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SB-65 Maternal care and services.(2021-2022)

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Date Published: 10/05/2021 09:00 PM
SB65:v91#DOCUMENT

Senate Bill No. 65
CHAPTER 449

An act to add Section 123660 to, to add Article 4.7 (commencing with Section 123635) to Chapter 2 of Part 2 of Division 106 of, and to add Article 4 (commencing with Section 128295) to Chapter 4 of Part 3 of Division 107 of, the Health and Safety Code, and to amend Section 11320.3 of, and to add and repeal Section 14132.24 of, the Welfare and Institutions Code, relating to maternal care and services.

[ Approved by Governor  October 04, 2021. Filed with Secretary of State  October 04, 2021. ]

LEGISLATIVE COUNSEL'S DIGEST


SB 65, Skinner. Maternal care and services.
(1) Existing law, the Nursing Practice Act, establishes the Board of Registered Nursing within the Department of Consumer Affairs for the licensure and regulation of the practice of nursing, and requires the board to issue a certificate to practice nurse-midwifery to a person who, among other qualifications, meets educational standards established by the board or the equivalent of those educational standards. Existing law, the Licensed Midwifery Practice Act of 1993, provides for the licensure of midwives by the Medical Board of California.
Existing law, the Song-Brown Health Care Workforce Training Act, provides for specified training programs for certain health care workers, including family physicians, registered nurses, nurse practitioners, and physician assistants. Existing law establishes a state medical contract program with accredited medical schools, hospitals, and other programs and institutions to increase the number of students and residents receiving quality education and training in specified primary care specialties and maximize the delivery of primary care and family physician services to underserved areas of the state.
This bill would enact the Midwifery Workforce Training Act, under which the Office of Statewide Health Planning and Development would, upon appropriation by the Legislature, contract with programs that train certified nurse-midwives and programs that train licensed midwives to increase the number of students receiving quality education and training as a certified nurse-midwife or a licensed midwife, as specified. The bill would require the office to contract only with programs that include, or intend to include, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities.
(2) Existing law requires the State Department of Public Health to track data on pregnancy-related deaths, including specified health conditions, indirect obstetric deaths, and other maternal disorders predominantly related to pregnancy and complications predominantly related to the puerperium, and requires this data to be published at least once every 3 years. Existing law also requires the department to develop a plan to identify causes of infant mortality and morbidity in California and to study recommendations on the reduction of infant mortality and morbidity in California.
This bill would, commencing August 1, 2022, establish the California Pregnancy-Associated Review Committee, and would require the committee to, among other things, identify and review all pregnancy-related deaths and severe maternal morbidity. The bill would require the committee to be composed of a minimum of 13 members, as specified, and would authorize the committee to request from any state department, commission, local health department, or coroner, among others, specified information, including death records, medical records, and autopsy reports. The bill would make all proceedings, activities, and opinions of the committee confidential.
This bill would require each county to annually report infant deaths to its respective local health department. The bill would require local health departments, upon appropriation by the Legislature, to establish a Fetal and Infant Mortality Review committee to investigate infant deaths to prevent fetal and infant death under specified circumstances, and would require those local health departments that participate in the Fetal and Infant Mortality Review process to annually investigate, track, and review cases of term infants, as defined, who were born following labor with the outcome of intrapartum stillbirth, early neonatal death, or postneonatal death. The bill would require counties, hospitals, birthing centers, and state entities to provide to local health departments death records, medical records, and autopsy reports, among other information, that will help the local health department conduct the fetal and infant mortality review.
By imposing duties on local officials, this bill would impose a state-mandated local program.
(3) 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 pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill would require the department to convene a workgroup to examine the implementation of the Medi-Cal doula benefit, as specified. No later than July 1, 2024, the bill would require the department to publish a report that addresses the number of Medi-Cal recipients utilizing doula services and identifies barriers that impede access to doula services, among other things, and would require the department to post that report on its internet website.
(4) Existing law provides for the California Work Opportunity and Responsibility to Kids (CalWORKs) program under which, through a combination of state and county funds and federal funds, each county provides cash assistance and other benefits to qualified low-income families. Existing law requires a recipient of CalWORKs to participate in welfare-to-work activities as a condition of eligibility, but provides an exemption to a woman who is pregnant and for whom it has been medically verified that the pregnancy impairs their ability to be regularly employed or participate in welfare-to-work activities or the county has determined that, at that time, participation will not readily lead to employment or that a training activity is not appropriate.
This bill would remove the medical verification and county determination requirements, and would instead provide an exemption to any recipient who is pregnant.
Because the bill would result in an increase in CalWORKs eligibility, thus increasing the duties of counties administering the CalWORKs program, the bill would impose a state-mandated local program.
Existing law continuously appropriates moneys from the General Fund to defray a portion of county costs under the CalWORKs program.
This bill would, instead, provide that the continuous appropriation would not be made for purposes of implementing the bill.
(5) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
(6) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 This act shall be known, and may be cited, as the California Momnibus Act.

