HB 925: The Georgia Maternal Health Momnibus Act; enact

House Bill 925

By: Representatives Cannon of the 58th, Miller of the 62nd, Scott of the 76th, Bazemore of the 69th, Hugley of the 141st, and others

A BILL TO BE ENTITLED

AN ACT

To amend Titles 31, 33, 34, 37, 45, 48, and 49 of the Official Code of Georgia Annotated, relating to health, insurance, labor and industrial relations, mental health, public officers and employees, revenue and taxation, and social services, respectively, so as to enact the "Georgia Maternal Health Momnibus Act"; to provide for legislative findings and intent; to provide for a short title; to repeal Code Section 31-2A-19, relating to pilot program for home visitation during pregnancy and early childhood, reporting, and funding requirement; to establish pilot programs to provide prenatal care and postpartum care through telemedicine and mobile health clinics for women residing in limited maternity care counties and maternity care deserts; to authorize rules and regulations, provide for reporting, provide for contingent effectiveness, and provide for termination and automatic repeal with respect to such pilot programs; to provide for group prenatal care and postpartum care classes and sessions to certain pregnant and postpartum women from low-income households; to authorize rules and regulations and provide for reporting with respect to the same; to require implicit bias initial and refresher training for certain healthcare professionals involved in perinatal care; to create and provide a purpose for the Regional Perinatal Center Advisory Committee; to provide for its composition and duties; to provide for assessment and recommendations to the commissioner of public health; to establish criteria for hospitals interested in being designated as a regional perinatal center; to authorize rules and regulations and provide for presentation of a plan every four years with respect to such committee; to provide for coverage for maternal mental health screening and care; to provide for a comprehensive quality metrics program with respect to such screening and care; to require the provision of educational materials upon signs and symptoms of perinatal mood and anxiety disorders; to establish a pilot program for remote maternal mental health screening and monitoring; to provide for legislative intent, authorize rules and regulations, and provide for funding and reporting with respect to such pilot program; to establish a pilot program to provide coverage under the Medicaid program for doula care for pregnant Medicaid recipients; to provide for doula qualifications, authorize rules and regulations, provide for reporting, provide for contingent effectiveness, and provide for termination and automatic repeal with respect to such pilot program; to provide for a public awareness campaign related to maternal health; to expand the Georgia WIC (Women, Infants, and Children) program to cover children up to six years of age and to provide for contingent effectiveness; to create and establish a purpose for the Supporting Healthy Moms Grant Program; to provide for the allocation of annual grant awards under such program; to provide for rules and regulations and reporting with respect to such program; to require certain accommodations in the workplace for pregnancy, childbirth, and related conditions; to provide for the specific powers and duties of the Commissioner of Labor related to such requirements; to provide for notice of rights and reasonable accommodations to job applicants and employees for circumstances related to pregnancy; to provide for a civil cause of action and relief; to provide for certain instruction and public education; to authorize rules and regulations and provide for construction with respect to such workplace accommodations; to exempt the sale or use of diapers from taxation; to require healthcare providers, healthcare facilities, and pharmacies to provide the Maternal Mortality Review Committee with psychiatric records; to create and provide a purpose for the Severe Maternal Morbidity Review Committee; to provide for the compilation, tracking, reporting, and public dissemination of data on severe maternal morbidity and pregnancy related deaths; to provide for a study on reducing severe maternal morbidity; to provide for a report and for automatic repeal of provisions relating to such study; to permit the release of clinical records of a deceased patient or deceased former patient to the Maternal Mortality Review Committee and the Severe Maternal Morbidity Review Committee; to remove the requirement that a medical examiner's inquiry for pregnant female deaths be done through a regional perinatal center; to provide for definitions; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

PART 1.

SECTION 1-1.

This Act shall be known and may be cited as the "The Georgia Maternal Health Momnibus Act."

PART 2.

Comprehensive and Equitable Maternal Healthcare

SECTION 2-1.

(a) The General Assembly of Georgia finds that:

(1) Georgia's maternal mortality rate is one of the highest in the nation, regardless of ethnic or socioeconomic background;

(2) According to the Commonwealth Fund, in 2020 the United States' mortality rate was 23.8 deaths per 100,000 live births, which is much higher than the 9.8 average of the Organization for Economic Cooperation and Development. In 2020, Georgia's rate of maternal mortality was 33.0 deaths per 100,000 live births;

(3) Systemic disparities, including lack of access to quality care across socioeconomic strata, contribute to poor maternal health outcomes. The Department of Public Health reports that over 80 percent of pregnancy related deaths in Georgia are preventable;

(4) Reports from the Georgetown Center for Children and Families show that nearly one in five (19.3 percent) of women of childbearing age (18-44) have no health insurance. This is one of the highest rates in the country, leaving Georgia forty-sixth overall as it relates to women's healthcare access. Georgia has the highest uninsured rate in the South, apart from Mississippi where 21.2 percent of women of childbearing age are uninsured;

(5) Social determinants of health, such as housing, transportation, and economic stability, significantly impact maternal health outcomes. Data from the Department of Public Health highlights transportation barriers as a leading factor in missed prenatal appointments;

(6) Ninety-three rural Georgia counties do not have a hospital with a labor and delivery unit, and there are no rural counties in the state with a maternal-fetal medicine specialist. Mothers in these areas are often more impacted by lack of transportation, little or no access to the social safety net, and the presence of few perinatal supportive resources; and

(7) Federal legislation such as the Black Maternal Health Momnibus Act of 2023 provides a comprehensive framework to address maternal health disparities, offering Georgia an opportunity to align state efforts with national goals.

