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Article 3. Community-based Perinatal System of California Health And Safety Code >> Division 106. >> Part 2. >> Chapter 2. >> Article 3.
The Legislature finds that a community-based system of
comprehensive perinatal care, including prenatal care, delivery
service, postpartum care, and neonatal and infant care are necessary
services that have been demonstrated effective in preventing or
reducing maternal, perinatal, and infant mortality and morbidity.
It is the intent of the Legislature in enacting this
article to maintain, to the extent resources are available, a
permanent statewide community-based comprehensive perinatal system to
provide care and services to low-income pregnant women and their
infants who are considered underserved in terms of comprehensive
perinatal care.
It is also the intent of the Legislature that the statewide,
community-based, comprehensive perinatal health care program be
developed by the department to conform with the guidelines set forth
in this article, and be integrated and coordinated with the perinatal
access program in Article 2.5 (commencing with Section 288).
It is further the intent of the Legislature that these guidelines
allow each applicant the flexibility to design a system specific to
the nature of the community and the needs of the clients.
It is further the intent of the Legislature that the director, in
allocating funds available for programs that provide comprehensive
perinatal care, follow the guidelines and principles developed in
this article.
The following definitions shall govern the construction of
this article:
(a) "Community-based comprehensive perinatal care" means a range of prenatal, delivery, postpartum, infant, and pediatric care services delivered in an urban community or neighborhood, rural area, city or county clinic, city or county health department, freestanding birth center, or other health care provider facility by health care practitioners trained in methods of preventing complications and problems during and after pregnancy, and in methods of educating pregnant women of these preventive measures, and who provide a continuous range of services. The health care practitioners shall, through a system of established linkages to other levels of care in the community, consult with, and, when appropriate, refer to, specialists.
(b) "Low income" means all persons of childbearing age eligible for Medi-Cal benefits under Chapter 7 (commencing with Section 14000) and all persons eligible for public social services for which federal reimbursement is available, including potential recipients. "Potential recipients" shall include the pregnant woman and her infant in a family where current social, economic and health conditions of the family indicate that the family would likely become a recipient of financial assistance within the next five years.
(c) "Prenatal care" means care received from conception until the completion of labor and delivery.
(d) "Perinatal care" means care received from the time of conception through the first year after birth.
(e) "Qualified organization" means any nonprofit, not-for-profit, or for-profit corporation with demonstrated expertise in implementing the Nurse-Family Partnership program or similar programs in different local settings.
(f) "Qualified trainer" means anyone who has been certified by the Nurse-Family Partnership to provide training.
(g) "Department" means the State Department of Public Health, unless otherwise designated.
(a) "Community-based comprehensive perinatal care" means a range of prenatal, delivery, postpartum, infant, and pediatric care services delivered in an urban community or neighborhood, rural area, city or county clinic, city or county health department, freestanding birth center, or other health care provider facility by health care practitioners trained in methods of preventing complications and problems during and after pregnancy, and in methods of educating pregnant women of these preventive measures, and who provide a continuous range of services. The health care practitioners shall, through a system of established linkages to other levels of care in the community, consult with, and, when appropriate, refer to, specialists.
(b) "Low income" means all persons of childbearing age eligible for Medi-Cal benefits under Chapter 7 (commencing with Section 14000) and all persons eligible for public social services for which federal reimbursement is available, including potential recipients. "Potential recipients" shall include the pregnant woman and her infant in a family where current social, economic and health conditions of the family indicate that the family would likely become a recipient of financial assistance within the next five years.
(c) "Prenatal care" means care received from conception until the completion of labor and delivery.
(d) "Perinatal care" means care received from the time of conception through the first year after birth.
(e) "Qualified organization" means any nonprofit, not-for-profit, or for-profit corporation with demonstrated expertise in implementing the Nurse-Family Partnership program or similar programs in different local settings.
(f) "Qualified trainer" means anyone who has been certified by the Nurse-Family Partnership to provide training.
(g) "Department" means the State Department of Public Health, unless otherwise designated.