SEC. 2.

 The Legislature finds and declares all of the following:
(a) The United States has the highest rates of maternal mortality among higher income countries. There are an estimated 700 deaths per year in the United States that are pregnancy-related, with about three in five deaths deemed preventable.
(b) The United States has an infant mortality rate that is higher than most higher income countries. Currently, the United States is ranked 33 out of 36 countries belonging to the Organization for Economic Cooperation and Development (OECD), with an average of 5.7 deaths per 1,000 live births.
(c) California’s Native American infant mortality rate is 11.7 deaths per 1,000 live births, followed by Black infants at 8.7 deaths per 1,000 live births, which is far above the state’s average of 4.2 deaths per 1,000 live births.
(d) In areas like Fresno, the disparities are even greater, with the infant mortality rate of Black infants at 20.3 deaths per 1,000 live births compared to White infants at 5.1 deaths per 1,000 live births.
(e) Prematurity is a leading cause of infant mortality and has been linked to lifelong conditions, such as behavioral development issues, learning difficulties, and chronic disease.
(f) Racism and racial bias in health care contribute to both the national maternal mortality and morbidity crisis and infant mortality and morbidity, in particular for pregnant and postpartum people and infants who are Black or Native American.
(g) A study looking at over 32 million births in the United States found that cisgender women of color, especially Black cisgender women, were more likely to experience additional negative birth outcomes from exposure to the effects of climate change, including increased temperature and air pollution from fires, which lead to increases in stillbirth and low birth weight, respectively.
(h) In the United States, transgender individuals represent an estimated 0.6 percent of the population. However, there is little research on the pregnancy outcomes in this community. In one very small study, the findings suggested that transgender persons are at more risk for depression during and after pregnancy.
(i) California has made great progress in the last decade to improve maternity care, and now boasts the lowest maternal mortality rate in the country. However, the improvements in maternal mortality have not come with a corresponding improvement in the racial disparities in maternal health. Black and Native American pregnant and postpartum people in California continue to die at higher rates than non-Hispanic White pregnant and postpartum people.
(j) California is failing pregnant and postpartum people, especially those in some of the state’s most vulnerable and marginalized communities. Pregnant and postpartum people in California report discrimination and bias in care based on their race, gender, and language. This leads to fear and distrust of the institutionalized maternal health care system, particularly by people of color.
(k) The COVID-19 pandemic has laid bare longstanding racial and socioeconomic inequities in our health care system.
(l) One of the essential goals of the State Department of Public Health is to reduce health and mental health disparities among vulnerable and underserved communities to achieve health equity throughout California. This essential goal should extend to health equity for birthing people and babies.
(m) California can do a better job to support pregnant, birthing, and postpartum people in our state, especially Black pregnant, birthing, and postpartum people, who are experiencing the brunt of racism, disparities, and inequities in health care access, services, and delivery.

SEC. 3.

 Article 4.7 (commencing with Section 123635) is added to Chapter 2 of Part 2 of Division 106 of the Health and Safety Code, to read:
Article  4.7. California Pregnancy-Associated Review Committee

123635.
 For the purposes of this section, the following terms apply:
(a) “Maternal mortality” or “maternal death” means the death of a person during pregnancy or within a year from the end of pregnancy, and related to, or aggravated by, the pregnancy or birth, including, but not limited to, death by suicide.
(b) “Pregnancy-associated death” means a death of a person while pregnant or within one year of the end of a pregnancy, regardless of the cause.
(c) “Pregnancy-related death” means a death that occurs while pregnant or up to a year postpartum from any cause related to, or aggravated by, the pregnancy or its management, irrespective of the duration of the pregnancy.
(d) “Severe maternal morbidity” means unexpected outcomes of pregnancy, labor, or delivery that result in significant short- or long-term consequences to the pregnant person’s mental or physical health.

