2019 Prenatal-to-Three Legislative Action Report

3/31/2020

Table of Contents

Overview
Significant 2019 Enactments
Additional Resources
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Early Care and Education Staff

Overview

The National Conference of State Legislatures tracks legislation related to the health and well-being of infants, toddlers and their families. In 2019, we tracked 129 prenatal-to-three bills enacted in 34 states and the District of Columbia.

This report summarizes significant 2019 legislative enactments in the following categories:

Breastfeeding
Home visiting and parent education
Maternal mental health
Infant and maternal mortality
Neonatal abstinence syndrome
Newborn screenings
Other

This report does not include all appropriations bills; however, it does highlight those that contain substantive policy enactments or focus on a specific program model.

Bar Chart | Map

2019 Prenatal-to-Three Legislative Action

The graph below illustrates the volume of legislation enacted in 2019 by topic. Place your mouse over the columns for details.

2019 Prenatal-to-Three Legislative Action

All Prenatal-to-Three Bills	129
Breastfeeding	31
Home Visiting	4
Maternal Mental Health	13
Infant and Maternal Mortality	48
Neonatal Abstinence Syndrome	4
Newborn Screenings	13
Other	15

Enacted Bills by Topic Map

Breastfeeding

State	Bill	Summary
Arkansas	SB 441	Requires advertising and marketing for medical marijuana to include certain warnings, including the potential harms to an unborn child or child through marijuana use while pregnant or breastfeeding.
California	AB 752	Requires specific multimodal transit stations that begin construction or a renovation on or after Jan. 1, 2021, to include a lactation room.
	SB 142	Requires an employer to provide a lactation room or location that includes prescribed features, including access to a sink and refrigerator in close proximity to the employee's workspace.
Colorado	SB 224	Allows the state agency in charge of licensing cannabis dispensaries to seek the assistance of the department of public health and environment on a range of issues, including the design of a warning sign for pregnant and breastfeeding women on the risks of using cannabis.
Connecticut	HB 7165	Provides Medicaid reimbursement for donor breast milk deemed medically necessary.
Illinois	HB 1438	Requires businesses selling marijuana to display signage discouraging the use of marijuana by pregnant and breastfeeding women.
	HB 2444	Expands the factors considered in favor of withholding or minimizing a sentence of imprisonment to include whether the defendant is the parent of a child or infant whose well-being will be negatively affected by the parent's absence, including if the child is breastfeeding.
	HB 3509	Allows donated human breast milk to be covered under health insurance and the state’s medical assistance program. Requires a prescription for donated human breast milk by a licensed medical practitioner and removes a requirement that the infant must be critically ill. Requires that milk be obtained from a human milk bank that meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health.
Kentucky	SB 18	Requires employers to make reasonable accommodations for any employee with limitations related to pregnancy, childbirth or related medical condition, including lactation. Requires employers to notify employees regarding their right to be free from discrimination for pregnancy, childbirth and related medical conditions.
Maine	LD 666/HP 487	Stipulates failure by an employer to provide a reasonable accommodation for an employee's pregnancy-related condition, including childbirth, related medical conditions and lactation, constitutes unlawful employment discrimination.
Minnesota	SB 12	Creates grants to educate the public on the dangers of skin lightening products, including the risks to infants, pregnant and breastfeeding women. Establishes May as Maternal Mental Health Month.
New Jersey	AB 314	Restricts use of isolated confinement in correctional facilities based on several criterion, including pregnancy or breastfeeding status.
	AB 5509	Requires health benefits coverage for breastfeeding support.
	AR 244	Urges the president and Congress to enact a law prohibiting an airline from counting breast milk or breast pumps against an airline's carry-on limit or restricting passengers from carrying breast milk onto aircraft.
	AR 245	Urges certain airline companies to change policies to allow passengers to carry breast pumps and breast milk onto aircraft without counting against carry-on limits.
	SB 104	Increases protections against employer discrimination based on several criterion, including pregnancy or breastfeeding status.
	SB 1735	Requires certain public facilities and offices to provide an on-site lactation room; requires the Department of Health to provide information about lactation room availability and requires the Department of Education to provide information on lactation policies in schools.
	SB 3805	Requires health benefits coverage for breastfeeding support.
New Mexico	SB 124	Requires correctional facilities to develop and implement breastfeeding policies for lactating inmates.
	SB 192	Requires courts to consider pregnancy or lactation when determining eligibility for release, bond and in the computation of good time credit. Enacts a presumption in favor of release for a person who is pregnant or lactating and requires a pregnant or lactating person released shall then be placed on the least restrictive conditions of release necessary to ensure return to custody.
New York	SB 748	Allows for an exemption from jury duty for breastfeeding women.
	SB 3387	Removes requirement for a referral prior to receiving lactation counseling services. Expands definition of qualified lactation care provider.
Oregon	HB 2341	Stipulates failure by an employer to provide a reasonable accommodation for an employee's pregnancy-related condition—including childbirth, related medical conditions and lactation—constitutes unlawful employment discrimination.
	HB 2593	Requires employers to provide lactating employees a reasonable rest period to express milk each time the employee has a need to express milk.
	SB 29	Makes changes to the licensure of lactation consultants and public disclosure policy for people who receive services from a lactation consultant.
Texas	HB 475	Includes infant nutrition and the importance of breastfeeding in a list of information to be disseminated by the Department of Health to foster children and other minors who are pregnant.
	HB 541	Relates to the right to express breast milk, provides that a mother is entitled to breastfeed her baby or express breast milk in any location in which the mother's presence is otherwise authorized to be.
Virginia	HB 1916	Develops state personnel policies that provide break time for nursing mothers to express breast milk.
	SJR 298	Designates August as Breastfeeding Awareness Month.
Washington	HB 1930	Revises provisions relating to the expression of breast milk in the workplace, and expands the definition of reasonable accommodation to provide reasonable break times for an employee to express breast milk for a certain number of years after a child's birth and provide a private location, other than a bathroom, for such purpose.
West Virginia	SB 1037	Requires a safety insert for medical cannabis to include a warning to pregnant and breastfeeding women about the risks of using cannabis while pregnant or breastfeeding.

