds does not represent a republican form of government guaranteed by the U.S. Constitution. CRLC continues that this program is very invasive of family life, and it sees the home-visitation program as one of supposed helpful programs which is foisted on the more vulnerable and less educated family members.
The Department of Finance (DOF) argues this bill places significant pressure on the Medi-Cal program to fund a new benefit, and including this benefit is likely unnecessary as the Department of Public Health administers the California Home Visiting Program which provides home visiting services to at-risk pregnant women and parents with young children. DOF states that, because this program already is in operation, this bill is unnecessary.
ASSEMBLY FLOOR: 79-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by: Scott Bain / HEALTH /
9/8/15 14:38:29
**** END ****
AB 50
Page 6
|
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 |
THIRD READING
Bill No: AB 50
Amended: 9/1/15 in Senate
SENATE HEALTH COMMITTEE: 8-0, 7/8/15
AYES: Hernandez, Nguyen, Hall, Monning, Nielsen, Pan, Roth, Wolk
NO VOTE RECORDED: Mitchell
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 79-0, 6/2/15 - See last page for vote
SUBJECT: Medi-Cal: evidence-based home visiting programs
DIGEST: This bill requires the Department of Health Care Services to develop a plan on or before January 1, 2017, to determine the feasibility of offering evidence-based home visiting programs, as defined, to Medi-Cal eligible pregnant and parenting women.
Existing law:
Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services. Children up to age 19 are eligible for Medi-Cal in families with incomes up to 266% of the federal poverty level (FPL) (266% of the FPL is at or below $52,641 annually for a family of three in 2015) and pregnant women are eligible with family incomes up to 322% of the FPL.
Establishes the Nurse-Family Partnership (NFP) program, which is administered by the Department of Public Health (DPH), to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Requires a county to satisfy specified requirements in order to be eligible to receive a grant. The provisions of the NFP program are subject to the normal Budget Act process and are operative to the extent funds are appropriated.
This bill:
Requires DHCS to develop a plan on or before January 1, 2017, to determine the feasibility of offering evidence-based home visiting programs to Medi-Cal eligible pregnant and parenting women. Requires DHCS to develop the plan in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and local governments, from diverse geographical regions of the state.
Requires DHCS to consider all of the following in developing the plan:
Establishing Medi-Cal coverage for evidence-based home visiting program services;
Incentives for Medi-Cal providers to offer evidence-based home visiting program services;
Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women; and,
Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
Requires DHCS, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
Defines an “evidence-based program” as a program that is based on scientific evidence demonstrating that the program model is effective, that is reviewed on site and compared to program model standards by the model developer or the developer’s designee at least every five years to ensure that the program continues to maintain fidelity with the program model, and that has had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and where the evaluation results have been published in a peer-reviewed journal.
Defines an “evidence-based home visiting program” as a program or initiative that does all of the following:
Meets, on or before April 1, 2015, the U.S. Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting criteria, as specified;
Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance;
Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age; and,
Targets participant outcomes that include all of the following:
Improved maternal and child health.
Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
Improvements in school readiness and achievement.
Reduction in crime or domestic violence.
Improvements in family economic self-sufficiency.
Improvements in coordination of, and referrals to, other community resources and support.
Improvements in parenting skills related to child development.
Comments
Author’s statement. According to the author, with rising health care costs and an increasing Medi-Cal eligible population across California, there is a need to strengthen the capacity of our current healthcare system to address the health needs of our most vulnerable populations at lower costs. Evidence-based home visiting programs are proven health-based interventions that can improve the health of low-income families in the state, while helping reduce overall costs to our system and improving system outcomes for the state. Voluntary evidence-based home visiting programs - such as NFP, Healthy Families America, Early Head Start (Home Based Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters - strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. With more than 37 years of evidence from randomized, controlled trials and longitudinal follow-up studies, evidence based home visiting programs have demonstrated sizeable, sustained improvements in maternal health, child health and development, economic stability of families, and helping break intergenerational poverty. By establishing mechanisms for Medi-Cal to increase the reach of home visiting programs, this bill substantially expands the scale of evidence-based home visiting programs in California.
Background. The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using federal Department of Justice funding. NFP provides first-time, low-income mothers with home visitation services by public health nurses. Typically beginning 18 to 28 weeks into their pregnancy, nurses work intensively with mothers to improve prenatal, maternal, and early childhood health and well-being, focusing on therapeutic relationships with the family designed to improve family functioning in health, home and neighborhood environment, family and friend support, parental roles, and major life events. The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500.
NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school by the time their infants were 24 months old. A 1997 RAND study examined the benefits for children and their families enrolled in early childhood intervention programs. The study found that the NFP generated increased tax revenues from increased employment and earnings, decreased enrollment in public assistance programs, reduced expenditures for education, health, and other services, including special education, emergency room visits, and stays in homeless shelters, and lowered criminal justice system costs.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee, one-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by DHCS (General Fund and federal funds).
