HB 432 — An Act providing for Maternal Care Access Program; and imposing duties on the Department of Health.

PRINTER'S NO.   416

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 432
                                               Session of
                                                 2025

     INTRODUCED BY CURRY, SANCHEZ, DONAHUE, PIELLI, RABB, FREEMAN,
        CERRATO, HILL-EVANS, VENKAT, GIRAL, PROBST, KHAN, MADDEN,
        WAXMAN, STEELE, OTTEN, KENYATTA, D. WILLIAMS, MAYES,
        HOHENSTEIN, O'MARA, BOYD, BOROWSKI, CEPHAS, GUENST,
        SHUSTERMAN AND GREEN, JANUARY 31, 2025

     REFERRED TO COMMITTEE ON CHILDREN AND YOUTH, JANUARY 31, 2025


                                    AN ACT
 1   Providing for Maternal Care Access Program; and imposing duties
 2      on the Department of Health.
 3      The General Assembly of the Commonwealth of Pennsylvania
 4   hereby enacts as follows:
 5   Section 1.    Short title.
 6      This act shall be known and may be cited as the Maternal Care
 7   Access Act.
 8   Section 2.    Definitions.
 9      The following words and phrases when used in this act shall
10   have the meanings given to them in this section unless the
11   context clearly indicates otherwise:
12      "At-risk."    A geographic area that has a limited number of
13   hospitals providing obstetric care, birth centers, obstetrician
14   gynecologists and certified nurse midwives.
15      "Average childbearing age."    Women of ages ranging from 10 to
16   60 years of age.
 1      "Birth center."     An entity licensed as a birth center under
 2   the act of July 19, 1979 (P.L.130, No.48), known as the Health
 3   Care Facilities Act.
 4      "Department."   The Department of Health of the Commonwealth.
 5      "Distressed hospital."     A hospital that:
 6          (1)   had a negative profit margin for at least the
 7      previous three consecutive calendar years; and
 8          (2)   is located more than 25 miles of travel distance on
 9      a roadway from another hospital located in this Commonwealth.
10      "Health care provider."     As defined in section 103 of the act
11   of March 20, 2002 (P.L.154, No.13), known as the Medical Care
12   Availability and Reduction of Error (Mcare) Act.
13      "Hospital."    As defined in section 802.1 of the Health Care
14   Facilities Act.
15      "Maternal Health Index."     An indicator of the health of a
16   patient as determined by the patient's health care provider, who
17   considers the following factors:
18          (1)   Prepregnancy obesity.
19          (2)   Prepregnancy diabetes.
20          (3)   Prepregnancy hypertension.
21          (4)   Prenatal care initiation in the first trimester.
22          (5)   Cigarette smoking.
23          (6)   Behavioral health factors.
24      "Maternal Vulnerability Index."      The measure of 43 county-
25   level social indicators, as published in the August 20, 2021,
26   report, updated June 22, 2022, entitled Getting Hyperlocal to
27   Improve Outcomes & Achieve Racial Equity in Maternal Health: The
28   U.S. Maternal Vulnerability Index, published by Surgo Ventures.
29      "Maternity care desert."     An area that does not have any of
30   the following:

20250HB0432PN0416                    - 2 -
 1          (1)    Hospitals providing obstetric care.
 2          (2)    Birth centers.
 3          (3)    Obstetrician gynecologists.
 4          (4)    Certified nurse midwives.
 5      "Maternity emergency services."        Care provided by a health
 6   care provider to a pregnant or postpartum patient as a result of
 7   one or more of the following symptoms:
 8          (1)    Chest pain.
 9          (2)    Decrease in fetal movement.
10          (3)    Dizziness.
11          (4)    Vomiting.
12          (5)    Heavy vaginal bleeding.
13          (6)    Loss of consciousness.
14          (7)    Seizures.
15          (8)    Severe abdominal pain or cramping.
16          (9)    Severe headache.
17          (10)     Sudden, spontaneous delivery.
18          (11)     Sudden swelling in the arms, legs or face.
19          (12)     Sudden changes in vision.
20          (13)     Shortness of breath.
21          (14)     High blood pressure.
22      "Patient."    As defined in section 103 of the Medical Care
23   Availability and Reduction of Error (Mcare) Act.
24      "Program."    The Maternal Care Access Program established
25   under section 3.
26      "Social Vulnerability Index."         The following demographic and
27   socioeconomic criteria, as provided in the most recent census
28   data published by the United States Census Bureau and employed
29   by the Centers for Disease Control and Prevention to determine
30   adversely affected communities, that the department uses to