Home Visiting and Parent Education

State	Bill	Summary
Nevada	AB 430	Requires the legislative committee on child welfare and juvenile justice to conduct an interim study related to home visitation services in the state. Requires a report with findings and recommendations.
New Hampshire	SB 274	Requires the newborn home visiting program to be made available to all Medicaid-eligible children and pregnant women without restriction.
New York	AB 6569	Requires the state Council on Children and Families to develop and make available on its website an internet mapping resource of all home visiting programs that meet certain criteria. Requires that home visiting programs and associated entities provide the information necessary to create such a resource.
Oregon	SB 526	Directs the Oregon Health Authority to design, implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families within the state to support healthy child development and strengthen families.

Maternal Mental Health

State	Bill	Summary
California	AB 577	Requires health care service plans to provide for the completion of covered services for up to 12 months for a person with written documentation of a maternal mental health diagnosis from a health care provider.
	AB 845	Requires the Medical Board, in determining the continuing education requirements for physicians and surgeons, to consider including a course in maternal mental health. Requires the board to periodically update any curricula developed pursuant to the bill to account for new research.
	ACR 92	Dedicates May 2019 as Maternal Mental Health Awareness Month.
	SB 104	Extends eligibility for a pregnant person receiving Medicaid or another specified program, and who has been diagnosed with a maternal mental health condition, for a period of one year following the last day of pregnancy.
Colorado	HB 1269	Requires coverage of behavioral, mental health and substance use disorder services, including perinatal maternal counseling, in parity with physical health services provided through private health insurance and Medicaid. Authorizes more providers to provide perinatal maternal counseling.
Georgia	HR 707	Recognizes May 1, 2019, as Maternal Mental Health Day.
Illinois	HB 5	Requires access to substance use and mental health services statewide for pregnant and postpartum women; requires programs are gender-responsive, trauma-informed, serve women and young children and prioritize justice-involved pregnant and postpartum women. Requires health care facilities be capable of transferring women to higher levels of care, while tracking and analyzing information related to their care, maternal morbidity and mortality.
	HB 2438	Amends the Insurance Code by specifying that any mental health condition that occurs during pregnancy or during the postpartum period including, but not limited to, postpartum depression, falls within provisions concerning mental and emotional disorders.
	HB 2897	Requires the Department of Public Health to investigate and apply for federal funding opportunities to support maternal mental health and report on their progress to the legislature.
	HB 3511	Requires the Department of Human Services to develop educational materials for health care professionals and patients about maternal mental health conditions. Requires hospitals to distribute such materials to employees who regularly work with pregnant or postpartum patients and incorporate these materials in any employee training.
	SB 1627	Allows a person to present a meritorious claim for relief from final orders and judgments if able to establish by a preponderance of evidence that the person was suffering from postpartum depression or postpartum psychosis, in addition to other factors.
Pennsylvania	HR 306 / SR 108	Recognizes May 2019 as Postpartum Depression Awareness Month.
Texas	HB 253	Requires the creation of a five-year strategic plan to improve access to postpartum depression screening, referral, treatment and support services.