123636.
 (a) The California Pregnancy-Associated Review Committee is hereby established under the State Department of Public Health to continuously engage in the comprehensive, regular, and uniform review and reporting of maternal deaths throughout the state. The department, in collaboration with the designated state perinatal quality collaborative, shall oversee the committee. The committee may incorporate the membership of the California Pregnancy-Associated Mortality Review Committee, as it existed on December 31, 2021.
(b) The purposes of the committee include, but are not limited to, all of the following:
(1) Identifying and reviewing all pregnancy-related deaths, including the cause, contributing factors, and disseminating findings.
(2) Analyzing common indicators of severe maternal morbidity to identify prevention opportunities and reduce near-miss experiences.
(3) Making recommendations on best practices to prevent maternal mortality and morbidity, including, but not limited to, addressing socioeconomic impacts, as well as various environmental impacts, including global warming, on pregnancy outcomes.
(4) Examining racial disparities and making recommendations on the prevention of racial disparities.
(5) Tracking and examining disparities experienced by lesbian, bisexual, transgender, intersex, and gender-nonconforming individuals and reporting findings, to the extent possible.
(6) Collecting and reviewing data from maternal death investigations and making recommendations about how to improve or streamline data collection and investigatory processes.
(c) (1) In addition to reviewing medical records, death certificates, and other pertinent reports, committee review of maternal deaths shall include, to the degree practicable, for populations experiencing disparity, voluntary interview with the following individuals:
(A) Pertinent surviving family members or support people present with direct knowledge of, or involvement in, the event, including the patient in cases of severe maternal morbidity. The committee shall transcribe or summarize in writing any oral statements received pursuant to this paragraph.
(B) Members of the medical team who were present or involved in the deceased individual’s direct care.
(2) In determining the practicality of the interviews pursuant to subparagraphs (A) and (B), the committee may prioritize interviews with populations that have a documented higher rate of maternal death.
(d) The committee shall publish its findings to the public every three years as part of the publication of data on severe maternal morbidity, as required pursuant to Section 123630.4. The committee’s findings shall also include recommendations on how to prevent severe maternal morbidity and maternal mortality and how to reduce racial disparities.
(e) (1) The committee shall be composed of a minimum of 13 members. The members shall be comprised of multidisciplinary personnel and experts in the field of maternal mortality and morbidity, data analysis in maternal and fetal health, women’s health, clinicians in maternal health, anesthesiology, pathology, and perinatology, and representatives from various public health entities, and shall include all of the following:
(A) At least one obstetrician.
(B) At least one certified nurse-midwife.
(C) At least one certified professional midwife.
(D) At least one hospital-based registered nurse or advanced practice nurse experienced in perinatal health.
(E) A clinician or patient advocate from a birthing center, if not already represented by a member otherwise listed.
(F) At least one public member with relevant personal experience related to maternal morbidity or maternal mortality who has experienced birth and does not fit in another classification.
(G) At least one doula.
(H) At least one person from a community-based organization that works in perinatal health.
(I) At least one person from an organization that works with populations that have disproportionately high occurrences of maternal mortality and morbidity.
(J) At least one person who is an expert on mental and behavioral health, preferably with experience in perinatal health.
(K) At least one person from a native tribe, preferably with experience in perinatal health.
(L) At least one representative of the Maternal, Child, and Adolescent Health Division of the department.
(M) At least one family physician.
(N) At least one emergency room physician familiar with perinatal health.
(2) The committee shall prioritize for membership members who are representative of the diversity and geographic locations of the pregnant people in populations with disproportionately high occurrences of maternal mortality and morbidity.
(3) The State Public Health Officer shall appoint a maternal mortality expert to be a member of the committee as the chair of the committee. The chair shall appoint the other members of the committee in accordance with the criteria specified in paragraph (1).
(4) The committee may create subcommittees, as needed, to carry out its duties.
(f) The committee may request from any state department, division, commission, local health department, or other agency of the state or political subdivision thereof, or any public authority, as well as hospitals, birthing facilities, medical examiners, coroners, coroner physicians, and any other facility or individual providing services associated with maternal mortality, and those individuals and entities shall provide information, including, but not limited to, death records, medical records, autopsy reports, toxicology reports, hospital discharge records, birth records, and any other information that will help the committee to properly carry out its functions, powers, and duties. The committee shall not request, and health care providers shall not provide, reports, testimony, or other information produced as a result of activities undertaken by organized committees of a hospital medical staff or peer review body, as defined in Section 805 of the Business and Professions Code, that has the responsibility to evaluate or improve the quality of care rendered in a hospital.
(g) Except as otherwise provided by this article, all proceedings and activities of the committee, all opinions of the members of the committee that are formed as a result of the committee’s proceedings and activities, and all records obtained, created, or maintained by the committee, including written reports and records of interviews or oral statements, shall be confidential, and in accordance with Sections 1157 and 1157.5 of the Evidence Code, shall not be subject to public inspection, discovery, subpoena, or introduction into evidence in any civil, criminal, legislative, administrative, or other proceeding.
(h) In no case shall the committee disclose any personally identifiable information to the public, or include any personally identifiable information in a case summary that is prepared pursuant to this article, or in any report that is prepared.
(i) To the extent prescribed by Sections 1157 and 1157.5 of the Evidence Code, members of the committee shall not be questioned in any civil, criminal, legislative, administrative, or other proceeding regarding information that has been presented in, or opinions that have been formed as a result of, a meeting or communication of the committee. However, nothing in this paragraph shall prohibit a committee member from being questioned, or from testifying, in relation to publicly available information or information that was obtained independently of the member’s participation on the committee, or as an expert witness in maternal death cases unrelated to their case review as a member of the committee.
(j) This section does not prohibit the committee from publishing, or from otherwise making available for public inspection, statistical compilations or reports that are based on confidential information, provided that those compilations and reports do not contain personally identifying information or other information that could be used to ultimately identify the individuals concerned, and shall utilize standard public health reporting practices for accurate dissemination of these data elements, especially with regard to the reporting of small numbers so as to inadvertently risk a breach of confidentiality or other disclosure.
(k) A health care provider, health care facility, or pharmacy providing access to medical records pursuant to this section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing the records.