California Black Health Network
California Nurses Association
Children Now
First 5 Alameda County
First 5 Association of California
First 5 California
First 5 Monterey County
First 5 Solano Children and Families Commission
First 5 Sonoma County Commission
First 5 Tehama
March of Dimes California Chapter
Monterey County Board of Supervisors
Parents as Teachers
Prevent Child Abuse America
San Mateo County Board of Supervisors
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
OPPOSITION: (Verified 8/31/15)
California Right to Life Committee
Department of Finance
ARGUMENTS IN SUPPORT: Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now states there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities. Many experts hail home visiting program diversity as essential to providing parents with choices, and ensuring that programs are well matched with local needs and strengths. Children Now concludes that it believes this bill can help promote a broad range of home visiting models, reflective of the diverse needs of families and young children in our state.
ARGUMENTS IN OPPOSITION: The California Right to Life Committee, Inc. (CRLC) writes in opposition that the language in this bill presumes to know better than families how to beget and raise children. CRLC writes the mingling of public and private funds does not represent a republican form of government guaranteed by the U.S. Constitution. CRLC continues that this program is very invasive of family life, and it sees the home-visitation program as one of supposed helpful programs which is foisted on the more vulnerable and less educated family members.
The Department of Finance (DOF) argues this bill places significant pressure on the Medi-Cal program to fund a new benefit, and including this benefit is likely unnecessary as the Department of Public Health administers the California Home Visiting Program which provides home visiting services to at-risk pregnant women and parents with young children. DOF states that, because this program already is in operation, this bill is unnecessary.
ASSEMBLY FLOOR: 79-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez
Prepared by: Scott Bain / HEALTH /
9/1/15 21:30:46
**** END ****
AB 50 (Mullin) Page 0 of 1
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 50 (Mullin) - Medi-Cal: evidence-based home visiting programs
|
|
Version: May 21, 2015 |
Policy Vote: HEALTH 8 - 0 |
Urgency: No |
Mandate: No |
Hearing Date: August 27, 2015 |
Consultant: Brendan McCarthy |
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 27, 2015
Bill Summary:
AB 50 would require the Department of Health Care Services to develop a plan determine the feasibility of providing evidence-based home visitation programs as a Medi-Cal benefit to pregnant and parenting women.
Fiscal Impact:
One-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by the Department of Health Care Services (General Fund and federal funds).
Committee Amendments:
Clarify that the bill only requires the Department to develop a plan to determine the feasibility of offering home visitation services.
-- END --
AB 50 (Mullin) Page 3 of 3
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 50 (Mullin) - Medi-Cal: evidence-based home visiting programs.
|
|
Version: May 21, 2015 |
Policy Vote: HEALTH 8 - 0 |
Urgency: No |
Mandate: No |
Hearing Date: August 17, 2015 |
Consultant: Brendan McCarthy |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 50 would require the Department of Health Care Services to develop a plan to ensure that evidence-based home visitation programs are provided as a Medi-Cal benefit to pregnant and parenting women.
Fiscal Impact:
One-time costs, likely from $250,000 to $500,000 per year for one to two years, to consult with stakeholders, review existing programs and program evaluations, and develop a plan for the provision of home visitation services in Medi-Cal by the Department of Health Care Services (General Fund and federal funds).
Unknown costs to provide home visitation services to Medi-Cal beneficiaries (unknown fund source). The cost to provide home visitation services will depend largely on how widely available the program is made to Medi-Cal beneficiaries. For example, the Department could develop a program that is made available to Medi-Cal beneficiaries who are most likely to benefit from intensive interventions. Alternatively, the Department could make a limited number of program slots available on a first come first serve basis. Given that there are almost 90,000 births to first time mothers in the Medi-Cal program every year, it is not likely that the Department would be able to offer home visitation services universally.
For example, if the Department offered access to a home visitation program to 10,000 first time mothers per year, the annual cost would be about $110 million per year, based on average program costs and participant duration in the existing program operated by the Department of Public Health.
The bill directs the Department to prioritize non-General Fund sources of funding for the program. Whether such sources of funding would be available in any significant amount is unknown.
Potentially significant offsetting savings to participating Medi-Cal beneficiaries (General Fund, federal funds, and local funds). According to a program evaluation of the existing home visitation programs offered in the state, there are significant offsetting savings that accrue over time due to program participation. That evaluation found that the average program expenditure per participant of $12,000 (over multiple years) was offset by about $11,000 in direct savings (mostly to state and local governments) due to reduced health care costs, child welfare spending, special education spending, and criminal justice system costs. In addition, the evaluation found overall social cost savings of about $40,000 per family, mainly due to reductions in child mortality and child abuse and improved health.