Infant and Maternal Mortality

State	Bill	Summary
Arkansas	HB 1440	Establishes a maternal mortality review committee.
	HB 1441	Establishes a maternal and perinatal outcomes quality review committee.
Arizona	SB 1040	Establishes an advisory committee on maternal fatalities and morbidity to recommend improvements to information collection concerning the incidence and causes of maternal fatalities and morbidity.
California	SB 464	Identifies implicit bias as a key cause of racial disparities in maternal health outcomes. Requires hospitals, birth centers and clinics that provide perinatal care to implement an evidence-based implicit bias program for all providers involved in perinatal care. Requires health care providers to complete initial basic training through the program and a refresher course every two years thereafter, or on a more frequent basis if deemed necessary by the facility. Requires the facility to provide a certificate of training completion upon request, to accept certificates of completion from other facilities, and to offer training to physicians not directly employed by the facility. Requires the state Department of Public Health to track and publish data on pregnancy-related death and severe maternal morbidity.
Colorado	HB 1122	Establishes a maternal mortality review committee to identify the causes of maternal mortality and develop recommendations to address preventable maternal deaths, including legislation, policies, rules and best practices.
District of Columbia	B 468 / B 469	Requires the Office of the Chief Medical Examiner to investigate all maternal mortalities occurring in the District of Columbia.
	R 484	Declares an emergency and the need to require the Office of the Chief Medical Examiner to investigate all maternal mortalities occurring in the District of Columbia.
Delaware	HCR 29	Recognizes April 11-17, 2019, as Black Maternal Health Awareness Week.
Georgia	HR 89	Creates the House Study Committee on Maternal Mortality; requires committee membership include a certain number of African American female legislators
Idaho	HB 109	Establishes a maternal mortality review committee to investigate causes and factors associated with deaths relating to pregnancy or childbirth.
Illinois	HB 1	Creates the Task Force on Infant and Maternal Mortality Among African Americans; stipulates membership requirements and requires an annual report with recommendations. Requires the Department of Public Health to provide technical support and assistance.
	HB 3	Requires the Department of Public Health to collect information regarding preterm birth, infant mortality, and maternal mortality and to use it to illustrate the disparity of those occurrences across different racial and ethnic groups; removes a provision that requires hospitals to report such disparities.
	HB 2895	Requires the Department of Public Health to ensure that all birthing facilities conduct annual continuing education for providers and staff of obstetric medicine, within emergency departments and other staff that may care for pregnant or postpartum women. Requires the continuing education to include yearly educational modules on management of severe maternal hypertension and obstetric hemorrhage.
	SR 63	Urges the General Assembly to continue to investigate and identify areas in which the state can improve the prevention of maternal mortality especially among vulnerable populations.
Indiana	SB 278	Establishes local fetal infant mortality review teams to identify similarities, trends and factual patterns concerning fetal deaths and infant deaths within an area of the state. Requires teams to be multidisciplinary and culturally diverse. Requires the employment of a statewide fetal infant mortality review coordinator to assist local teams.
	HB 1007	Requires the state Department of Health to establish a perinatal navigator program. Requires health care providers to use a validated and evidence-based verbal screening tool to assess substance use disorder in pregnant women. Requires health care providers who identify pregnant women with substance use disorders, and who are not currently receiving treatment, to provide treatment or refer patients to treatment.
Louisiana	HR 294 / SR 240	Requests the Department of Health take immediate action to address racial disparities in maternal and child health outcomes and the alarming rate of mortality for African American infants and mothers in Louisiana.
Maryland	HB 583	Requires the Maternal Mortality Review Program, in consultation with the Office of Minority Health and Health Disparities, to make recommendations to reduce any disparities in the maternal mortality rate.
	HB 796	Requires the secretary of health to provide copies of certain death certificates to the Maternal Mortality Review Program. Provides that certain proceedings, records and files are not subject to subpoena, discovery or introduction into evidence.
	SB 356	Requires the secretary of health to report annually on findings from the Maternal Mortality Review Program and racial disparities in maternal mortality rates.
Michigan	SR 33	Commemorates April 11-17, 2019, as Black Maternal Health Week.
Missouri	SB 514	Establishes a Pregnancy-Associated Mortality Review Board, stipulates membership and responsibilities; requires an annual report to the legislature with findings on state data and recommendations.