(a) The department shall develop and maintain a statewide
comprehensive community-based perinatal services program and enter
into contracts, grants, or agreements with health care providers to
deliver these services in a coordinated effort to the extent
permitted under federal law and regulation. These contracts, grants,
or agreements shall be made in medically underserved areas or areas
with demonstrated need. Nothing in this section shall be construed to
prevent reallocation of resources or use of new moneys for the
development of new community-based comprehensive perinatal systems in
underserved areas or areas with demonstrated need, and
supplementation of systems already in existence.
(b) As a condition of receiving funds from the Maternal and Child Health program, contractors shall bill the Medi-Cal program for services provided to Medi-Cal recipients.
(b) As a condition of receiving funds from the Maternal and Child Health program, contractors shall bill the Medi-Cal program for services provided to Medi-Cal recipients.
(a) There is hereby established a voluntary nurse home
visiting grant program for expectant first-time mothers, their
children, and their families, to be administered by the department
pursuant to Section 123492. The program may be cited as the
Nurse-Family Partnership program.
(b) The goals and objectives of the program shall be the same as, but shall not be limited to, those in the community-based comprehensive perinatal health care system as set forth in Section 123505.
(c) The department shall adopt regulations for the implementation of this section in accordance with Section 123516.
(b) The goals and objectives of the program shall be the same as, but shall not be limited to, those in the community-based comprehensive perinatal health care system as set forth in Section 123505.
(c) The department shall adopt regulations for the implementation of this section in accordance with Section 123516.
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 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 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 child's 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 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 visitor's caseload to no more than 25 active families at any given time.
(i) Provide for every eight nurse home visitors a full-time nurse supervisor who holds at least a bachelor's 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) 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) Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(m) 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) 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) Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(p) Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
(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 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 child's 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 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 visitor's caseload to no more than 25 active families at any given time.
(i) Provide for every eight nurse home visitors a full-time nurse supervisor who holds at least a bachelor's 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) 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) Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.
(m) 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) 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) Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.
(p) Prohibit the use of moneys received for the program as a match for grants currently administered by the department.
(a) The department may accept voluntary contributions, in
cash or in-kind, to pay for the costs in the implementation of the
program under Section 123492. These private donations shall be
deposited into the California Families and Children Account, which is
hereby created in the State Treasury, in which, notwithstanding
Section 13340 of the Government Code, is hereby continuously
appropriated to the department for purposes of implementing Section
123492. No state funds shall be used in implementing Section 123492.
(b) The department shall only distribute grants established under Section 123492 if the Director of Finance determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the program.
(c) The department's administration costs shall not exceed 5 percent of the moneys in the account created under subdivision (a). Any costs to the department incurred prior to the account receiving funds shall be reimbursed to the department from funds in the account.
(d) The department shall not apply for grants or solicit private funds.
(e) If, as of January 1, 2009, the Director of Finance determines pursuant to subdivision (a) that there are insufficient funds on deposit in the account to implement the voluntary nurse home visiting grant program, the account shall cease to exist.
(b) The department shall only distribute grants established under Section 123492 if the Director of Finance determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the program.
(c) The department's administration costs shall not exceed 5 percent of the moneys in the account created under subdivision (a). Any costs to the department incurred prior to the account receiving funds shall be reimbursed to the department from funds in the account.
(d) The department shall not apply for grants or solicit private funds.
(e) If, as of January 1, 2009, the Director of Finance determines pursuant to subdivision (a) that there are insufficient funds on deposit in the account to implement the voluntary nurse home visiting grant program, the account shall cease to exist.
(a) The department shall seek any federal waiver or waivers
that may be necessary to maximize funds from the federal government
including, but not limited to, funds provided under Title 19 of the
Social Security Act to provide funds for a full range of preventive
perinatal services.
(b) The department shall, in preparing its budget for submission each year, coordinate all funding sources intended primarily for perinatal care made available through the Budget Act to maximize the delivery of perinatal care services and to avoid duplication of programs and funding.