Background:
Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary.
The Department of Public Health manages two home visitation programs for first time mothers in the state. Those programs are funded with federal funds and are operated at the local level by counties. The programs have a total capacity to serve about 2,200 families per year (although families can participate for more than one year). About 85% of program participants qualify for Medi-Cal. As noted above, an independent program evaluation of one of the programs indicated that the overall, society-wide benefits of the program are significantly larger than the direct program costs.
Proposed Law:
AB 50 would require the Department of Health Care Services to develop a plan to ensure that evidence-based home visitation programs are provided as a Medi-Cal benefit to pregnant and parenting women.
Specific provisions of the bill would:
Require the Department to develop a plan, before January 1, 2017 to ensure that evidence-based home visitation programs are offered and provided to pregnant and parenting Medi-Cal beneficiaries;
Require the Department to consider issues relating to funding and other issues;
Require the Department to identify potential fund sources;
Require the Department to report every five years on program implementation.
Staff Comments:
Based on the existing programs managed by the Department of Public Health, there seems to be significant opportunity to improve maternal and child health and social outcomes at a relatively small net cost to the state, per participant. However, whether or not those positive outcomes will translate from a relatively small program into a much larger, more widely available program in Medi-Cal is uncertain.
The bill would require the Department to plan for and then implement such a home visitation program. The bill is not very prescriptive in how the Department should offer such a benefit in Medi-Cal. For example, participation could limited by specific eligibility criteria or simply based on a fixed number of participants. The bill gives very broad authority to the Department to develop and implement the program.
It would be more prudent for the Legislature to require the Department to develop a plan for offering home visitation services in Medi-Cal and then provide that information to the Legislature. The Legislature could then evaluate the potential costs and benefits of providing home visitation services in Medi-Cal before actually authorizing implementation of the program.
-- END --
AB 50 (Mullin) Page 5 of 5
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 50
AUTHOR: |
Mullin |
||
VERSION: |
May 21, 2015 |
||
HEARING DATE: |
July 8, 2015 |
|
|
CONSULTANT: |
Scott Bain |
||
SUBJECT: Medi-Cal: evidence-based home visiting programs.
SUMMARY:
Requires the Department of Health Care Services to develop a plan on or before January 1, 2017, to ensure that evidence-based home visiting programs, as defined, are offered and provided to Medi-Cal eligible pregnant and parenting women.
Existing law:
Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services. Children up to age 19 are eligible for Medi-Cal in families with incomes up to 266% of the federal poverty level (FPL) (266% of the FPL is at or below $52,641 annually for a family of 3 in 2015) and pregnant women are eligible with family incomes up to 322% of the FPL
Establishes the Nurse-Family Partnership (NFP) program, which is administered by the Department of Public Health (DPH), to provide grants for voluntary nurse home visiting programs for expectant first-time mothers, their children, and their families. Requires a county to satisfy specified requirements in order to be eligible to receive a grant. The provisions of the NPF program are subject to the normal Budget Act process and are operative to the extent funds are appropriated.
This bill:
Requires DHCS to develop a plan on or before January 1, 2017, to ensure that evidence-based home visiting programs are offered and provided to Medi-Cal eligible pregnant and parenting women. Requires DHCS to develop the plan in consultation with stakeholders, including, but not limited to, representatives from Medi-Cal managed care plans, public and private hospitals, evidence-based home visiting programs, and local governments, from diverse geographical regions of the state.
Requires DHCS to consider all of the following in developing the plan:
Establishing Medi-Cal coverage for evidence-based home visiting program services;
Incentives for Medi-Cal providers to offer evidence-based home visiting program services;
Other mechanisms to fund evidence-based home visiting program services for Medi-Cal eligible pregnant and parenting women; and,
Identifying among evidence-based home visiting programs those with established evidence to improve health outcomes, the experience of care, and cost savings to the health care system.
Requires DHCS, in developing the plan, to prioritize the identification of funding sources, other than General Fund moneys, to fund evidence-based home visiting program services, including local, federal, or private funds, or any other funds made available for these program services.
Requires DHCS, on or before January 1, 2022, and every five years thereafter, to report to the Legislature on implementation progress and the effectiveness of evidence-based home visiting services in improving maternal and child health outcomes, the experience of care, and cost savings to the Medi-Cal program and the state.
Defines an “evidence-based program” as a program that is based on scientific evidence demonstrating that the program model is effective, that is reviewed on site and compared to program model standards by the model developer or the developer’s designee at least every five years to ensure that the program continues to maintain fidelity with the program model, and that has had demonstrated and replicated significant and sustained positive outcomes that have been in one or more well-designed and rigorous randomized controlled research designs, and where the evaluation results have been published in a peer-reviewed journal.