New Hampshire	SB 118	Establishes a Standing Child Fatality Review Committee to conduct comprehensive, multidisciplinary reviews of preventable infant, child and youth deaths so as to identify factors associated with the deaths and make recommendations for system changes to improve services for infants, children, and youth.
New Jersey	AB 1862	Establishes the Maternal Mortality Review Commission to annually review and report on rates and causes of maternal death and to recommend improvements in maternal care.
	AR 113	Urges enactment of federal Maternal Health Accountability Act of 2017.
	AR 219 / SR 121	Encourages Department of Health to develop set of standards for respectful care at birth and to conduct a public outreach initiative.
	AR 226 / SR 126	Urges Centers for Disease Control to adopt uniform data system to collect information on maternal mortality.
	SB 1870	Requires the Child Fatality and Near Fatality Review Board to study racial and ethnic disparities that contribute to infant mortality; addresses disparities in breastfeeding initiation and duration to increase supports among racial and ethnic populations.
New Mexico	SB 215	Establishes the Maternal Mortality and Severe Maternal Morbidity Review Committee. Stipulates membership and responsibilities including recommendations to reduce maternal mortality and severe maternal morbidity.
Nevada	AB 169	Establishes the Maternal Mortality Review Committee. Stipulates membership and responsibilities including a biennial report with findings and recommendations.
New York	AB 3276	Establishes a statewide maternal mortality review board. Stipulates responsibilities including a biennial report with recommendations to reduce maternal mortality and severe maternal morbidity and issues of racial, economic or other disparities in maternal outcomes. Establishes a Maternal Mortality and Morbidity Advisory Council to review findings of the state and local maternal mortality review boards, hold public hearings and issue an annual report with recommendations.
	SB 6529	Specifies the makeup and structure of the State Maternal Mortality Review Board.
Oklahoma	HB 2334	Establishes the Maternal Mortality Review Committee; specifies the committee’s duties and structure. Requires the committee to review cases of pregnancy-related deaths and make recommendations to the state commissioner of health.
Pennsylvania	HR 324	Designates the month of May 2019 as Healthy Babies Month.
	HR 239	Recognizes the month of May 2019 as Preeclampsia Awareness Month.
	HR 27 / SR 7	Designates Jan. 23, 2019, as Maternal Health Awareness Day.
Rhode Island	HB 5543 / SB 574	Establishes the Multidisciplinary Maternal Mortality Review Committee; specifies committee’s membership and duties, including examining emerging trends in pregnancy-related deaths, identifying potential demographic, geographic, and structural points for prevention and other factors. Requires a report with findings and recommendations.
	HB 5929	Celebrates the week of March 22-28, 2019, as World Doula Week.
South Carolina	SB 21	Amends duties of the Maternal Morbidity and Mortality Review Committee; assigns information collecting responsibilities to Department of Health and Environmental Control staff to provide to the committee; requires other agencies to provide necessary data to the committee.
	SB 767	Welcomes the March of Dimes to the State House and recognizes May 1, 2019, as Healthy Mother’s Day.
Tennessee	HB 1388	Adds neonatal care as a component of the Department of Health's plan for perinatal care; requires annual reporting to the legislature on the quality and outcomes of perinatal care provided through the state’s Medicaid program.
Texas	SB 750	Requires the Health and Human Services Commission to evaluate and enhance the quality of maternal health care services, including prenatal, postpartum and maternal mental health. Requires the state to seek federal funding to implement a model of care for Medicaid recipients in the prenatal and postpartum periods.
	HB 25	Requires the Maternal Mortality and Morbidity Task Force to establish a pilot program for providing medical transportation program services to pregnant women and new mothers.
	SB 2132	Requires the commission that operates Healthy Texas Women programs to consult with the Maternal Mortality and Morbidity Task Force to improve the process for providing information.
	SB 748	Requires an annual report on state actions taken to address maternal mortality rates. Creates a program to deliver prenatal and postpartum care through telehealth or telemedicine services in certain counties. Requires the implementation of a high-risk maternal care coordination services pilot program. Establishes an account fund newborn screening.
Virginia	HB 2546	Establishes a Maternal Mortality Review Team; specifies membership and duties.
Washington	SB 5425	Expands membership requirements of the Maternal Mortality Review Panel; establishes requirements for data sharing related to maternal mortality between the Department of Health and other entities.
West Virginia	SB 564	Extends Medicaid coverage to mothers and their newborn infants to 185% of the federal poverty level.

