PRINTER'S NO. 3574
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2136
Session of
2024
INTRODUCED BY CURRY, MAYES, VENKAT, KAZEEM, KINSEY, PROBST,
O'MARA, WAXMAN, HOHENSTEIN, KHAN, CEPHAS, ISAACSON,
SHUSTERMAN, BOYD, ROZZI, BOROWSKI, HILL-EVANS, DONAHUE,
SANCHEZ, CEPEDA-FREYTIZ, D. WILLIAMS, FLEMING, SCHLOSSBERG,
OTTEN, CERRATO, DALEY, HANBIDGE AND GREEN, AUGUST 21, 2024
REFERRED TO COMMITTEE ON HEALTH, AUGUST 21, 2024
AN ACT
Providing for Maternal Care Access Program; and imposing duties
on the Department of Health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Maternal Care
Access Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"At-risk." A geographic area that has a limited number of
hospitals providing obstetric care, birth centers, obstetrician
gynecologists and certified nurse midwives.
"Average childbearing age." Women of ages ranging from 10 to
60 years of age.
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"Birth center." An entity licensed as a birth center under
the act of July 19, 1979 (P.L.130, No.48), known as the Health
Care Facilities Act.
"Department." The Department of Health of the Commonwealth.
"Distressed hospital." A hospital that:
(1) had a negative profit margin for at least the
previous three consecutive calendar years; and
(2) is located more than 25 miles of travel distance on
a roadway from another hospital located in this Commonwealth.
"Health care provider." As defined in section 103 of the act
of March 20, 2002 (P.L.154, No.13), known as the Medical Care
Availability and Reduction of Error (Mcare) Act.
"Hospital." As defined in section 802.1 of the Health Care
Facilities Act.
"Maternal Health Index." The following factors:
(1) Prepregnancy obesity.
(2) Prepregnancy diabetes.
(3) Prepregnancy hypertension.
(4) Prenatal care initiation in the first trimester.
(5) Cigarette smoking.
(6) Behavioral health factors.
"Maternal Vulnerability Index." The measure of 43 county-
level social indicators, as published in the August 20, 2021,
report, updated June 22, 2022, entitled Getting Hyperlocal to
Improve Outcomes & Achieve Racial Equity in Maternal Health: The
U.S. Maternal Vulnerability Index, published by Surgo Ventures.
"Maternity care desert." An area that does not have any of
the following:
(1) Hospitals providing obstetric care.
(2) Birth centers.
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(3) Obstetrician gynecologists.
(4) Certified nurse midwives.
"Maternity emergency services." Care provided by a health
care provider to a pregnant or postpartum patient as a result of
one or more of the following symptoms:
(1) Chest pain.
(2) Decrease in fetal movement.
(3) Dizziness.
(4) Vomiting.
(5) Heavy vaginal bleeding.
(6) Loss of consciousness.
(7) Seizures.
(8) Severe abdominal pain or cramping.
(9) Severe headache.
(10) Sudden, spontaneous delivery.
(11) Sudden swelling in the arms, legs or face.
(12) Sudden changes in vision.
(13) Shortness of breath.
(14) High blood pressure.
"Program." The Maternal Care Access Program established
under section 3.
"Social Vulnerability Index." The use of United States
Census Bureau factors, as used by the Centers for Disease
Control and Prevention, as follows:
(1) Percentage of population unemployed.
(2) Percentage of population without a high school
diploma.
(3) Percentage of population without health insurance.
(4) Percentage of population below 150% of the poverty
rate.
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(5) Percentage of households 65 years of age and older.
(6) Percentage of households aged 17 and younger.
(7) Percentage of households with individuals with a
disability.
(8) Percentage of single-parent households.
(9) English language proficiency.
(10) Racial and ethnic minority population.
(11) Number of mobile homes.
(12) Number of multiunit housing structures.
(13) Number of households without a vehicle.
(14) Housing crowding.
(15) Group quarters.
"Zone." A maternal care access zone established under
section 4.
Section 3. Maternal Care Access Program.
(a) Establishment.--The Maternal Care Access Program is
established in the department for the purpose of identifying
counties in this Commonwealth that would benefit from increased
access to skilled and licensed maternal health care providers
and resources to improve maternal health outcomes. The
department may promulgate regulations necessary for the
implementation of the program.
(b) Oversight.--The department may assign oversight
authority of the program to another office or program in the
department.
(c) Program resources.--The program may only distribute
resources to birth centers, obstetrician gynecologists,
certified nurse midwives or county health departments or
hospitals providing obstetric care in zones designated in this
act.
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Section 4. Maternal care access zones.
(a) Designation.--A county that meets the specified
qualifications in this section may be designated by the
department as a zone. The department may determine whether a
zone is considered at-risk or a maternity care desert.
(b) Qualifications.--The department shall consider the
following criteria when designating a zone as either at-risk or
a maternity care desert:
(1) The ratio of females of average childbearing age to
full-time equivalent maternity care health professionals.
(2) The percentage of females of average childbearing
age with income at or below 200% of the Federal poverty
level.
(3) Travel time and distance to the nearest provider
trained and licensed to provide the necessary care, and 9.7
miles and above constitutes an at-risk or maternity care
desert.
(4) The Social Vulnerability Index.
(5) Lack of maternity emergency services.
(6) The Maternal Health Index.
(7) The number of distressed hospitals in the area.
(8) The number of health care providers of color in the
area.
(9) The maternal mortality rate.
(10) The percentage of births covered by Medicaid.
(11) The number of birth centers in the area.
(12) Total obstetrician gynecologists in the area.
(13) The number of certified nurse midwives in the area.
(14) The Maternal Vulnerability Index.
(15) The number of births per day in the area and the
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number of skilled and licensed maternal health care providers
per birth.
(c) Scoring.--The department shall provide scoring for all
counties in this Commonwealth based on the criteria specified in
this section. The scoring of criteria shall determine the need
for designation as a zone and whether a zone is considered to be
at-risk or a maternity care desert. An at-risk county shall have
a lower score and a maternity care desert shall have a higher
score. The department shall determine the scoring parameters.
(d) Reporting.--A hospital shall report the criteria under
this section to the appropriate county health department or the
department. The county health department shall report the
criteria under this section to the department.
Section 5. Regions.
(a) Establishment.--The following regions are established
throughout this Commonwealth for the purpose of resource
distribution:
(1) Region 1 shall consist of Cameron, Clarion,
Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango,
and Warren Counties.
(2) Region 2 shall consist of Allegheny, Armstrong,
Beaver, Butler, Cambria, Fayette, Greene, Indiana, Jefferson,
Lawrence, Somerset, Washington and Westmoreland Counties.
(3) Region 3 shall consist of Adams, Bedford,
Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata,
Lancaster, Lebanon, Mifflin, Perry and York Counties.
(4) Region 4 shall consist of Blair, Bradford, Centre,
Clearfield, Clinton, Columbia, Lycoming, Montour,
Northumberland, Snyder, Tioga, Union and Sullivan Counties.
(5) Region 5 shall consist of Carbon, Lackawanna,
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Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill,
Susquehanna, Wyoming and Wayne Counties.
(6) Region 6 shall consist of Berks, Bucks, Chester,
Delaware, Montgomery and Philadelphia Counties.
(b) Resource distribution.--The department must equitably
distribute resources to regions as specified in this section.
Section 6. Effective date.
This act shall take effect in 180 days.
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