SB2219 HD1

SECTION 1. The legislature finds that it is in the State's best interests to ensure that women receive appropriate interconception care following a pregnancy. In a report presented to the Hawaii women's legislative caucus by the department of health, based upon pregnancy risk assessment monitoring system data analysis findings, interconception care was defined as "a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management." Interconception care refers to the set of care services between pregnancies.

By improving the health of women before the next pregnancy, preconception and interconception care can improve the health of the women and their infants. Other department of health findings presented to the Hawaii women's legislative caucus included:

(1) Compared to women with other health coverage, women on QUEST are three times less likely to access prenatal care in their first trimester of pregnancy;

(2) Compared to women with other health coverage, women with QUEST coverage are 1.5 times more likely to have an unintended pregnancy, three times more likely to smoke during their last trimester of pregnancy, and three to four times more likely to use illicit drugs;

(3) Compared to recently-delivering women with other health coverage, women with QUEST coverage are twice as likely to experience postpartum sadness or depression and ten per cent more likely to have a low birthweight or prematurely born infant;

(4) Compared to recently-delivering women with other health coverage, women on QUEST were at three to four times higher risk of experiencing intimate partner violence while pregnant; and

(5) Compared to recently-delivering women with other health coverage, women on QUEST were just as likely to have their infants receive their first well-baby check, but were two times more likely not to have received the recommended post-partum check for new mothers.

This data indicates that women with QUEST coverage are at increased risk for poor pregnancy outcomes for their current, as well as, their future offspring. Improving interconception health can result in improved reproductive health outcomes and has the potential to reduce societal costs as well. Interconception care is intended to promote the health of women of reproductive age before their next pregnancy, which can improve pregnancy-related outcomes.

The State's QUEST program presently serves over 3,300 pregnant women a year and covers the pregnant women for up to 60 days after delivery. The legislature finds that it would be in the best interests of the State for QUEST coverage to be extended for up to six months following a pregnancy.

The purpose of this Act is to expand the period of coverage under QUEST for post‑partum and interconception care services for six months post-pregnancy.

SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§346‑ Interconception care coverage. (a) Beginning July 1, 2009, the department shall provide comprehensive coverage to pregnant QUEST recipients for post‑partum and interconception care for six months post-pregnancy.

The department shall administer this benefit in a manner that meets the federal requirements that are a condition of the receipt of federal funds by the State.

(b) For purposes of this section:

"Comprehensive coverage" means the full scope of preventive and primary care services for a woman following a pregnancy.

"Interconception care" means a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management.

(c) Notwithstanding any law to the contrary, the department shall make appropriate adjustments to the rate of payment per participating recipient paid to health maintenance organizations and prepaid health plans pursuant to section 346-59(d), to allow for post-partum and interconception care coverage to QUEST recipients as defined in this section, administered by a person licensed to practice medicine under chapter 453 or 460. Health maintenance organizations and prepaid health plans shall not be required to increase coverage to QUEST recipients for post-partum and interconception care administered to QUEST recipients, as defined in this section, administered by a person licensed to practice under chapter 453 or 460 until the department makes adjustments to the rate of payment per participating recipient."

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 to expand the QUEST coverage for post‑partum and interconception care for pregnant women for six months post-pregnancy.

The sum appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 4. New statutory material is underscored.

SECTION 5. This Act shall take effect on July 1, 2008.

THE SENATE	S.B. NO.	2219
TWENTY-FOURTH LEGISLATURE, 2008		S.D. 2
STATE OF HAWAII		H.D. 1