(b) It is the intent of the General Assembly to address systemic disparities, invest in social determinants of health, and provide comprehensive support to improve maternal health outcomes for mothers in Georgia.

SECTION 2-2.

Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Article 1 of Chapter 2A, relating to the Department of Public Health generally, by repealing Code Section 31-2A-19, relating to pilot program for home visitation during pregnancy and early childhood, reporting, and funding requirement, and enacting a new Code Section 31-2A-19 to read as follows:

"31-2A-19.

(a) As used in this Code section, the term:

(1) 'Distant site' means a site at which an obstetric provider is located while providing healthcare services by means of telemedicine, which may include the home of such obstetric provider.

(2) 'Limited maternity care county' means a county in this state that has fewer than two hospitals or birth centers offering obstetric care or fewer than 60 obstetric providers per 10,000 births.

(3) 'Maternity care desert' means a county in this state that does not have a hospital or birth center offering obstetric care or an obstetric provider.

(4) 'Obstetric provider' means a licensed physician or advanced practice registered nurse who is licensed to practice obstetrics and gynecology in this state.

(5) 'Telemedicine' means the use of electronic information and telecommunications technologies that include, at minimum, audio and video equipment to enable two-way, real-time interactive communication between a patient and an obstetric provider at a distant site, which services are compliant with federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and breach notification rules. Such term shall include audio-only, telephone communication only when two-way, real-time audio-visual communication is unavailable to or inaccessible by the patient or is infeasible, impractical, or otherwise not medically advisable, as determined by the obstetric provider providing telemedicine services to the patient.

(6) 'Virtual prenatal care' means at-home prenatal healthcare for a pregnant woman provided by an obstetric provider facilitated through the use of telemedicine and home-monitoring devices or other equipment, as deemed appropriate by such obstetric provider. Such term includes consultations and monitoring, including, but not limited to, monitoring for conditions such as diabetes and hypertension; mental health evaluations; nutritional evaluations; and guidance on personal care.

(b) The department shall develop, implement, and conduct a three-year pilot program to provide virtual prenatal care to pregnant women in limited maternity care counties and maternity care deserts to improve birth outcomes and to decrease maternal morbidity and mortality. The pilot program shall begin on July 1, 2026, and shall provide up to five virtual prenatal care visits for each eligible pregnant woman. Such eligibility shall be established based on criteria, terms, and conditions as determined by the department, in coordination with the Department of Community Health.

(c) No later than July 1, 2027, and annually thereafter, the department shall submit to the Governor, the Speaker of the House of Representatives, the President of the Senate, and the chairpersons of the House Committee on Public Health and the Senate Health and Human Services Committee a detailed written report on the effectiveness of the pilot program. The final report shall additionally include recommendations, if any, as to the expansion or permanency of the pilot program and any proposed changes to such program relative to such recommendations.

(d) The department is authorized to promulgate rules and regulations as may be necessary to implement and effectuate the provisions of this Code section.

(e) This Code section shall be contingent upon appropriations made by the General Assembly specifically for the department for the purposes set forth in this Code section and shall stand repealed by operation of law on December 1, 2029."

SECTION 2-3.

Said title is further amended by adding new Code sections to read as follows:

"31-2A-21.

(a) For purposes of this Code section, the term:

(1) 'Limited maternity care county' means a county in this state that has fewer than two hospitals or birth centers offering obstetric care or fewer than 60 obstetric providers per 10,000 births.

(2) 'Maternity care desert' means a county in this state that does not have a hospital or birth center offering obstetric care or an obstetric provider.

(3) 'Obstetric provider' means a physician or advanced practice registered nurse licensed to practice obstetrics and gynecology in this state.

(4) 'Postpartum care' means healthcare for a woman for a period of one year following a birth, miscarriage, stillbirth, or neonatal death. Such term includes physiological assessments, mental health evaluations, nutritional evaluations, and guidance on personal and newborn care. Such term includes at least four visits with an obstetric provider as follows:

(A) An initial visit within 24 hours of a birth, miscarriage, stillbirth, or neonatal death;

(B) A follow-up visit within the first three weeks postpartum;

(C) A follow-up visit within the first eight weeks postpartum;

(D) A comprehensive visit no later than 12 weeks postpartum; and

(E) Intermediary and ongoing care as needed.

(b) The department shall develop, implement, and conduct a three-year pilot program for the purpose of providing postpartum care through mobile health clinics in limited maternity care counties and maternity care deserts, beginning on July 1, 2026. The department, in coordination with the Department of Community Health, shall establish eligibility criteria, terms, and conditions for such pilot program.

