BILL NUMBER: S7740A

SPONSOR: WEBB
 
TITLE OF BILL:

An act to amend the public health law, in relation to review of projects
affecting the availability of maternity services

 
PURPOSE:

The purpose of this legislation is to require the public health and
health planning council (PHHPC) to regulate any changes in perinatal
services offered by general hospitals in New York State.

 
SUMMARY OF PROVISIONS:

Section 1 amends Paragraph v of subdivision 2 of section 2803 of the
public health law to require the commissioner to promulgate regulations
related to requiring general hospitals to submit an application for
review and approval to add, decertify, or change the method of delivery
of perinatal services.

              

Section 2 establishes the effective date.

  
USTIFICATION:

The United States is experiencing a growing maternal health crisis, a
recent study showed maternal deaths have more than doubled over the last
20 years for every racial group in every state but continue to dispro-
portionately impact Black women when compared to their white counter-
parts.(1) Our state is not an exception to this alarming reality, in
2018 the pregnancy-related mortality ratio in New York was 18.2 per
100,000 live births, and 78% of those deaths were preventable according
to a report by the New York State Department of Health.(2) The report
showed the pregnancy related mortality rate for Black women was five
times higher than White women in 2018, highlighting the ongoing racial
disparity in New York.(3)

Access to quality maternity care is essential to preventing adverse
health outcomes related to pregnancy and eliminating health disparities.
Unfortunately, maternal health will only further decline as delivery
units continue to shut down across the country, particularly in rural
areas where at least 89 obstetric units were closed between 2015 and
2019 according to the American Hospital Association.(4) Ongoing closures
intensify the already inequitable access to maternity care we see
nationally and in our home state.  Since 2008, 28 hospitals across the
state have closed or reduced obstetric care.(5) Moreover, as of 2022,
more than four percent of women in New York did not have a birthing
hospital within 30 minutes of their homes; this problem is more acute in
rural areas across the state where over 47% of women lived more than 30
minutes from a birthing center.(6)

Hospitals are obligated by law to submit a Certificate of Need for the
establishment, construction, renovation, acquisitions of major medical
equipment, adding or removing services, and change of ownership for
approval by the Department of Health and/or PHHPC, depending on the type
of review required by regulation. However, there is no requirement that
major changes to maternity care undergo a full review before the PHHPC.
Thus, significant changes in availability of labor and delivery services
in a community can be advanced with limited community input or PHHPC
oversight and engagement.

In June 2023, St. Peter's Health Partners announced plans to close
Troy's Burdett Birth Center, the only birthing facility left in Rensse-
laer County, New York and one of the only providers of low-intervention,
midwifery led birth care in the Capital Region.(7) In 2022, there were
881 births at Burdett, and more than half of the patients are insured by
Medicaid.(8) Eliminating an access point to quality maternity care will
further deepen the already unacceptable health disparities we see in
this state related to maternal health outcomes. St. Peter's provided
notice of intended closure just prior to the effective date of a new law
that requires a health equity impact assessment be done on Certificate
of Need Applications.  Ultimately, St. Peters agreed to conduct an
assessment after intense criticism from the local community.(9)

In addition to completing a health equity impact assessment, general
hospitals should also be required to undergo a full review when seeking
to close maternity services. This proposed legislation would stipulate a
process for PHHPC to oversee the provision of perinatal services. The
reality is that closure of maternity units will have an impact on not
only patients but also other components of the healthcare system. The
PHHPC is a diverse council that represents the provider, labor, and
patient community and therefore is well positioned to weigh in on
impacts of discontinuation of services. It is essential that communities
across the state maintain access to quality perinatal care services, and
that attempts to reduce access through a closure of services is trans-
parent and has strong oversight to protect and advance the health and
wellbeing of those impacted.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.
(1) Fleszar LG, Bryant AS, Johnson CO, et al., JAMA, "Trends in State-
Level Maternal Mortality by Racial and Ethnic Group in the United
States." https://jamanetwork.com/journals/jama/article-abstract/
2806661?resultClick-1 (July 3, 2023)
(2) NYS Department of Health, "New York State Report on Pregnancy Asso-
ciated Deaths in 2018"
https://vvvvw.health.ny.govicommunity/adults/women/docs/maternal mortal-
ity review 2018.pdf (April-2022)
(3) Ibid.
(4) American Hospital Association, "Obstetrics U.S. Rural Hospitals"
https://www.aha.org/system/files/mediefile/2022/04/Infographic-rural-
health-obstetrics-15ap22.pdf (2022)
(5) Silberstein, R., Times Union "Maternity wards continue to close
across New York"
https://www.timQSUnion.com/health/article/maternity-wards-continue-close
-across-newyork18376042.php?utmcampaign=CMS%20Sharing%20Toole/0
20(Premium)&utmsource=share-byemail&utmmedium=email (October 8, 2023)
(6) Fontenot, J, Lucas, R, Stoneburner, A, Brigance, C, Hubbard, K,
Jones, E, Mishkin, K., March of Dimes "Where You Live Matters:  Materni-
ty Care Deserts and the Crisis of Access and Equity in New York."
(Updated July 2023) https://vvww.marchofdimes.org/peristats/reports/new-
york/maternity-ca re-deserts*
(7) Save Burdett Birth Center, "About"
https://www.saveburdettbirthcenter.com/who-we-are (2023)
(8) Qi, Lyan, Wall Street Journal, "Fight to Save a New York Birth
Center Tests State Law" https://wwvv.wsj.com/heal
h/healthcare/fight-to-save-a-nw-york-birth-center-tests-state-law-9cd5be
3b (September 27, 2023_
(9) Silberstein, R., Times Union "St. Peter's agrees to conduct impact
study for birth center closure"
https://www.timesunion.com/health/article/
st-peter-s-agrees-conductimpact-study-birth-18185553.0hp (July 9, 2023)