Defines an “evidence-based home visiting program” as a program or initiative that does all of the following:
Meets, on or before April 1, 2015, the U.S. Department of Health and Human Services Maternal, Infant, and Early Childhood Home Visiting criteria, as specified;
Contains home visiting as a primary service delivery strategy by providers satisfying home visiting program requirements to provide services to families with a pregnant or parenting woman who is eligible for medical assistance;
Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to five years of age; and,
Targets participant outcomes that include all of the following:
Improved maternal and child health.
Prevention of child injuries, child abuse or maltreatment, and reduction of emergency department visits.
Improvements in school readiness and achievement.
Reduction in crime or domestic violence.
Improvements in family economic self-sufficiency.
Improvements in coordination of, and referrals to, other community resources and support.
Improvements in parenting skills related to child development.
FISCAL EFFECT:
According to the Assembly
Appropriations Committee:
Costs to DHCS in the range of $200,000 to develop the specified plan in consultation with stakeholders.
Unknown, significant cost pressure to provide home visiting services through Medi-Cal FFS or managed care (unspecified local/private/potentially General Fund/federal funds). For example, if an additional 1,000 additional women were served, costs would be $5 million to $12 million for services, depending on the program model. Various home visiting program models may meet the bill's criteria.
The funding source is not specified, but the author points out counties, managed care plans, hospitals, foundations, and local First 5 programs all may have interest in funding the program if a structure was in place to accommodate service delivery and leverage federal funds – meaning local or private funding coupled with federal funds may be a viable approach. The state is pursuing an 1115 waiver from the federal government, through which other states have received approval for federal matching funds for home visiting.
Home visiting programs have a strong evidence base of outcomes based on randomized controlled trials. To the extent the delivery of home visiting programs is expanded, and assuming the most successful programs are selected:
Some level of reduced state costs associated with fewer pre-term deliveries, high-risk pregnancies, and childhood injuries in Medi-Cal, and likely reductions in beneficiaries of California Work Opportunity and Responsibility to Kids Program benefits based on better labor market outcomes and less welfare participation among service recipients.
Cost savings may accrue to counties or school districts based on documented reductions in child abuse and fewer youth crimes, reduced youth substance abuse, and fewer remedial school services.
PRIOR VOTES:
Assembly Floor: |
79 - 0 |
Assembly Appropriations Committee: |
17 - 0 |
Assembly Health Committee: |
16 - 0 |
COMMENTS:
Author’s statement. According to the author, with rising health care costs and an increasing Medi-Cal eligible population across California, there is a need to strengthen the capacity of our current healthcare system to address the health needs of our most vulnerable populations at lower costs. Evidence-based home visiting programs are proven health-based interventions that can improve the health of low-income families in the state, while helping reduce overall costs to our system and improving system outcomes for the state. Voluntary evidence-based home visiting programs - such as NFP, Healthy Families America, Early Head Start (Home Based Option), Parents as Teachers, and Home Instruction for Parents of Preschool Youngsters - strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. With more than 37 years of evidence from randomized, controlled trials and longitudinal follow-up studies, evidence based home visiting programs have demonstrated sizeable, sustained improvements in maternal health, child health and development, economic stability of families, and helping break intergenerational poverty. By establishing mechanisms for Medi-Cal to increase the reach of home visiting programs, this bill would substantially expand the scale of evidence-based home visiting programs in California.
Background. The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using federal Department of Justice funding. NFP provides first-time, low-income mothers with home visitation services by public health nurses. Typically beginning 18 to 28 weeks into their pregnancy, nurses work intensively with mothers to improve prenatal, maternal, and early childhood health and well-being, focusing on therapeutic relationships with the family designed to improve family functioning in health, home and neighborhood environment, family and friend support, parental roles, and major life events. The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500.
NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school by the time their infants were 24 months old. A 1997 RAND study examined the benefits for children and their families enrolled in early childhood intervention programs. The study found that the NFP generated increased tax revenues from increased employment and earnings, decreased enrollment in public assistance programs, reduced expenditures for education, health, and other services, including special education, emergency room visits, and stays in homeless shelters, and lowered criminal justice system costs.Prior legislation. ACR 155 (Bocanegra, Chapter 144, Statutes of 2014), urges the Governor to identify evidence-based solutions to reduce children’s exposure to adverse childhood experiences, address the impacts of those experiences, and invest in preventive health care, mental health and, wellness interventions.