Neonatal Abstinence Syndrome

State	Bill	Summary
Indiana	SB 141	Requires providers to counsel female patients capable of childbirth about the risks of substance use disorder treatment to a fetus, including fetal opioid dependency and neonatal abstinence syndrome.
Montana	HJR 32	Requires an interim committee to conduct a study on the prevalence of neonatal abstinence syndrome in the state, and best practices for reducing opioid and other drug use by pregnant women and the occurrence of neonatal abstinence syndrome in newborns. Requires a report with findings and recommendations.
Texas	HB 405	Designates June as Neonatal Abstinence Syndrome Awareness Month.
	SB 436	Mandates the Department of Health and Human Services improve health care services to pregnant women with opioid use disorder and infants with neonatal abstinence syndrome, increase access to medication-assisted treatment for women with opioid use disorder during pregnancy and the postpartum period, and conduct a pilot program for hospitals with expertise caring for newborns with neonatal abstinence syndrome.

Newborn Screenings

State	Bill	Summary
Arkansas	HB 1074	Requires newborn screening for spinal muscular atrophy; mandates insurance policies cover newborn screening for spinal muscular atrophy.
California	AB 1004	Requires that state Medicaid (Medi-Cal) plans include developmental screening services for children up to age 3 that comply with guidelines established by the American Academy of Pediatrics.
Connecticut	HB 7282	Requires newborn screening for spinal muscular atrophy.
Indiana	SB 41	Requires newborn screening of Krabbe disease, Pompe disease and Hurler syndrome.
Louisiana	HCR 34	Requests the Department of Health to study the costs and benefits associated with the addition of mucopolysaccharidosis type I and Pompe disease to the newborn screening panel
	SCR 16	Requests the Department of Health to add spinal muscular atrophy to the newborn screening panel.
Oregon	HB 2563	Establishes the Newborn Bloodspot Screening Advisory Board; specifies membership, duties and powers.
Pennsylvania	HR 475	Recognizes September 2019 as Newborn Screening Awareness Month.
South Carolina	HB 3036	Requires neonatal testing for Krabbe disease, Pompe disease and Hurler syndrome. Creates the Newborn Screening Advisory Committee to review the feasibility and advisability of including additional disorders in neonatal testing.
Texas	HB 2255	Sets forth requirements related to informing parents of children who do not pass their hearing screenings of early childhood intervention services and the primary statewide resource center for their child, in addition to educational and informational materials. Requires creation of reporting confidentiality guidelines.
Virginia	HB 1174/ SB 449	Directs the Board of Health to amend regulations governing newborn screening to include Pompe disease and mucopolysaccharidosis type 1.
	HB 1362	Requires screening tests for certain time-critical disorders in newborns and children be performed seven days a week.
	HB 2026	Directs the Board of Health to amend regulations governing newborn screening to include screening for congenital cytomegalovirus in newborns who fail the newborn hearing screen.