(c) No later than July 1, 2027, and annually thereafter, the department shall submit a detailed written report on the effectiveness of the pilot program to the Governor, the Speaker of the House of Representatives, the President of the Senate, and the chairpersons of the House Committee on Public Health and the Senate Health and Human Services Committee. The final report shall additionally include recommendations, if any, as to the expansion or permanency of the pilot program and any proposed changes to the pilot program relative to such recommendations.

(d) This Code section shall be contingent upon appropriations made by the General Assembly specifically for the department for the purposes set forth in this Code section and shall stand repealed by operation of law on December 1, 2029.

31-2A-22.

(a) As used in this Code section, the term:

(1) 'Eligible participant' means a pregnant or postpartum woman who meets the income eligibility guidelines set forth by the Georgia WIC (Women, Infants, and Children) program, as of July 1, 2025.

(2) 'Group prenatal care' means a structured class designed for pregnant women provided in a supportive group setting and based on an evidence based model that is focused on equipping pregnant women with essential prenatal knowledge and skills, including, but not limited to, labor and delivery preparation, breastfeeding, lactation, and newborn care.

(3) 'Group postpartum care' means a structured class designed for postpartum women provided in a supportive group setting focused on equipping such women with essential knowledge and skills for the postpartum period, including, but not limited to, physical recovery, nutrition, emotional well-being, maternal mental health, newborn care, and lactation support. With respect to postpartum women separated from their newborns due to child welfare intervention or any other cause, such term includes counseling sessions and any consultative sessions related to providing reunification assistance.

(4) 'Postpartum woman' means a woman up to 12 months after the end of a pregnancy.

(b) Subject to available funding, the department shall develop, implement, and conduct a program to provide group prenatal care and group postpartum care to eligible participants, whether in-person or online. Such program shall begin on July 1, 2026, and shall provide up to five group prenatal care visits and up to five group postpartum care visits for each eligible participant at no cost to such participant.

(c) Any person providing group prenatal care or group postpartum care under the program shall have completed the appropriate training, as determined by the department.

(d) No later than June 30, 2027, and annually thereafter, the department shall submit to the Governor, the Speaker of the House of Representatives, the President of the Senate, and the chairpersons of the House Committee on Public Health and the Senate Health and Human Services Committee a detailed report on the effectiveness of the program and recommendations, if any, as to proposed legislation to improve such program.

(e) The department is authorized to promulgate rules and regulations as may be necessary to implement and effectuate the provisions of this Code section.

31-2A-23.

(a) As used in this article, the term:

(1) 'Healthcare professional' means a physician or other healthcare practitioner licensed, accredited, or certified to perform specified physical, mental, or behavioral healthcare services consistent with his or her scope of practice under the laws of this state.

(2) 'Implicit bias' means a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudice and implicit stereotypes that often operate at a level below conscious awareness and without intentional control.

(3) 'Implicit prejudice' means prejudicial negative feelings or beliefs about a group that a person holds without being aware of them.

(4) 'Implicit stereotypes' means the unconscious attributions of particular qualities to a member of a certain social group. Implicit stereotypes are influenced by experience and are based on learned associations between various qualities and social categories, including race or gender.

(5) 'Perinatal care' means the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods.

(6) 'Perinatal facility' means a hospital, clinic, or birthing center that provides perinatal care.

(7) 'Pregnancy related death' means the death of a woman while pregnant or within 365 days of the end of a pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.

(b) Every perinatal facility in this state shall implement an evidence based implicit bias program for all healthcare professionals involved in the perinatal care of patients within such facility.

(c) An implicit bias program implemented pursuant to subsection (b) of this Code section shall include:

(1) Identification of previous or current unconscious biases and misinformation;

(2) Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion;

(3) Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose;

(4) Information on the effects, including, but not limited to, ongoing personal effects, of historical and contemporary exclusion and oppression of minority communities;

(5) Information about cultural identity across racial or ethnic groups;

(6) Information relative to communicating more effectively across identities, including racial, ethnic, religious, and gender identities;

(7) Discussion on power dynamics and organizational decision making;

(8) Discussion on health inequities within the perinatal care field, including information on how implicit bias impacts maternal and infant health outcomes;

(9) Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider-community relations issues in the community; and

(10) Information on reproductive justice.

(d)(1) A healthcare professional shall complete initial basic training through the implicit bias program based on the components described in subsection (c) of this Code section.

(2) Upon completion of the initial basic training, a healthcare professional shall complete a refresher course under the implicit bias program every two years thereafter, or on a more frequent basis if deemed necessary by the perinatal facility, in order to keep current with changing racial, identity, and cultural trends and best practices in decreasing interpersonal and institutional implicit bias.

(e) Each perinatal facility in this state shall provide a certificate of training completion to another perinatal facility or a training attendee upon request. A perinatal facility may accept a certificate of completion from another perinatal facility to satisfy the training requirement provided for in this Code section from a healthcare professional who works in more than one perinatal facility.

(f) If a healthcare professional involved in the perinatal care of patients is not directly employed by a perinatal facility, the facility shall offer the training to such healthcare professional.