123637.
 This article is operative on August 1, 2022.

SEC. 4.

 Section 123660 is added to the Health and Safety Code, to read:

123660.
 (a) The Legislature finds that the Fetal and Infant Mortality Review process is used to identify and take action to prevent a wide range of local social, economic, public health, education, environmental, and safety factors that contribute to the tragedy of fetal and infant loss.
(b) (1) Each county shall annually report infant deaths to the local health department.
(A) The data shall be aggregated to ensure data reflects how regionalized care systems are, or should be, collaborating to improve fetal and infant health outcomes based on standard statistical methods for accurate dissemination of public health data without risking a confidentiality or other disclosure breach.
(B) The data shall be disaggregated by racial and ethnic identity.
(2) A local health department shall, subject to subdivision (e), establish a Fetal and Infant Mortality Review committee to investigate infant deaths to prevent fetal and infant death if both of the following apply with respect to the county:
(A) The county has five or more infant deaths in a single year.
(B) The county has a death rate that is higher than the state’s death rate for two consecutive years.
(c) A local public health department that participates in the Fetal and Infant Mortality Review process established by the department shall do all of the following:
(1) Annually investigate, track, and review a minimum amount of 20 percent of the county’s cases of term infants who were born following labor with the outcome of intrapartum stillbirth, early neonatal death, or postneonatal death, focusing on demographic groups that are disproportionately impacted by infant death. A county that has less than five deaths in a year shall investigate at least one death. For purposes of this section, “term infants” means infants who are at 36 weeks or more of gestation.
(2) Establish a committee for fetal and infant mortality reviews led by local health departments. The committee shall include members of the community, and shall not include anyone employed by a law enforcement agency. In counties where the coroner, medical examiner, or other medical professional is employed by law enforcement, these individuals can share information with the committee in their medical professional capacity only.
(A) All data and records obtained, prepared, created, and maintained in anticipation of a review meeting shall be confidential. Data and records prepared, created, and maintained in anticipation of a review meeting shall not be subject to public records requests, subpoena, or civil processes and shall not be admissible in evidence in connection with any administrative, judicial, executive, legislative, or other proceeding.
(B) All participants engaged in and associated with the review process shall sign a confidentiality agreement that states they will not discuss or share information about individual cases and the proceedings of the review meeting, outside of the meeting. This shall not preclude the committee from publishing, or from otherwise making available for public inspection, statistical compilations or reports that are based on confidential information, provided that those compilations or reports do not contain personally identifying information or other information that could be used to ultimately identify the individuals concerned, and shall utilize standard public health reporting practices for accurate dissemination of these data elements, especially with regard to the reporting of small numbers so as to inadvertently risk a breach of confidentiality or other disclosure.
(C) To the extent prescribed by Sections 1157 and 1157.5 of the Evidence Code, members of a team, persons attending a team meeting, and persons who present information to a team may not be questioned in any administrative, civil, or criminal proceeding regarding information presented in, or opinions formed as a result of, a meeting. This subparagraph does not prohibit a person from testifying to information obtained independently of the team or that is public information. A health care provider, health care facility, or pharmacy providing access to medical records pursuant to this section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing the records.
(3) Conduct voluntary interviews with individuals who have experienced child loss or surviving family members of maternal or infant death who have knowledge of the event. The interview shall include questions to determine if the pregnant person had concerns about perinatal care during any point in their pregnancy or postpartum care, whether there were disagreements about care offered and received, and whether the pregnant person had asked for certain care that was denied or not received.
(4) Conduct a report or investigation, to the degree practicable, with all medical staff involved with the event.
(5) Offer grief counseling to surviving family members.
(d) Counties, hospitals, birthing centers, and state entities shall provide to local health departments death records, medical records, autopsy reports, toxicology reports, hospital discharge records, birth records, and any other information that will help the local health department conduct the fetal and infant mortality review within 30 days of a request made in writing by a local health department. The local health department shall not request, and health care providers shall not provide, reports, testimony, or other information produced as a result of activities undertaken by organized committees of a hospital medical staff or peer review body, as defined in Section 805 of the Business and Professions Code, that has the responsibility to evaluate or improve the quality of care rendered in a hospital.
(e) The requirements of this section apply to a local health department only upon the appropriation of funds by the Legislature for these purposes in the annual Budget Act or another act.

SEC. 5.

 Article 4 (commencing with Section 128295) is added to Chapter 4 of Part 3 of Division 107 of the Health and Safety Code, to read:
Article  4. Midwifery Workforce Training Act

128295.
 This article shall be known, and may be cited, as the Midwifery Workforce Training Act.

128296.
 The Legislature finds and declares that maternity care providers are in short supply and maldistributed around the state, resulting in what the March of Dimes defines as “maternity care deserts” and “limited-access maternity care areas.” Many major counties are on track to have a critical shortage of maternity care providers by 2025. Maternity care is often the very first primary health care interaction, and the most common primary care interaction over the life of a woman and birthing person’s reproductive lifespan. Black and Native American individuals and other people of color in particular have significant difficulty in accessing maternity care and family planning services. Black women die from pregnancy-related causes at a rate of three to four times that of White women. Black infants are more than twice as likely to die in their first year as White infants. Access to quality care and resultant outcomes are intricately linked. Racial disparities in outcomes, especially, are connected in part to quality of and ability to access maternity care, especially by care providers whose care models elevate patient-centered, holistic, and culturally sensitive care. This kind of care is the hallmark of the midwifery model.

