Healthy Moms and Babies Act will address growing maternal health concerns

Iowa Senate News Release

For Immediate Release: Feb. 19, 2020

DES MOINES – Senate Democrats have proposed legislation to address the growing maternal health crisis in Iowa.

“Iowa is facing a maternal health crisis that we simply cannot ignore,” says Senator Janet Petersen, the Senate Democratic Leader. “Iowa’s maternal mortality rate has more than doubled in the past three years, hospital labor and delivery departments are shuttering at record speed, and 66 Iowa counties no longer have a single OB/GYN practicing in their county.”

The scope of the problem includes:

• Iowa has lost 37 labor and delivery departments.
  MAP OF OB UNITS | LIST OF CLOSURES
• Iowa has the lowest number of obstetricians per capita in the country. Two-thirds of rural Level 1 hospitals have no obstetrician on staff.
• Compared to other states, Iowa has a high rate of cesarean births, an indicator of potential health problems for mother and child.

“Iowa taxpayers pay for more than 40% all births in our state through Medicaid,” Petersen said. “Governor Reynolds has put a system in place that allows out-of-state companies to make a profit off of labor and delivery services while our rural hospitals are financially penalized for providing care. Iowa’s privatized Medicaid doesn’t cover the full cost of delivering babies, which hurts rural and urban hospitals.” 

The Healthy Moms and Babies Act (SF 2062), co-sponsored by 18 members of the Iowa Senate, will address the maternal health care crisis by:

• Adjusting Medicaid rates so that hospitals are adequately reimbursed for the care they provide.
• Ensuring labor and delivery units use proven practices—known as “safety bundles”—that save lives during delivery.
• Expanding home visiting services for pregnant women, new moms and babies.

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Closure-Map-Dec-2019

Summary of SF 2062: “Healthy Moms and Babies Act”

Background

Maternal health in Iowa is experiencing a crisis.

Maternal death rates are higher in the U.S. than in any other developed nation, and they are rising.  In Iowa, maternal mortality has more than doubled in three years.

In addition, moms-to-be are now sicker than in the past, with increasing maternal age, higher levels of obesity and related health complications, and societal problems such as substance abuse and mental health, all playing a role.

To compound these problems, access to care is diminishing and the provider workforce is shrinking. Iowa has seen 37 labor and delivery units in critical access hospitals close since the year 2000, and Iowa has the lowest number of obstetricians per capita in the country, according to the American College of Obstetricians and Gynecologists.

• 64% of rural Level 1 hospitals have no obstetrician on staff
• Iowa ranks 50^th out of 50 in the number of OB/GYNs per capita
• Iowa has a high rate of cesarean births which can lead to future health problems

As of October 2019, 37 of Iowa’s 118 community hospitals have closed their birthing units since 2000, according to the Iowa Department of Public Health. There were two closures in 2019, down from eight closures in 2018 — the most in a single year. Since then, Mount Pleasant, New Hampton and Muscatine have announced closures.  Most of those closures have happened at smaller facilities. Hospitals are not reimbursed for the cost of the standard of care for labor and delivery so they lose money on every birth.

About 40% of births in Iowa are Medicaid so making improvements to maternal care in the Medicaid program is key to improving maternal health and birth outcomes in Iowa. Privatized Medicaid doesn’t cover the costs for delivering babies in Iowa when health care providers follow the standard of care.

Division I:  Medicaid Maternal and Child Health Improvements

DHS is directed to adopt rules under both fee-for-service and managed care Medicaid, amend any managed care contracts, and apply for any Medicaid plan amendments or waivers necessary to improve care for moms and babies in all the following ways:

1. Provide reimbursement in an amount that appropriately covers the entire standard of care costs for labor and delivery;
2. Provide the same reimbursement for maternal-fetal medicine services and comprehensive maternity care when provided in person or via telehealth (covering both facility and professional fees);
3. Allow continuous Medicaid eligibility for a woman for a 12-month postpartum period (compared to 60 days currently);
4. Provide comprehensive maternity care which includes the basic number of prenatal and postpartum visits recommended by ACOG (American College of Obstetricians and Gynecologists), any additional prenatal or postpartum visits that are medically necessary, necessary laboratory, nutritional assessment and counseling, health education, personal counseling, managed care, outreach and follow-up services, and treatment of conditions which may complicate pregnancy;
5. Provide reimbursement for doula care;
6. Reimbursement for breastfeeding supports, counseling, and supplies including the standard cost of breast pumps and electronic breast pumps;
7. Reimbursement for transportation to all prenatal and postpartum care appointments; and
8. Reimbursement for all postpartum care products such as breast pads, period pads, comfort products, pain relievers, and other similar products.

Division II:  Maternal Best Practices/Safety Bundles and Hospital Requirements

Licensed hospitals that provide labor and delivery services shall be required to do the following:

1. Adopt and implement the current best practices or safety bundles recommended by ACOG and the Alliance for Innovation on Maternal Health; details here https://www.medpagetoday.com/obgyn/pregnancy/74631

These maternal safety bundles include action measures for:

• Obstetrical Hemorrhage
• Severe Hypertension/Preeclampsia
• Prevention of Venous Thromboembolism
• Reduction of Low Risk Primary Cesarean Births/Support for Intended Vaginal Birth
• Reduction of Peripartum Racial Disparities
• Postpartum care access and standards

1. Provide information to the public, including but not limited to maternity and neonatal level of care status and the meaning of that status;
2. Provide cesarean birth statistics;
3. Provide statistics on the number of vaginal births after cesarean (VBAC) and vaginal births after two cesareans (VBA2C);
4. Provide rate of exclusive breastfeeding upon discharge;
5. Provide all moms and babies receiving labor and delivery services with information and assistance in applying for services and health care coverage including but not limited to Medicaid; AEA agencies; WIC; and home visiting programs; prior to discharge from the hospital; and
6. Have a comprehensive labor and delivery unit closure plan in place that includes a plan for future births and pregnancies and the capacity of other providers to absorb the services in case of unit closure.

Division III:  Expanded Home Visiting Services

DHS is directed to seek federal approval for any state plan amendment or waiver necessary in order to collaborate with the Department of Public Health and the Department of Education to expand maternal and infant home visiting services under Medicaid that:

• promote healthy pregnancies;
• positive birth outcomes; and
• healthy infant growth and development.

The departments shall design a home visiting approach that maximizes coordination and blending of programs and funding, reduces duplication of efforts and ensures that the services provided meet federal evidence-based criteria. Home visiting should start prenatally and include mental health services.