31-2A-24.

(a) As used in this Code section, the term 'maternal near-miss' means a woman who survived a near-death complication occurring during a pregnancy, during childbirth, or within 42 days of the end of a pregnancy.

(b) The department shall create a comprehensive public awareness campaign targeting women located in rural and underserved communities to increase awareness about maternal health by developing and making available on the department's website educational materials and support resources. Such materials and resources shall include, but shall not be limited to:

(1) Information on prenatal care, including, but not limited to, nutrition, the importance of prenatal care visits, what to expect during such visits, and key prenatal screenings;

(2) Information on common causes of maternal near-misses and strategies to reduce the risk of severe maternal morbidity;

(3) Information on postpartum care, including, but not limited to, nutrition, physical recovery, and newborn care; and

(4) A geographically indexed guide on government funded, free, and low-cost services available to support pregnant and postpartum women, including, but not limited to, healthcare services, educational classes and peer support groups for prenatal and postpartum care, mental health counseling services, transportation assistance programs, and food assistance programs which shall include a description of the services offered and contact information.

(c) The department shall maintain a comprehensive webpage on its website dedicated to maternal health that includes all educational materials and support resources identified or created pursuant to this Code section."

SECTION 2-4.

Said title is further amended by adding a new article to read as follows: "ARTICLE 4

31-2A-70.

As used in this article, the term:

(1) 'Advisory committee' or 'committee' means the Regional Perinatal Center Advisory Committee established pursuant to Code Section 31-2A-71.

(2) 'Regional perinatal center' means a specially qualified hospital identified by the department and designated to a specific geographic region to lead collaboration between hospitals and providers to increase the likelihood that deliveries are performed in a hospital with an appropriate level of care for mothers and infants.

31-2A-71.

(a) There is established the Regional Perinatal Center Advisory Committee for the purpose of considering and making recommendations to the commissioner concerning the addition, reduction, or transition of regional perinatal centers in this state. The committee shall advise the commissioner on the estimated costs to the department necessary to implement such recommendations.

(b) The Regional Perinatal Center Advisory Committee shall be composed of not less than 11 nor more than 21 members to be appointed by the commissioner, who shall appoint one of such members to serve as chairperson. All appointments to the committee shall be for a term of four years. A member shall serve until his or her successor has been duly appointed. The commissioner may reappoint any member.

(c) The advisory committee shall meet upon the call of the chairperson.

(d) Beginning on July 1, 2026, and every four years thereafter, the department, in conjunction with the advisory committee, shall assess and make recommendations to the commissioner on the adequacy of the regional perinatal system and consider hospital or labor and delivery closures. Such assessment shall evaluate whether:

(1) Perinatal facilities in each region are equipped and prepared to stabilize infants and mothers before transport;

(2) Coordination exists between maternity care in each region and regional perinatal centers;

(3) All identified high-risk pregnancies and deliveries are promptly evaluated in consultation with regional perinatal centers and referred to the appropriate designated regional perinatal center for the proper management and treatment of such conditions as needed;

(4) An adequate transport system is available in the region for the transfer of high-risk mothers and infants and specifically considers:

(A) The distance and travel time between referring hospitals and regional perinatal centers;

(B) The types of vehicles used for transport and whether a need exists for additional vehicles; and

(C) The need for upgraded vehicles and transport equipment; and

(5) Each regional perinatal center provides:

(A) Consultation for patients requiring special services, including transport;

(B) Coordination and assurance of follow-up medical care for maternal and neonatal patients requiring special services;

(C) Educational support to ensure quality care in institutions involved in perinatal healthcare in the region;

(D) An annual education plan with all birthing centers in the region;

(E) Compilation and analysis of perinatal data from the center and referring hospitals; and

(F) Coordination of perinatal health services within the region.

(e) When changes to the regional perinatal centers are approved by the department after recommendation by the advisory committee, the department shall submit to the Office of Planning and Budget prior to the General Assembly's next legislative session a budget request seeking appropriations to implement such changes.

31-2A-72.

To be designated as a regional perinatal center a hospital shall notify the department of the following:

(1) Such hospital's ability to meet the standards for regional perinatal centers;

(2) Any additional funding necessary to bring such hospital up to the standards for regional perinatal centers;

(3) Any special planning problems in such hospital's perinatal region, including, but not limited to, transportation, shortage of facilities, and personnel;

(4) A description of perinatal care currently being provided;

(5) A description of services that can be provided by the center in patient care, education, and consultation to hospitals within the perinatal region; and

(6) Any other information requested by the department.

31-2A-73.

Beginning on July 1, 2026, and every four years thereafter, the department shall present to the Governor, the Speaker of the House of Representatives, and the President of the Senate a plan for the designated perinatal centers in every region of the state. Such plan shall include funding considerations to aid hospitals in meeting the standards and for continuing requirements, including, but not limited to, patient care, professional education, training programs, and physical facilities.

31-2A-74.

The department shall be authorized to promulgate rules and regulations to carry out the purposes of this article."

SECTION 2-5.