AB 543 (Ma, 2010) would have extended, from January 1, 2009 to January 1, 2014, the sunset of the California Children and Families Account (Account). Governor Schwarzenegger vetoed AB 543 stating: "Since the Nurse-Family Partnership program was signed into law in 2006, there have been no private or federal funds received by the state for this program. Since there are no funds to appropriate, there is no need to extend the sunset date for the program’s fund account."
AB 1829 (Ma, 2008) would have extended, from January 1, 2009, to January 1, 2011, the sunset of the Account. Governor Schwarzenegger vetoed AB 1829, stating: "The historic delay in passing the 2008-2009 State Budget has forced me to prioritize the bills sent to my desk at the end of the year's legislative session. Given the delay, I am only signing bills that are the highest priority for California. This bill does not meet that standard and I cannot sign it at this time."
SB 1596 (Runner, Chapter 878,
Statutes of 2006) establishes the NFP program
administered by the Department of Health Services (now DPH).
Support. Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now states there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities. Many experts hail home visiting program diversity as essential to providing parents with choices, and ensuring that programs are well matched with local needs and strengths. Children Now concludes that it believes this bill can help promote a broad range of home visiting models, reflective of the diverse needs of families and young children in our state.
Opposition. The California Right to Life Committee, Inc. (CLRC) writes in opposition that the language in this bill presumes to know better than families how to beget and raise children. CLRC writes the mingling of public and private funds does not represent a republican form of government guaranteed by the U.S. Constitution. CLRC continues that this program is very invasive of family life, and it sees the home-visitation program as one of supposed helpful programs which is foisted on the more vulnerable and less educated family members.
SUPPORT AND OPPOSITION:
Support: California Nurses Association
Children Now
First 5 Alameda County
First 5 Association of California
First 5 California
First 5 Solano Children and Families Commission
First 5 Sonoma County Commission
First 5 Tehama
March of Dimes California Chapter
Monterey County Board of Supervisors
Parents as Teachers
Prevent
Child Abuse America
San Mateo County Board of Supervisors
Santa Clara County Board of Supervisors
Solano County Board of Supervisors
Oppose: California
Right to Life Committee
-- END --
AB 50
Page 2
ASSEMBLY THIRD READING
AB 50
(Mullin)
As Amended May 21, 2015
Majority vote
Committee |
Votes |
Ayes |
Noes |
Health |
16-0 |
Bonta, Maienschein, Burke, Chávez, Chiu, Gomez, Gonzalez, Lackey, Nazarian, Patterson, Ridley-Thomas, Rodriguez, Santiago, Thurmond, Waldron, Wood |
|
Appropriations |
17-0 |
Gomez, Bigelow, Bonta, Calderon, Chang, Daly, Eggman, Gallagher, Eduardo Garcia, Gordon, Holden, Jones, Quirk, Rendon, Wagner, Weber, Wood |
|
SUMMARY: This bill requires the Department of Health Care Services (DHCS) to develop a plan, in consultation with stakeholders, on or before January 1, 2017, to ensure that evidence-based home visiting programs, as defined, are offered and provided to Medi-Cal eligible pregnant and parenting women, as specified. It also requires DHCS, in developing the plan, to prioritize the identification of funding sources for home visiting services other than state General Fund, including local, federal, private, or other funds.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
Costs to DHCS in the range of $200,000 to develop the specified plan in consultation with stakeholders.
Unknown, significant cost pressure to provide home visiting services through Medi-Cal FFS or managed care (unspecified local/private/potentially General Fund/federal funds). For example, if an additional 1,000 additional women were served, costs would be $5 million to $12 million for services, depending on the program model. Various home visiting program models may meet the bill's criteria.
The funding source is not specified, but the author points out counties, managed care plans, hospitals, foundations, and local First 5 programs all may have interest in funding the program if a structure was in place to accommodate service delivery and leverage federal funds – meaning local or private funding coupled with federal funds may be a viable approach. The state is pursuing an 1115 waiver from the federal government, through which other states have received approval for federal matching funds for home visiting.
Home visiting programs have a strong evidence base of outcomes based on randomized controlled trials. To the extent the delivery of home visiting programs is expanded, and assuming the most successful programs are selected:
Some level of reduced state costs associated with fewer pre-term deliveries, high-risk pregnancies, and childhood injuries in Medi-Cal, and likely reductions in beneficiaries of California Work Opportunity and Responsibility to Kids Program benefits based on better labor market outcomes and less welfare participation among service recipients.
Cost savings may accrue to counties or school districts based on documented reductions in child abuse and fewer youth crimes, reduced youth substance abuse, and fewer remedial school services.