(c) The department shall develop and implement a uniform sliding fee schedule for women provided perinatal care through the perinatal services program. The fee schedule shall be based on family size and income, but in no case shall the fee exceed the actual cost of the services provided. The department shall not implement any schedule developed pursuant to this section sooner than 30 days after the department has provided the chairperson of the Joint Legislative Budget Committee and the chairperson of the fiscal committee of each house with the developed schedule. All free clinics, as defined in paragraph (2) of subdivision (a) of Section 1204 shall be exempt from this subdivision. All organizations funded under the Public Health Service Act, Sections 254b and 254c of Title 42 of the United States Code, shall be permitted to utilize those sliding fee scales mandated by federal law or regulation in lieu of the sliding fee scale adopted by the department.
(b) The department shall, in preparing its budget for submission each year, coordinate all funding sources intended primarily for perinatal care made available through the Budget Act to maximize the delivery of perinatal care services and to avoid duplication of programs and funding.
(c) The department shall develop and implement a uniform sliding fee schedule for women provided perinatal care through the perinatal services program. The fee schedule shall be based on family size and income, but in no case shall the fee exceed the actual cost of the services provided. The department shall not implement any schedule developed pursuant to this section sooner than 30 days after the department has provided the chairperson of the Joint Legislative Budget Committee and the chairperson of the fiscal committee of each house with the developed schedule. All free clinics, as defined in paragraph (2) of subdivision (a) of Section 1204 shall be exempt from this subdivision. All organizations funded under the Public Health Service Act, Sections 254b and 254c of Title 42 of the United States Code, shall be permitted to utilize those sliding fee scales mandated by federal law or regulation in lieu of the sliding fee scale adopted by the department.
The department shall monitor the delivery of services under
contracts, grants, and agreements provided for in this article
through a uniform health data collection system that utilizes
epidemiologic methodology. The department may collect data from
providers receiving funds through this program as necessary to
evaluate program effectiveness.
The goals of the community-based comprehensive perinatal
health care system shall be:
(a) To decrease and maintain the decreased level of perinatal, maternal, and infant mortality and morbidity in the State of California.
(b) To support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants.
(a) To decrease and maintain the decreased level of perinatal, maternal, and infant mortality and morbidity in the State of California.
(b) To support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants.
The program objectives of the community-based comprehensive
perinatal health care system shall be the following:
(a) To ensure continuing availability and accessibility to early prenatal care within the areas presently served and to develop a community-based comprehensive perinatal system in other areas of the state that are medically underserved or have demonstrated need.
(b) To assure the appropriate level of maternal, newborn and pediatric care services necessary to provide the healthiest outcome for mother and infant.
(c) To ensure postpartum, family planning, and followup care through the first year of life, and referral to an ongoing primary health care provider.
(d) To include support and ancillary services such as nutrition, health education, public health nursing, and social work that have been demonstrated to decrease maternal, perinatal, and infant mortality and morbidity, as components of comprehensive perinatal care.
(e) To ensure that care shall be available regardless of the patient's financial situation.
(f) To ensure, to the extent possible, that the same quality of care shall be available to all pregnant women.
(g) To promote program flexibility by recognizing the needs within an area and providing for unique programs to meet those needs.
(h) To emphasize preventive health care as a major component of any perinatal program, and to support outreach programs directed at low-income pregnant women that will encourage early entry into, and appropriate utilization of, the perinatal health care system.
(a) To ensure continuing availability and accessibility to early prenatal care within the areas presently served and to develop a community-based comprehensive perinatal system in other areas of the state that are medically underserved or have demonstrated need.
(b) To assure the appropriate level of maternal, newborn and pediatric care services necessary to provide the healthiest outcome for mother and infant.
(c) To ensure postpartum, family planning, and followup care through the first year of life, and referral to an ongoing primary health care provider.
(d) To include support and ancillary services such as nutrition, health education, public health nursing, and social work that have been demonstrated to decrease maternal, perinatal, and infant mortality and morbidity, as components of comprehensive perinatal care.
(e) To ensure that care shall be available regardless of the patient's financial situation.
(f) To ensure, to the extent possible, that the same quality of care shall be available to all pregnant women.
(g) To promote program flexibility by recognizing the needs within an area and providing for unique programs to meet those needs.
(h) To emphasize preventive health care as a major component of any perinatal program, and to support outreach programs directed at low-income pregnant women that will encourage early entry into, and appropriate utilization of, the perinatal health care system.