Title 33 of the Official Code of Georgia Annotated, relating to insurance, is amended in Chapter 1, relating to general provisions, by adding a new Code section to read as follows:

"33-1-28.

(a) As used in this Code section, the term:

(1) 'Maternal mental health screening' means the use of an independent, evidence based screening instrument that is in accordance with nationally recognized clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy. Such guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(2) 'Medically necessary' shall have the same meaning as set forth in Code Section

33-1-27.

(3) 'Mental healthcare provider' means any person licensed under Title 43 to provide prenatal, labor and delivery, or postpartum care, including without limitation physicians, psychiatrists, psychologists, advanced practice registered nurses, physician assistants, licensed clinical social workers, and licensed professional counselors and marriage and family therapists.

(4) 'Telehealth services' means services provided via two-way, real-time interactive communication between a patient and a mental healthcare provider at a distant site through telecommunications equipment, which services are compliant with federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and breach notification rules.

(b) Each health benefit policy issued, delivered, or renewed in this state shall provide coverage for medically necessary:

(1) Maternal mental health screening during the prenatal period and 12 months postpartum; and

(2) Care and treatment for those screenings positive for maternal mental health conditions.

(c) All services provided for in this Code section shall be covered whether provided in person or through telehealth services.

(d) The provisions of this Code section shall apply to all policies, contracts, and certificates executed, delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026."

SECTION 2-6.

Title 49 of the Official Code of Georgia Annotated, relating to social services, is amended in Article 7 of Chapter 4, relating to medical assistance generally, by adding new Code sections to read as follows:

"49-4-159.5.

(a) Except in cases where the woman refuses a maternal mental health screening as provided for in Code Section 33-1-28, a pregnant or postpartum woman seeking healthcare from a physician or other healthcare provider shall be screened for perinatal mood and anxiety disorders, as determined necessary:

(1) At the pregnant woman's first prenatal visit;

(2) When the pregnant woman is from 28 through 32 weeks' gestation;

(3) Between delivery and discharge from the facility where the pregnant woman gives birth;

(4) At the woman's six-week postpartum obstetrical visit;

(5) If there is a pregnancy loss and at the follow-up obstetric visit after such loss; and

(6) At a pediatric visit occurring when the infant is three months of age or, if there is no such visit, at the postpartum woman's healthcare visit any time from three months to one year after pregnancy loss or delivery.

(b) The right to refuse the mental health screening described in subsection (a) of this Code section shall not exist for a patient determined by the physician or other healthcare provider to be mentally incompetent.

(c)(1) The maternal mental health screening provided for in subsection (a) of this Code section shall be conducted by the physician or other healthcare provider who is providing prenatal, obstetric, or postpartum care of the pregnant woman or pediatric care of the woman's infant, as deemed necessary by such physician or healthcare provider. Each such screening shall utilize questionnaires that conform with nationally recognized clinical practice guidelines and shall be used for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a woman's mental health, well-being, disease, or condition as supported by medical and scientific evidence.

(2) Additional maternal mental health screenings, which may be refused, may be conducted at any other point during the pregnancy or the postpartum period as deemed necessary by the physician or other healthcare provider. Appropriate referral information and resources addressing perinatal mood or anxiety disorders shall be provided during such screenings.

(d) A physician or other healthcare provider who provides obstetric or pediatric care shall provide educational materials through electronic or other means on the signs and symptoms of perinatal mood and anxiety disorders to pregnant and postpartum women under his or her care, or to mothers of children under his or her care, as deemed necessary by such physician or healthcare provider.

(e) The provisions of this Code section shall not preclude any other healthcare provider acting within his or her scope of practice from screening for maternal mental health conditions or from providing referral information and resources or educational materials on perinatal mood and anxiety disorders.

(f) Relative to maternal mental health screenings, the department shall establish a comprehensive quality metrics program that includes:

(1) Process measures, including, but not limited to:

(A) Percentage of eligible patients screened at each required interval;

(B) Time from positive screen to first behavioral health contact;

(C) Completion rates for referrals to behavioral health services; and

(D) Utilization rates of telehealth services;

(2) Outcome measures, including, but not limited to:

(A) Rates of postpartum depression and anxiety identification;

(B) Emergency department utilization for mental health concerns;

(C) Psychiatric hospitalization rates; and

(D) Duration of treatment engagement;

(3) Equity measures, including, but not limited to:

(A) Screening and treatment rates stratified by race, ethnicity, and geographic location; and

(B) Disparities in access to care and outcomes; and

(4) Patient experience measures, including, but not limited to:

(A) Satisfaction with screening process;

(B) Perceived barriers to care; and

(C) Experiences with telehealth services.

(g) No later than January 1, 2026, the department shall establish a three-year pilot program for remote maternal mental health screening and monitoring. Such program shall:

(1) Prioritize high-risk populations and rural communities;

(2) Include telehealth services;

(3) Integrate with existing maternal health programs, including home visiting services; and

(4) Collect data on program effectiveness and barriers to care.