COMMENTS: According to the author, this bill is necessary to increase accessibility for nurse led home visiting and help improve efficiency on this piece of our system of care. This bill helps to address the rising costs of Medi-Cal and potential burdens of rising Medi-Cal enrollment. With increased Medi-Cal enrollments come the societal savings, care coordination, case management, and healthcare outcomes that Nurse Family Partnership (NFP) and other evidence-based nurse home visiting programs, provide for the consistent solutions resonating among stakeholders. These measures will help improve Healthcare Effectiveness Data and Information Set measures, access to services, and reduce costs while further increasing savings. It is the responsibility of the Legislature and in the best interest of all California citizens to prioritize efficiency and effectiveness in the consideration of fiscal expenditures.
The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using Federal Department of Justice funding. The successful implementation of these initial NFP pilot sites demonstrated to other California communities that it was possible to replicate a scientific-based health strategy while also tailoring the program to meet the needs of each community. NFP seeks to continue to build new partnerships with medical managed care entities, school districts, military bases, clinics and hospitals in order to serve the thousands more eligible families in California that could benefit from NFP’s evidenced-based outcomes model.
The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500. The California NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school, by the time their infants were 24 months old.
Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now notes that nationally, as well as in California, there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities.
This bill has no known opposition.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000648
AB 50
Page 3
Date of Hearing: May 27, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB 50
(Mullin) – As Amended May 21, 2015
Policy Committee: |
Health |
Vote: |
16 - 0 |
|
|
|
|
|
|
|
|
Urgency: No State Mandated Local Program: No Reimbursable: >
SUMMARY:
This bill requires the Department of Health Care Services (DHCS) to develop a plan, in consultation with stakeholders, on or before January 1, 2017, to ensure that evidence-based home visiting programs, as defined, are offered and provided to Medi-Cal eligible pregnant and parenting women. It requires the department to consider:
Establishing Medi-Cal coverage for evidence-based home visiting program services.
Incentives for Medi-Cal providers to offer evidence-based home visiting program services.
Other mechanisms to fund evidence-based home visiting program services for pregnant and parenting women.
It also requires DHCS, in developing the plan, to prioritize the identification of funding sources for home visiting services other than state General Fund, including local, federal, private, or other funds.
FISCAL EFFECT:
Costs to DHCS in the range of $200,000 to develop the specified plan in consultation with stakeholders.
Unknown, significant cost pressure to provide home visiting services through Medi-Cal FFS or managed care (unspecified local/private/potentially GF/federal funds). For example, if an additional 1,000 additional women were served, costs would be $5 million to $12 million for services, depending on the program model. Various home visiting program models may meet the bill's criteria.
The funding source is not specified, but the author points out counties, managed care plans, hospitals, foundations, and local First 5 programs all may have interest in funding the program if a structure was in place to accommodate service delivery and leverage federal funds—meaning local or private funding coupled with federal funds may be a viable approach. The state is pursuing an 1115 waiver from the federal government, through which other states have received approval for federal matching funds for home visiting.
Home visiting programs have a strong evidence base of outcomes based on randomized controlled trials. To the extent the delivery of home visiting programs is expanded, and assuming the most successful programs are selected:
Some level of reduced state costs associated with fewer pre-term deliveries, high-risk pregnancies, and childhood injuries in Medi-Cal, and likely reductions in beneficiaries of CalWorks benefits based on better labor market outcomes and less welfare participation among service recipients.
Cost savings may accrue to counties or school districts based on documented reductions in child abuse and fewer youth crimes, reduced youth substance abuse, and fewer remedial school services.
COMMENTS:
Purpose. The purpose of this bill is to expand the reach of evidence-based home visiting programs that have been shown to improve maternal and child health, reduce instances of child abuse and injury, and improve coordination and referral to other supportive services, among other outcomes. Currently, only 4,000 families are being served throughout the state, out of an estimated 100,000 families with first-time mothers who could benefit from these services. This bill intends to leverage federal financial participation and Medi-Cal health care delivery infrastructure to expand the reach and funding of these successful programs, and provide flexibility to DHCS to consider different options to design the delivery of these services.
Background. The first years of life are a sensitive period in the process of development, laying a foundation for cognitive functioning; behavioral, social, and self-regulatory capacities; and physical health in childhood and beyond. Variations in early childhood experiences lead to disparities in school readiness and in health status, and these gaps often persist. Early childhood interventions are designed to counteract stressors in early childhood and promote healthy development. Services provided in a home visiting program include medical care, behavioral health care, health education, counseling, and assistance with and referral to other services. Services can be provided by nurses, social workers, or trained paraprofessionals, depending on the program.
Home Visiting Outcomes. Quantitative scientific research has demonstrated that home visiting can improve the lives of participating children and families. One home visiting program in particular, Nurse-Family Partnership, has demonstrated through numerous randomized controlled trials significant and sustained outcomes related to health, academic performance, criminal justice involvement, and improved parent-child interaction. The outcomes documented by evidence-based home visiting programs are consistent with state goals identified in the Governor's Let’s Get Healthy California Task Force final report, including: reduction in Adverse Childhood Experiences, reduction of nonfatal incidents of child maltreatment, proportion of third grade students whose reading skills are at or above proficient, and teen smoking and depression.