Other

State	Bill	Summary
Colorado	HB 1038	Requires coverage of dental services to children and pregnant women under the state’s children’s basic health plan.
	HB 1193	Encourages health care practitioners and county departments of human or social services to identify pregnant or postpartum women for the purpose of providing state-funded substance use disorder treatment services. Creates a high-risk families cash fund to be used for high-risk parents with substance use disorders and children and youth with behavioral health disorders.
	SB 63	Requires creation of a strategic action plan to address the decline of family child care homes and available infant child care throughout the state. Requires the strategic action plan to include the anticipated costs of implementing the recommendations made in the plan.
Illinois	HB 2	Amends the Medical Patient Rights Act to include certain pregnancy and childbirth-related rights for every woman. Requires the State Departments of Public Health, Health Care and Family Services, Children and Family Services, and Human Services to post information about these rights on their public websites. Requires that every health care provider, licensed child care center, Head Start and community center post information about these rights in a prominent place and on their websites.
Louisiana	HB 536	Establishes licensure requirements for free-standing birth centers; authorizes the Department of Health to establish rules to ensure the health, safety, welfare, and wellbeing of persons receiving services at such centers.
Maine	SB 524	Requires a report to determine the state’s capacity to respond to responsibilities under the Individuals with Disabilities Education Act and to provide early and periodic screening, diagnostic and treatment services to children from birth to age 8, the gaps in services and the costs of addressing those gaps.
Maryland	HB 127	Requires that all small employer health benefit plans, or carriers participating in the Individual Exchange, provide a 90-day special enrollment period during which an eligible employee who becomes pregnant and an eligible employee’s spouse or dependent who becomes pregnant may be enrolled under the plan. Requires that the health benefit plan become effective on the first day of the month in which the individual receives confirmation of the pregnancy.
	HB 520 / SB 406	Increases funding to the Maryland Prenatal and Infant Care Coordination Services Grant Program Fund. Establishes a maternal and child health task force.
New Jersey	AB 5021	Expands the medical assistance program to include prenatal services. Requires application of waivers necessary to implement changes and to secure federal funds.
	SB 3365	Establishes a perinatal episode of care pilot program in Medicaid. Defines the perinatal episode of care steering committee.
	SB 3406	Requires all licensed health care professionals to complete and submit the perinatal risk assessment form for each pregnant Medicaid recipient and other eligible recipients of care. Sets forth provisions related to data collection, reimbursement and data analysis.
New York	SB 3788	Prohibits the sale of crib bumper pads and restricts the use of such pads in child care facilities.
Oregon	HB 2005	Creates the Family and Medical Leave Insurance Program to provide an eligible employee with a portion of wages for up to 12 weeks while that employee is on family or medical leave. Allows an additional two weeks of benefits if leave is related to pregnancy, childbirth or a related medical condition including lactation.
	HB 2024	Creates a program to increase supply of infant and toddler care in high-need communities to serve families at or below 200% of the federal poverty level. Requires quality measures and professional development opportunities for participating child care providers.
Texas	HB 650	Requires correctional officers to be trained in medical and mental health care issues applicable to pregnant inmates, including the impact on a pregnant inmate and the inmate's unborn child of the use of restraints, placement in administrative segregation and invasive searches. Requires a study of visitation policies, requires educational programming relating to pregnancy and parenting, and provides requirements for housing of pregnant inmates.

Additional Resources

Prenatal-to-Three Policies
Early Care and Education Bill Tracking Database
Maternal And Child Health Bill Tracking Database
Pritzker Children's Initiative
National Collaborative for Infants and Toddlers (NCIT) Online Solution Center
Prenatal-to-Three Policy Impact Center | recent webinar