(h) The department may allocate sufficient funds for the pilot program provided for in subsection (g) of this Code section to support:

(1) Technology infrastructure and support;

(2) Provider training and technical assistance; and

(3) Program evaluation and reporting.

(i) The department shall:

(1) Promulgate rules and regulations necessary to implement this Code section;

(2) Establish a process for monitoring compliance; and

(3) Report annually to the Senate Health and Human Services Committee and the House Committees on Health and Public Health on the implementation progress and outcomes of the requirements of this Code section.

(j) The annual report provided in subsection (i) of this Code section shall be required from July 1, 2026, through July 1, 2028.

(k) To implement the provisions of this Code section, the department shall, when necessary, submit a Medicaid state plan amendment or waiver request to the United States Department of Health and Human Services.

49-4-159.6.

(a) It is the intent of the General Assembly to advance maternal health outcomes by recognizing doula care as part of the maternal healthcare workforce. Doula care has been associated with Medicaid cost savings of around $1,000.00 per birth, a decreased likelihood of cesarean delivery, a reduced need for an epidural during labor, lower preterm birth rates, improved rates of breastfeeding, shorter births, reduced rates of perinatal mood and anxiety disorders, increased positive feelings about the birth experience, and feelings of empowerment about individual pregnancy outcomes.

(b) As used in this Code section, the term 'doula' means a professional who provides physical, emotional, and informational support to clients before, during, and after childbirth to help them achieve a healthy and satisfying birth experience and who has completed the appropriate training, as determined by the department.

(c) The department shall develop, implement, and conduct a one-year pilot program to provide Medicaid coverage for doula care for pregnant Medicaid recipients. Beginning on July 1, 2026, such pilot program may provide reimbursement for up to five doula visits for each pregnant Medicaid recipient, which may include visits for prepartum care, labor and delivery, and postpartum care.

(d) No later than December 1, 2027, the department shall submit to the Governor, the President of the Senate, the Speaker of the House of Representatives, and the chairpersons of the House Committee on Health, the Senate Health and Human Services Committee, the House Committee on Appropriations, and the Senate Appropriations Committee a detailed written report on the implementation and effectiveness of the pilot program. Such report shall include the health outcomes of participants and recommendations on the best process of reimbursing doulas to promote retention in the perinatal workforce. Such report shall also include recommendations, if any, as to expansion or permanency of the pilot program and any proposed changes to the program relative to such recommendations.

(e) The department is authorized to promulgate rules and regulations as may be necessary to implement and effectuate the provisions of this Code section. (f)(1) This Code section shall be contingent upon appropriations made by the General Assembly specifically for the department for the purposes set forth in this Code section.

(2) This Code section shall terminate on December 31, 2027, and this Code section shall be repealed by operation of law on such date."

PART 3.

Social Determinants in Maternal Health

SECTION 3-1.

Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Article 1 of Chapter 1, relating to general provisions, by adding a new Code section to read as follows:

"31-1-26.

(a) The department, through its Division of Public Health, shall, to the extent that state funds are available for such purpose, expand the Georgia WIC (Women, Infants, and Children) program, established in accordance with Section 17 of the Child Nutrition Act of 1966, 42 U.S.C. Section 1786, to cover children who have had their fifth birthday but have not yet attained their sixth birthday.

(b) This Code section shall become effective on July 1, 2026, only if prior to such date, funds are specifically appropriated by the General Assembly for the department for the purposes set forth in this Code section."

SECTION 3-2.

Said title is further amended in Article 1 of Chapter 2A, relating to the Department of Public Health generally, by adding a new article to read as follows: "ARTICLE 5

31-2A-90.

As used in this article, the term:

(1) 'Early childhood services program' means a program that offers services designed to support the development and well-being of infants and toddlers, including, but not limited to, early intervention, early learning, childcare, or parenting education.

(2) 'Early intervention' means services and support for infants and toddlers with developmental delays, chronic health conditions, and disabilities and their families. Such term includes early identification and screening of infants and toddlers for such developmental delays, conditions, and disabilities.

(3) 'Eligible program' means an early childhood services program or an essential support services program.

(4) 'Essential support services program' means a program that offers housing assistance, food assistance, or nonemergency medical transportation services to pregnant and postpartum women in this state.

(5) 'Grant program' means the Supporting Healthy Moms Grant Program established pursuant to Code section 31-2A-91.

(6) 'Infant' or 'toddler' means a child under three years of age.

(7) 'Parenting education' means courses designed for parents of infants and toddlers to enhance parenting skills and knowledge taught by educators possessing the appropriate qualifications, certifications, experience, as determined by the department.

(8) 'Postpartum woman' means a woman up to one year after the end of pregnancy.

(9) 'Qualified sponsor' means a nonprofit organization incorporated in this state with a tax-exempt status pursuant to Section 501(c)(3) of the Internal Revenue Code of 1986; or governmental sponsor of a program that meets the conditions of this Code section.

31-2A-91.

(a) Subject to available funding, the department shall establish the Supporting Healthy Moms Grant Program to provide grant funding, on an annual basis, to qualified sponsors of eligible programs in this state that provide services focused on advancing and addressing social determinants of maternal health and that provide early childhood services.