Current Funding for Home Visiting. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is a federal program created in the Patient Protection and Affordable Care Act of 2010 that awards grants to home visiting programs. Current California home visiting programs are partially funded by MEICHV funding. The California Department of Public Health administers the federal grant that funds 22 sites in 21 local health jurisdictions that provide services using one of two nationally recognized home visiting models, Healthy Families America and Nurse-Family Partnership. CDPH reports 3,500 families have been served since funding became available. According to CDPH, many counties have infrastructure in place to provide home visiting services.
According to a report from the National Academy for State Health Policy, "Medicaid Financing of Early Childhood Home Visiting Programs," a number of states have used various Medicaid funding mechanisms to support home visiting, including targeted case management, administrative case management, enhanced prenatal benefits, managed care contracts, and traditional Medicaid services. Currently, it appears that administrative challenges of weaving together which services are billable through which mechanism pose barriers to widespread adoption of these mechanisms to fund programs.
Staff Comments. Evidence is impressive that the highest-quality home visiting programs result in substantial benefits and potential long-term reductions in cost, and represent an opportunity to proactively address challenging issues of health disparities and intergenerational poverty. However, not all home visiting programs are created equal. Although the bill specifies program models shall have demonstrated replicated significant and sustained positive outcomes, staff suggests the author consider ensuring potential investments fund services that are most likely to deliver the highest value when considering costs and benefits.
Funding for these programs is complicated by the fact they address outcomes in a number of different fiscal and policy areas. No one sector garners all the potential returns on an investment in early intervention, but the program addresses desirable outcomes in health care, social services, criminal justice, and education. Given the mounting evidence that health disparities are heavily linked to poverty and socioeconomic disparities in these other sectors, and the ability to potentially leverage federal funds through Medi-Cal to support these programs, it appears reasonable to focus state efforts on developing mechanisms through Medi-Cal to expand the delivery of these services.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
AB 50
Page 4
Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 50
(Mullin) – As Amended April 6, 2015
SUBJECT: Medi-Cal: nurse home visiting programs.
SUMMARY: Requires the Department of Health Care Services (DHCS) to develop and implement a plan to ensure that Nurse-Family Partnership and other evidence-based nurse home visiting programs are offered to Medi-Cal eligible pregnant women. Specifically, this bill:
Requires the Department of Health Care Services (DHCS) to develop and implement, by January 1, 2017, a plan to ensure that NFP and other evidence-based nurse home visiting programs are offered to all Medi-Cal eligible pregnant women.
Requires DHCS, on or before January 1, 2022, and every five years afterwards, to report to the Legislature on implementation progress and the effectiveness of evidence-based nurse home visiting services.
Defines a "nurse home visiting program" as a program that does the following:
Contains home visitations by a registered nurse to households with a pregnant woman as a primary service;
Offers services on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children from prenatal to two years old; and,
Identifies participant outcomes that include improved maternal and child health, improvements in school readiness, reductions in crime or domestic violence, and other outcomes as specified.
EXISTING LAW:
Establishes the NFP as a voluntary nurse home visiting grant program for expectant first-time mothers, their children, and their families, administered by the Department of Public Health (DPH).
Requires DPH to develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of NFP and requires a county, to be eligible to receive an NFP grant, to agree to specific staffing and service-related provisions.
Permits DPH to accept voluntary contributions, in cash or in-kind, to pay for the costs in the implementation of the NFP and requires private donations to be deposited into the California Families and Children Account, which is created and continuously appropriated to DHCS under this bill.
Prohibits state funds from being used to implement this bill.
Allows DPH to distribute grants if the Director of the Department of Finance (DOF) determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the NFP. Prohibits DPHs' administration costs from exceeding 5% of the moneys in the account.
Permits DPH, in consultation with the NFP administrators, to contract with one or more qualified organizations to assist DPH in ensuring that grantees implement the program as established under this bill and to conduct an annual evaluation of the implementation of the grant program on a statewide basis. Requires the first evaluation to be due 12 months after the award of grants.
FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.
COMMENTS:
PURPOSE OF THIS BILL. According to the author, this bill is necessary to increase accessibility for nurse led home visiting and help improve efficiency on this piece of our system of care. This bill helps to address the rising costs of Medi-Cal and potential burdens of rising Medi-Cal enrollment. With increased Medi-Cal enrollments come the societal savings, care coordination, case management, and healthcare outcomes that NFP and other evidence-based nurse home visiting programs, provide for the consistent solutions resonating among stakeholders. These measures will help improve HEDIS measures, access to services, and reduce costs while further increasing savings. It is the responsibility of the Legislature and in the best interest of all California citizens to prioritize efficiency and effectiveness in the consideration of fiscal expenditures.