20250HB0432PN0416                     - 3 -
 1   designate a zone in section 4(b):
 2            (1)    Percentage of population that is unemployed.
 3            (2)    Percentage of population without a high school
 4      diploma.
 5            (3)    Percentage of population without health insurance.
 6            (4)    Percentage of population with income at or below
 7      150% of the Federal poverty level.
 8            (5)    Percentage of households 65 years of age and older.
 9            (6)    Percentage of households aged 17 and younger.
10            (7)    Percentage of households with individuals with a
11      disability.
12            (8)    Percentage of single-parent households.
13            (9)    English language proficiency.
14            (10)    Racial and ethnic minority population.
15            (11)    Number of mobile homes.
16            (12)    Number of multiunit housing structures.
17            (13)    Number of households without a vehicle.
18            (14)    Housing crowding.
19            (15)    Group quarters.
20      "Zone."      A maternal care access zone established under
21   section 4.
22   Section 3.      Maternal Care Access Program.
23      (a)   Establishment.--The Maternal Care Access Program is
24   established in the department for the purpose of identifying
25   counties in this Commonwealth that would benefit from increased
26   access to skilled and licensed maternal health care providers
27   and resources to improve maternal health outcomes. The
28   department may promulgate regulations necessary for the
29   implementation of the program.
30      (b)   Oversight.--The department may assign oversight

20250HB0432PN0416                       - 4 -
 1   authority of the program to another office or program in the
 2   department.
 3      (c)   Program resources.--The program may only distribute
 4   resources to birth centers, obstetrician gynecologists,
 5   certified nurse midwives or county health departments or
 6   hospitals providing obstetric care in zones designated in this
 7   act.
 8   Section 4.     Maternal care access zones.
 9      (a)   Designation.--A county that meets the specified
10   qualifications in this section may be designated by the
11   department as a zone. The department may determine whether a
12   zone is considered at-risk or a maternity care desert.
13      (b)   Qualifications.--The department shall consider the
14   following criteria when designating a zone as either at-risk or
15   a maternity care desert:
16            (1)   The ratio of females of average childbearing age to
17      full-time equivalent maternity health care providers.
18            (2)   The percentage of females of average childbearing
19      age with income at or below 200% of the Federal poverty
20      level.
21            (3)   Travel time and distance to the nearest health care
22      provider trained and licensed to provide the necessary care,
23      considering the ideal travel distance should be no more than
24      30 minutes to the nearest obstetric facility and within a
25      9.7-mile radius from home during the third trimester.
26            (4)   The Social Vulnerability Index.
27            (5)   Lack of maternity emergency services.
28            (6)   The Maternal Health Index.
29            (7)   The number of distressed hospitals in the area.
30            (8)   The number of health care providers of color in the

20250HB0432PN0416                    - 5 -
 1      area.
 2            (9)    The maternal mortality rate.
 3            (10)    The percentage of births covered by Medicaid.
 4            (11)    The number of birth centers in the area.
 5            (12)    Total number of obstetrician gynecologists in the
 6      area.
 7            (13)    The number of certified nurse midwives in the area.
 8            (14)    The Maternal Vulnerability Index.
 9            (15)    The number of births per day in the area and the
10      number of skilled and licensed maternal health care providers
11      per birth.
12      (c)   Scoring.--The department shall provide scoring for all
13   counties in this Commonwealth based on the criteria specified in
14   this section. The scoring of criteria shall determine the need
15   for designation as a zone and whether a zone is considered to be
16   at-risk or a maternity care desert. An at-risk county shall have
17   a lower score and a maternity care desert shall have a higher
18   score. The department shall determine the scoring parameters.
19      (d)   Reporting.--A hospital shall report the criteria under
20   this section to the appropriate county health department or the
21   department. The county health department shall report the
22   criteria under this section to the department.
23   Section 5.      Regions.
24      (a)   Establishment.--The following regions are established
25   throughout this Commonwealth for the purpose of resource
26   distribution:
27            (1)    Region 1 shall consist of Cameron, Clarion,
28      Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango,
29      and Warren Counties.
30            (2)    Region 2 shall consist of Allegheny, Armstrong,

20250HB0432PN0416                     - 6 -
 1      Beaver, Butler, Cambria, Fayette, Greene, Indiana, Jefferson,
 2      Lawrence, Somerset, Washington and Westmoreland Counties.
 3            (3)   Region 3 shall consist of Adams, Bedford,
 4      Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata,
 5      Lancaster, Lebanon, Mifflin, Perry and York Counties.
 6            (4)   Region 4 shall consist of Blair, Bradford, Centre,
 7      Clearfield, Clinton, Columbia, Lycoming, Montour,
 8      Northumberland, Snyder, Tioga, Union and Sullivan Counties.
 9            (5)   Region 5 shall consist of Carbon, Lackawanna,
10      Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill,
11      Susquehanna, Wyoming and Wayne Counties.
12            (6)   Region 6 shall consist of Berks, Bucks, Chester,
13      Delaware, Montgomery and Philadelphia Counties.
14      (b)   Resource distribution.--The department shall equitably
15   distribute resources to the regions specified in this section.
16   Section 6.     Effective date.
17      This act shall take effect in 180 days.




20250HB0432PN0416                     - 7 -