(b) The department shall oversee the grant program and is authorized to contract with an external organization to implement and administer such grant program.

31-2A-92.

To be considered for a grant under the grant program, a qualified organization shall:

(1) Have a primary mission of advancing maternal health, addressing social determinants of maternal health, or providing early childhood services;

(2) Have a system of financial accountability consistent with generally accepted accounting principles, including an annual budget;

(3) With respect to a nonprofit organization, have a board that hires and supervises a director who manages the organization's operations;

(4) Have provided services under an eligible program for a minimum of one year;

(5) Provide free services under an eligible program; and

(6) Maintain confidentiality of all data, files, and records of clients related to the services provided and in compliance with state and federal laws.

31-2A-93.

(a) The commissioner shall approve each grant or expenditure of money from the grant program.

(b) The commissioner's decision on the granting of funds from the grant program to qualified sponsors shall be based on a competitive selection process.

(c) The grant program may be used for expenditures related to the routine administration of the program; provided, however, that, in any given year, expenditures for the routine administration of the grant program may not exceed 10 percent of the total amount of money available in the grant fund.

(d) The commissioner is authorized to promulgate rules and regulations as necessary to implement and administer the provisions of this article.

31-2A-94.

Not later than November 1, 2026, and annually thereafter, the department shall submit to the Governor and the General Assembly a report on the financial status of the grant program and a summary of its operations for the preceding year."

SECTION 3-3.

Title 34 of the Official Code of Georgia Annotated, relating to labor and industrial relations, is amended in Chapter 2, relating to Department of Labor, by revising paragraph (5) of and by adding a new paragraph to subsection (a) of Code Section 34-2-6, relating to specific powers and duties of the Commissioner of Labor, to read as follows: "(3.1) To make investigations, collect and compile statistical information, and report upon the conditions and matters relating to the enforcement and effect of Chapter 5B of this title and of the rules issued thereunder and to receive and resolve complaints related to such chapter in accordance with the rules and regulations issued thereunder;" "(5) To do all in his or her power to promote the voluntary arbitration, mediation, and conciliation of disputes between employers and employees and to avoid strikes, picketing, lockouts, boycotts, blacklisting, discriminations, and legal proceedings in matters of employment. In pursuance of this duty, the Commissioner may appoint temporary boards of arbitration, provide necessary expenses of such boards, order reasonable compensation not exceeding $15.00 per day for each member engaged in such arbitration, prescribe rules for such arbitration boards, conduct investigations and hearings, publish in print or electronically reports and advertisements, and do all things convenient and necessary to accomplish the purpose of this chapter and Chapter 5B of this title. The Commissioner may designate a mediator and may, from time to time, detail employees or persons not in the department to act as his or her assistants for the purpose of executing such provisions. Employees of the Department of Labor shall act on temporary boards without extra compensation. Nothing in this Code section or in this chapter shall be construed to prohibit or limit in any way employees' rights to bargain collectively;"

SECTION 3-4.

Said title is further amended by adding a new chapter to read as follows: "CHAPTER 5B

34-5B-1.

As used in this chapter, the term:

(1) 'Employer' means any person or entity that employs one or more employees and shall include the state and its political subdivisions.

(2) 'Pregnancy' means medical needs arising from pregnancy, childbirth, or related conditions, including, but not limited to, lactation.

(3) 'Reasonable accommodations' shall include, but shall not be limited to, more frequent or longer breaks, time off to recover from childbirth, acquisition or modification of equipment, seating, temporary transfer to a less strenuous or hazardous position, job restructuring, light duty, break time and private nonbathroom space for expressing breast milk, assistance with manual labor, or modified work schedules.

(4) 'Undue hardship' means an action requiring significant difficulty or expense, when considered in light of the factors set forth in Code Section 34-5B-4.

34-5B-2.

(a) It shall constitute an unfair employment practice for an employer, unless such employer can demonstrate that an undue hardship on such employer's program, enterprise, or business would result, to:

(1) Fail or refuse to make a reasonable accommodation to a job applicant or employee for circumstances related to pregnancy, if such job applicant or employee so requests;

(2) Take adverse action against a job applicant or an employee who requests or uses an accommodation;

(3) Deny employment opportunities to a job applicant or employee, if such denial is based on the need of the employer to make reasonable accommodations to such job applicant or employee for circumstances related to pregnancy;

(4) Require a job applicant or employee affected by pregnancy to accept an accommodation that such job applicant or employee chooses not to accept;

(5) Require an employee to take leave if another reasonable accommodation can be provided to such employee for circumstances related to pregnancy;

(6) Count an absence related to pregnancy against an employee under a no fault attendance policy; or

(7) Fail to reinstate such employee to such employee's original job or to an equivalent position with equivalent pay and accumulated seniority, retirement, fringe benefits, and other applicable service credits when such employee's need for reasonable accommodations ceases.