BACKGROUND. The first California NFP implementing agencies were launched in 1996 in Fresno, Los Angeles, and Alameda Counties using Federal Department of Justice funding. The successful implementation of these initial NFP pilot sites demonstrated to other California communities that it was possible to replicate a scientific-based health strategy while also tailoring the program to meet the needs of each community. NFP seeks to continue to build new partnerships with medical managed care entities, school districts, military bases, clinics and hospitals in order to serve the thousands more eligible families in California that could benefit from NFP’s evidenced-based outcomes model.
The NFP sites in California have served approximately 9,000 families, of which the majority are Latino. The median age of the mothers is 18 years. Seventy-two percent are enrolled in Medi-Cal, and the median annual household income is $13,500. The California NFP has documented outcomes for enrollees, and demonstrated a 23% reduction in cigarette smoking during pregnancy. In addition, of those mothers who entered the program without a high school diploma or General Educational Development Test (GED), 42% had earned their diploma or GED, 25% continued to work toward their diploma or GED, and 15% were pursuing education beyond high school, by the time their infants were 24 months old.
MATERNAL, INFANT, EARLY CHILDHOOD HOME VISITING PROGRAM. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is a federal program that supports pregnant women and families and helps at-risk parents of children from birth to kindergarten entry tap the resources and hone the skills they need to raise children who are physically, socially and emotionally healthy and ready to learn. The Federal Health Resources and Services Administration, in close partnership with the Administration for Children and Families, funds States, territories and tribal entities to develop and implement voluntary, evidence-based home visiting programs using models that are proven to improve child health and to be cost effective. On February 19, 2015, the Department of Health and Human Services announced $386 million in grant awards to states, territories, and nonprofit organizations to support the MEICHV Program. California NFP programs are partially funded by MEICHV funding.
SUPPORT. Children Now states in support that voluntary early childhood home visiting programs strengthen the critical parent-child relationship and connect families with information and resources during the pivotal time from pregnancy to age five. Extensive research has shown that voluntary home visiting programs increase family self-sufficiency, positive parenting practices, and maternal and child health. Children Now notes that nationally, as well as in California, there is a diverse array of home visiting program models in use, including both nationally-known, intensive program models, as well as locally designed programs intended to engage isolated populations or address other specific local priorities. Many experts hail home visiting program diversity as essential to providing parents with choices, and ensuring that programs are well matched with local needs and strengths. Children Now concludes that it believes this bill can help promote a broad range of home visiting models, reflective of the diverse needs of families and young children in our state.
PREVIOUS LEGISLATION.
ACR 155 (Bocanegra), Chapter 144, Statutes of 2014, urges the Governor to identify evidence-based solutions to reduce children’s exposure to adverse childhood experiences, address the impacts of those experiences, and invest in preventive health care, mental health and, wellness interventions.
AB 543 (Ma) of 2010 would have extended, from January 1, 2009 to January 1, 2014, the sunset of the California Children and Families Account (Account). Governor Schwarzenegger vetoed AB 543 stating: "Since the Nurse-Family Partnership program was signed into law in 2006, there have been no private or federal funds received by the state for this program. Since there are no funds to appropriate, there is no need to extend the sunset date for the program’s fund account."
AB 1829 (Ma) of 2008 would have extended, from January 1, 2009, to January 1, 2011, the sunset of the Account. Governor Schwarzenegger vetoed AB 1829, stating: "The historic delay in passing the 2008-2009 State Budget has forced me to prioritize the bills sent to my desk at the end of the year's legislative session. Given the delay, I am only signing bills that are the highest priority for California. This bill does not meet that standard and I cannot sign it at this time."
SB 1596 (Runner), Chapter 878, Statutes of 2006, establishes the NFP program administered by the Department of Health Services (now DPH).
POLICY COMMENTS. The NFP is existing law in the Health and Safety code. This bill establishes new requirements for evidence-based nurse home visiting programs in the Welfare and Institutions code section. This is duplicative and unnecessary in order to meet the intent of expanding access to evidence-based nurse home visiting programs. Instead of adding a new section, the Committee may recommend broadening the provisions that currently govern NFP Programs in Health and Safety code to include other evidence-based nurse home visiting programs.
REGISTERED SUPPORT / OPPOSITION:
Support
American Nurses
Association\California
California Right to Life
Committee
Children Now
Parents as Teachers
Prevent
Child Abuse America
Opposition
None on file.
Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097
Bill Author
Bill Co-Author(s):