128297.
 For purposes of this article, the following definitions apply:
(a) “Certified nurse-midwife” means an advanced practice nurse with training in midwifery, as specified in, and a certificate issued pursuant to, Article 2.5 (commencing with Section 2746) of Chapter 6 of Division 2 of the Business and Professions Code.
(b) “Licensed midwife” means an individual who has been issued a license to practice midwifery pursuant to Article 24 (commencing with Section 2505) of Chapter 5 of Division 2 of the Business and Professions Code.
(c) “Office” means the Office of Statewide Health Planning and Development (OSHPD).
(d) “Programs that train certified nurse-midwives” means a nurse-midwifery education program that is operated by a California school of nursing and approved by the Accreditation Commission for Midwifery Education, or that is authorized by the Regents of the University of California or by the Trustees of the California State University, or that is approved by the Board of Registered Nursing.
(e) “Programs that train licensed midwives” means a midwifery education program operated by a California school of midwifery, and accredited by the Midwifery Education Accreditation Council (MEAC), or approved by the Bureau for Private and Postsecondary Education, or approved by the state licensing and regulatory board for licensed midwives.

128298.
 (a) It is the intent of the Legislature to provide for a program designed primarily to increase the number of students receiving quality education and training as a certified nurse-midwife or a licensed midwife in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives, in order to maximize the delivery of reproductive services to specific areas of California where there is a recognized unmet priority need.
(b) (1) The office shall establish a program to contract with programs that train certified nurse-midwives and programs that train licensed midwives in accordance with the global standards for midwifery education and the international definition of “midwife” as established by the International Confederation of Midwives in order to increase the number of students receiving quality education and training as a certified nurse-midwife or as a licensed midwife.
(2) The office shall only contract with programs that train certified nurse-midwives and programs that train licensed midwives that, at minimum, include, or that intend to create, a component of training designed for medically underserved multicultural communities, lower socioeconomic neighborhoods, or rural communities, and that are organized to prepare program graduates for service in those neighborhoods and communities, or that seek to recruit and retain racially and ethnically diverse students, underrepresented groups, or people from underserved or historically marginalized communities.
(3)  The office may adopt standards and regulations necessary to carry out this article. In adopting eligibility standards for programs that train certified nurse-midwives and that train licensed midwives in accordance with the standards set forth in subdivisions (a) and (b), the office may accept those educational standards and competencies established by the respective state licensing and regulatory bodies for certified nurse-midwives and for licensed midwives. The office shall take care not to implement education or competency standards beyond what is required for the training programs by their respective state licensing and regulatory bodies that could inadvertently create an unnecessary barrier for training programs to obtain funding for the training of midwives in California.
(4) The office shall develop alternative strategies to provide long-term stability for, or expansion of, this act, such as through funding provided by private foundations and administered by the office for the purposes of carrying out this article.
(5) Nothing in this article prevents the office from developing a protocol to contract with potential programs that train nurse-midwives or that train licensed midwives, in order to support the initial startup of new training programs, as long as the eligibility requirements of this article are met or can be met through the award of funds.
(6) The office may pay contracted programs that train certified nurse-midwives and programs that train licensed midwives in an amount calculated based on a single per-student capitation formula, or through another method, in order to cover the costs of innovative special projects or programs.
(7) Funds appropriated to the office for purposes of this article and awarded by the office to eligible programs that train certified nurse-midwives or programs that train licensed midwives may be used by the training program to develop new initiatives, projects, or curriculum, or to expand existing initiatives, projects, or curriculum. Awarded funds may also be used for general support and sustainability of the overall training program, or to sustain specific components of the training program, including, but not limited to, tuition assistance for students, or support for preceptor recruitment, or to sustain preceptor training sites for students.
(c) This section shall be implemented only upon an appropriation by the Legislature for these purposes in the annual Budget Act or another act.

128299.
 This article shall become operative on January 1, 2022.

SEC. 6.

 Section 11320.3 of the Welfare and Institutions Code is amended to read:

11320.3.
 (a) (1) Except as provided in subdivision (b) or if otherwise exempt, every individual, as a condition of eligibility for aid under this chapter, shall participate in welfare-to-work activities under this article.
(2) Individuals eligible under Section 11331.5 shall be required to participate in the Cal-Learn Program under Article 3.5 (commencing with Section 11331) during the time that article is operative, in lieu of the welfare-to-work requirements, and subdivision (b) shall not apply to that individual.
(b) The following individuals shall not be required to participate for so long as the condition continues to exist:
(1) An individual under 16 years of age.
(2) (A) A child attending an elementary, secondary, vocational, or technical school on a full-time basis.
(B) A person who is 16 or 17 years of age, or a person described in subdivision (d) who loses this exemption, shall not requalify for the exemption by attending school as a required activity under this article.
(C) Notwithstanding subparagraph (B), a person who is 16 or 17 years of age who has obtained a high school diploma or its equivalent and is enrolled or is planning to enroll in a postsecondary education, vocational, or technical school training program shall also not be required to participate for so long as the condition continues to exist.
(D) For purposes of subparagraph (C), a person shall be deemed to be planning to enroll in a postsecondary education, vocational, or technical school training program if the person or the person’s parent, acting on the person’s behalf, submits a written statement expressing the person’s intent to enroll in such a program for the following term. The exemption from participation shall not continue beyond the beginning of the term, unless verification of enrollment is provided or obtained by the county.
(3) An individual who meets either of the following conditions:
(A) The individual is disabled as determined by a doctor’s verification that the disability is expected to last at least 30 days and that it significantly impairs the recipient’s ability to be regularly employed or participate in welfare-to-work activities, provided that the individual is actively seeking appropriate medical treatment.
(B) The individual is of advanced age.
(4) A nonparent caretaker relative who has primary responsibility for providing care for a child and is either caring for a child who is a dependent or ward of the court or caring for a child in a case in which a county determines the child is at risk of placement in foster care, and the county determines that the caretaking responsibilities are beyond those considered normal day-to-day parenting responsibilities such that they impair the caretaker relative’s ability to be regularly employed or to participate in welfare-to-work activities.
(5) An individual whose presence in the home is required because of illness or incapacity of another member of the household and whose caretaking responsibilities impair the recipient’s ability to be regularly employed or to participate in welfare-to-work activities.
(6) A parent or other relative who meets the criteria in subparagraph (A) or (B).
(A) (i) The parent or other relative has primary responsibility for personally providing care to a child six months of age or under, except that, on a case-by-case basis, and based on criteria developed by the county, this period may be reduced to the first 12 weeks after the birth or adoption of the child, or increased to the first 12 months after the birth or adoption of the child. An individual may be exempt only once under this clause.
(ii) An individual who received an exemption pursuant to clause (i) shall be exempt for a period of 12 weeks, upon the birth or adoption of any subsequent children, except that this period may be extended on a case-by-case basis to six months, based on criteria developed by the county.
(iii) In making the determination to extend the period of exception under clause (i) or (ii), the following may be considered:
(I) The availability of childcare.
(II) Local labor market conditions.
(III) Other factors determined by the county.