In processing and awarding contracts, grants, or agreements
pursuant to this article, the department shall evaluate the ability
of applicants to meet, to the maximum extent possible, the following
criteria:
(a) The applicant's prior experience in providing community-based, comprehensive perinatal care and services to low-income women and infants.
(b) The applicant's ability to provide comprehensive perinatal care, either directly or through subcontract. Those services comprising comprehensive perinatal care include, but are not limited to, the following:
(1) Initial and ongoing physical assessment.
(2) Psychosocial assessments and counseling, and referral when appropriate.
(3) Nutrition assessments, counseling and referral to counseling on food supplement programs, vitamins, and breast-feeding.
(4) Health educational assessments, and intervention and referral, including childbirth preparation and parenting.
(5) Outreach and community education.
(6) Laboratory, radiology, and other specialized services as indicated.
(7) Delivery, postpartum followup, and pediatric care through the first year of life.
(c) The quality of care that is being, or has been provided to low-income women and infants by health care providers.
(d) Whether the area that is, or that will be, serviced by the applicant is medically underserved or has otherwise demonstrated the need for comprehensive, community-based perinatal services.
(e) The applicant's ability to use an appropriate multidisciplinary staff working as a team, in consultation with obstetricians, pediatricians, and family practitioners when appropriate, to provide a full range of comprehensive perinatal care services. Staffing patterns shall reflect, to the maximum extent feasible, at all levels, the cultural, linguistic, ethnic, and other social characteristics of the community served. This staff shall include at least one of those persons described in paragraphs (1) to (3), inclusive, of this subdivision, as follows, and may include, but not be limited to, a combination of those persons described in paragraphs (4) to (10), inclusive, of this subdivision, as follows:
(1) An obstetrician.
(2) A pediatrician.
(3) A family practice physician.
(4) Certified nurse midwives, public health nurses, nurse practitioners, or physician assistants.
(5) Nutritionists.
(6) Social workers.
(7) Health and childbirth educators.
(8) A family planning counselor.
(9) Community outreach peer workers.
(10) A translator.
(a) The applicant's prior experience in providing community-based, comprehensive perinatal care and services to low-income women and infants.
(b) The applicant's ability to provide comprehensive perinatal care, either directly or through subcontract. Those services comprising comprehensive perinatal care include, but are not limited to, the following:
(1) Initial and ongoing physical assessment.
(2) Psychosocial assessments and counseling, and referral when appropriate.
(3) Nutrition assessments, counseling and referral to counseling on food supplement programs, vitamins, and breast-feeding.
(4) Health educational assessments, and intervention and referral, including childbirth preparation and parenting.
(5) Outreach and community education.
(6) Laboratory, radiology, and other specialized services as indicated.
(7) Delivery, postpartum followup, and pediatric care through the first year of life.
(c) The quality of care that is being, or has been provided to low-income women and infants by health care providers.
(d) Whether the area that is, or that will be, serviced by the applicant is medically underserved or has otherwise demonstrated the need for comprehensive, community-based perinatal services.
(e) The applicant's ability to use an appropriate multidisciplinary staff working as a team, in consultation with obstetricians, pediatricians, and family practitioners when appropriate, to provide a full range of comprehensive perinatal care services. Staffing patterns shall reflect, to the maximum extent feasible, at all levels, the cultural, linguistic, ethnic, and other social characteristics of the community served. This staff shall include at least one of those persons described in paragraphs (1) to (3), inclusive, of this subdivision, as follows, and may include, but not be limited to, a combination of those persons described in paragraphs (4) to (10), inclusive, of this subdivision, as follows:
(1) An obstetrician.
(2) A pediatrician.
(3) A family practice physician.
(4) Certified nurse midwives, public health nurses, nurse practitioners, or physician assistants.
(5) Nutritionists.
(6) Social workers.
(7) Health and childbirth educators.
(8) A family planning counselor.
(9) Community outreach peer workers.
(10) A translator.