(iv) Effective January 1, 2013, the parent or other relative has primary responsibility for personally providing care to one child from birth to 23 months, inclusive. The exemption provided for under this clause shall be available in addition to any other exemption provided for under this subparagraph. An individual may be exempt only once under this clause.
(B) In a family eligible for aid under this chapter due to the unemployment of the principal wage earner, the exemption criteria contained in subparagraph (A) shall be applied to only one parent.
(7) A recipient who is pregnant. A pregnant recipient may volunteer to participate in welfare-to-work activities.
(c) Any individual not required to participate may choose to participate voluntarily under this article, and end that participation at any time without loss of eligibility for aid under this chapter, if the individual’s status has not changed in a way that would require participation.
(d) (1) Notwithstanding subdivision (a), a custodial parent who is under 20 years of age and who has not earned a high school diploma or its equivalent, and who is not exempt or whose only basis for exemption is paragraph (1), (2), (5), (6), (7), or (8) of subdivision (b), shall be required to participate solely for the purpose of earning a high school diploma or its equivalent. During the time that Article 3.5 (commencing with Section 11331) is operative, this subdivision shall only apply to a custodial parent who is 19 years of age.
(2) Section 11325.25 shall apply to a custodial parent who is 18 or 19 years of age and who is required to participate under this article.
(e) Notwithstanding paragraph (1) of subdivision (d), the county may determine that participation in education activities for the purpose of earning a high school diploma or equivalent is inappropriate for a custodial parent who is 18 or 19 years of age only if that parent is reassigned pursuant to an evaluation under Section 11325.25, or, at appraisal is already in an educational or vocational training program that is approvable as a self-initiated program as specified in Section 11325.23. If that determination is made, the parent shall be allowed to continue participation in the self-initiated program subject to Section 11325.23. During the time that Article 3.5 (commencing with Section 11331) is operative, this subdivision shall only apply to a custodial parent who is 19 years of age.
(f) A recipient shall be excused from participation for good cause when the county has determined there is a condition or other circumstance that temporarily prevents or significantly impairs the recipient’s ability to be regularly employed or to participate in welfare-to-work activities. The county welfare department shall review the good cause determination for its continuing appropriateness in accordance with the projected length of the condition, or circumstance, but not less than every three months. The recipient shall cooperate with the county welfare department and provide information, including written documentation, as required to complete the review. Conditions that may be considered good cause include, but are not limited to, the following:
(1) Lack of necessary supportive services.
(2) In accordance with Article 7.5 (commencing with Section 11495), the applicant or recipient is a victim of domestic violence, but only if participation under this article is detrimental to or unfairly penalizes that individual or their family.
(3) Licensed or license-exempt childcare for a child 10 years of age or younger is not reasonably available during the individual’s hours of training or employment including commuting time, or arrangements for childcare have broken down or have been interrupted, or childcare is needed for a child who meets the criteria of subparagraph (C) of paragraph (1) of subdivision (a) of Section 11323.2, but who is not included in the assistance unit. For purposes of this paragraph, “reasonable availability” means childcare that is commonly available in the recipient’s community to a person who is not receiving aid and that is in conformity with the requirements of Public Law 104-193. The choices of childcare shall meet either licensing requirements or the requirements of Section 11324. This good cause criterion shall include the unavailability of suitable special needs childcare for children with identified special needs, including, but not limited to, disabilities or chronic illnesses.

SEC. 7.

 Section 14132.24 is added to the Welfare and Institutions Code, to read:

14132.24.
 (a) No later than April 1, 2022, and until December 31, 2023, the Department of Health Care Services shall convene a workgroup to examine the implementation of the doula benefit provided under the Medi-Cal program. The workgroup shall be comprised of doulas, health care providers, consumer and community advocates, health plans, county representatives, and other stakeholders with experience with doula services as determined by the department.
(b) The workgroup shall consider all of the following:
(1) Ensuring that doula services are available to Medi-Cal beneficiaries who are eligible for and want doula services.
(2) Minimizing barriers and delays in payments to a Medi-Cal doula or in reimbursement to Medi-Cal recipients for doula services received.
(3) Making recommendations for outreach efforts so that all Medi-Cal recipients within the eligible and other target populations are aware of the option to use doula services.
(c) (1) No later than July 1, 2024, the department shall publish a report that provides the number of Medi-Cal recipients utilizing doula services, broken down by race, ethnicity, primary language, health plan, and county. The report shall also identify any barriers that impede access to doula services in the prenatal, labor and delivery, and postpartum periods and make recommendations to the department and the Legislature to reduce any identified barriers.
(2) The report shall provide a numerical comparison in the birthing outcomes of Medi-Cal recipients who receive doula services with those who do not, including, but not limited to, rates of cesarean delivery births, maternal or infant mortality, other maternal morbidity, and, to the extent available through information voluntarily provided by the Medi-Cal recipient, breast and chest feeding outcomes.
(3) The report shall utilize standard public health reporting practices for accurate dissemination of these data elements, especially with regard to the reporting of small numbers so as to avoid inadvertently risking a breach of confidentiality or other disclosure.
(4) The department shall post this report on its internet website.
(d) This section shall remain in effect only until January, 1, 2025, and as of that date is repealed. The repeal of this section shall not prevent the department from continuing to convene the workgroup referenced in subdivision (a) or issuing reports referenced in subdivision (c), should the department determine that either activity is helpful or necessary in order to monitor, evaluate, or expand access to Medi-Cal doula services.

SEC. 8.

 No appropriation made pursuant to Section 15200 of the Welfare and Institutions Code shall be made for purposes of this act.

SEC. 9.

 The Legislature finds and declares that Sections 3 and 4 of this act, which add Sections 123636 and 123660 to the Health and Safety Code, impose a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
In order to protect the confidential identity and information of persons who are the subject of, or a part of, a maternal death review or fetal and infant mortality review, it is necessary to ensure that this confidential information is protected from the public.

SEC. 10.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.