(a) The department, in consultation with the program
administrators, may contract with one or more qualified organizations
to assist the department in ensuring that grantees implement the
program as established under Section 123491 and to conduct an annual
evaluation of the implementation of the grant program on a statewide
basis. The first evaluation shall be due 12 months after the award of
grants pursuant to Section 123492.
(b) (1) In conducting its monitoring and evaluation activities, the department shall be guided by program performance standards developed by the department in consultation with the Nurse-Family Partnership program.
(2) The annual evaluation shall contain, but not be limited to, the extent to which each grantee participating in the program has done each of the following:
(A) Recruited a population of low-income, first-time mothers.
(B) Enrolled families early in pregnancy and followed them through the second birthday of the child.
(C) Conducted visits that are of comparable frequency, duration, and content as those delivered in the randomized clinical trials of the program.
(D) Assessed the health and well-being of the mothers and children enrolled in the program according to common indicators of maternal, child, and family health.
(b) (1) In conducting its monitoring and evaluation activities, the department shall be guided by program performance standards developed by the department in consultation with the Nurse-Family Partnership program.
(2) The annual evaluation shall contain, but not be limited to, the extent to which each grantee participating in the program has done each of the following:
(A) Recruited a population of low-income, first-time mothers.
(B) Enrolled families early in pregnancy and followed them through the second birthday of the child.
(C) Conducted visits that are of comparable frequency, duration, and content as those delivered in the randomized clinical trials of the program.
(D) Assessed the health and well-being of the mothers and children enrolled in the program according to common indicators of maternal, child, and family health.
(a) In developing a comprehensive system, health care
providers funded under this article may perform the following
activities to ensure that a full range of program components of a
comprehensive, community-based health care system are available,
accessible, and utilized by pregnant women and infants:
(1) Coordinate specific linkages with one another.
(2) Subcontract the services specified in this article.
(3) Provide additional services not specifically listed in this article. These additional services shall include, but shall not be limited to the Women, Infants, and Children (WIC) food supplement program, services offered by local health departments, and public and private social welfare agencies. Nothing contained in this article shall be construed to prohibit a subcontractor from being reimbursed pursuant to a fee for service, capitation, or other payment mechanism.
(b) All services and educational materials shall be provided in the primary languages of the clients served, provided that there are at least 5 percent or 100 persons, whichever is less, of the total beneficiary population served annually by each facility, who share language other than English and who are limited-English speaking. "Limited-English speaking" means a person who uses a language other than English in order to communicate effectively.
(c) Health care providers applying for a contract, grant, or agreement under this article shall indicate the manner in which their service elements will be coordinated with existing community resources and services and with hospitals of all levels in the area to ensure each client receives the appropriate level or care at the appropriate time. The department may require written agreements between contractors and hospital or hospitals in the area regarding delivery services, and protocols for referral and transfer when special treatment services are required. The department may, when requested by the grantee or contractor, assist in achieving coordination and written agreements pertaining to the delivery of these services.
(1) Coordinate specific linkages with one another.
(2) Subcontract the services specified in this article.
(3) Provide additional services not specifically listed in this article. These additional services shall include, but shall not be limited to the Women, Infants, and Children (WIC) food supplement program, services offered by local health departments, and public and private social welfare agencies. Nothing contained in this article shall be construed to prohibit a subcontractor from being reimbursed pursuant to a fee for service, capitation, or other payment mechanism.
(b) All services and educational materials shall be provided in the primary languages of the clients served, provided that there are at least 5 percent or 100 persons, whichever is less, of the total beneficiary population served annually by each facility, who share language other than English and who are limited-English speaking. "Limited-English speaking" means a person who uses a language other than English in order to communicate effectively.
(c) Health care providers applying for a contract, grant, or agreement under this article shall indicate the manner in which their service elements will be coordinated with existing community resources and services and with hospitals of all levels in the area to ensure each client receives the appropriate level or care at the appropriate time. The department may require written agreements between contractors and hospital or hospitals in the area regarding delivery services, and protocols for referral and transfer when special treatment services are required. The department may, when requested by the grantee or contractor, assist in achieving coordination and written agreements pertaining to the delivery of these services.
The provisions contained in this article shall be subject
to the normal Budget Act process and shall be operative to the extent
funds are appropriated for this purpose.