(b) The employer shall in good faith engage in a timely and interactive process with the job applicant or employee to determine effective reasonable accommodations. (c)(1) An employer shall provide written notice of the right to be free from discrimination in relation to pregnancy to:

(A) New employees at the commencement of employment;

(B) Existing employees within 120 days after the effective date of this chapter; and

(C) Any employee who notifies such employer of her pregnancy within ten days of such notification.

(2) Such notice shall be conspicuously posted at an employer's place of business in an area accessible to employees and shall be available in English and other languages commonly spoken in such employer's place of business.

34-5B-3.

The employer shall have the burden of proving undue hardship. In making a determination of undue hardship, the factors that may be considered include, but shall not be limited to:

(1) The nature and cost of the accommodation;

(2) The overall financial resources of the employer, the overall size of the business of the employer with respect to the number of employees, and the number, type, and location of its facilities; and

(3) The effect on expenses and resources or the impact otherwise of such accommodation upon the operation of the employer.

34-5B-4.

(a) Any individual who is aggrieved by an unfair employment practice against such individual in violation of this chapter may institute a civil action against the persons engaged in such prohibited conduct. Such action may be maintained in any court of competent jurisdiction and shall be commenced no later than one year after the alleged prohibited conduct occurred.

(b) The court may grant as relief, as it deems appropriate, any permanent or temporary injunction, temporary restraining order, or other order, including, but not limited to, the hiring or reinstatement of the plaintiff to such individual's original position or an equivalent position. The court may award to the plaintiff back pay. The court may award court costs and reasonable attorney's fees to the prevailing party.

34-5B-5.

The Department of Labor shall develop courses of instruction and conduct ongoing public education efforts as necessary to inform employers, employees, employment agencies, and job applicants about their rights and responsibilities under this chapter.

34-5B-6.

The Commissioner of Labor shall promulgate rules and regulations as are necessary to implement and effectuate the provisions of this chapter.

34-5B-7.

This chapter shall not be construed to preempt, limit, diminish, or otherwise affect any other provision of law relating to sex discrimination or pregnancy or in any way to diminish the coverage for pregnancy under any other provision of this title."

SECTION 3-5.

Title 48 of the Official Code of Georgia Annotated, relating to revenue and taxation, is amended in Part 1 of Article 1 of Chapter 8, relating to general provisions regarding state sales and use tax, by revising paragraph (58) of Code Section 48-8-3, relating to exemptions from sales and use taxes, as follows:

"(58) The sale or use of diapers Reserved;" PART 4.

Maternal Health Data Collection, Research, and Innovation

SECTION 4-1.

Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Article 1 of Chapter 2A, relating to general provisions regarding the Department of Public Health, by revising subsection (d) of Code Section 31-2A-16, relating to Maternal Mortality Review Committee established, as follows:

"(d)(1) Health care Healthcare providers licensed pursuant to Title 43, health care healthcare facilities licensed pursuant to Chapter 7 of Title 31 this title, and pharmacies licensed pursuant to Chapter 4 of Title 26 shall provide reasonable access to the committee to all relevant medical records associated with a case under review by the committee within 30 days of receiving a request for such records, unless prohibited by state or federal law.

(2) A health care healthcare provider, health care healthcare facility, or pharmacy providing access to medical and psychiatric records pursuant to this Code section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing such records."

SECTION 4-2.

Said title is further amended in said article by adding a new Code section to read as follows:

"31-2A-16.1.

(a) There is established within the department a Severe Maternal Morbidity Review Committee to collect and track data on severe maternal morbidity and study and make recommendations on strategies to reduce severe maternal morbidity. The committee shall be multidisciplinary and composed of members as deemed appropriate by the department. The committee may contract with an external organization to assist in collecting, analyzing, and disseminating severe maternal morbidity information, organizing and convening meetings of the committee, and conducting other tasks as may be incident to these activities.

(b) The committee shall, in coordination with the Maternal Mortality Review Committee:

(1) Collect and track medical records and other relevant data on severe maternal morbidity, including, but not limited to, all of the following health conditions:

(A) Obstetric hemorrhage;

(B) Hypertension;

(C) Preeclampsia and eclampsia;

(D) Venous thromboembolism;

(E) Sepsis;

(F) Cerebrovascular accident; and

(G) Amniotic fluid embolism;

(2) Collect and track data on pregnancy related deaths, including, but not limited to, deaths relative to the conditions provided in subparagraphs (A) through (G) of paragraph (1) of this subsection, indirect obstetric deaths, and other maternal disorders predominantly related to pregnancy and complications predominantly related to the postpartum period;

(3) Consult with relevant experts to evaluate collected records and data;

(4) Develop and make recommendations regarding reducing severe maternal morbidity;

(5) Disseminate findings and recommendations regarding reducing severe maternal morbidity; and

(6) Not later than July 1, 2026, complete a study on:

(A) Reducing severe maternal morbidity, including, but not limited to, all of the health conditions set forth in subparagraphs (A) through (G) of paragraph (1) of this subsection; and

(B) Identifying more effective methods for the early detection of, and interventions for, other pregnancy related medical conditions that can lead to an increased risk of severe maternal morbidity, including, but not limited, to hyperemesis gravidarum. (c)(1) Healthcare providers licensed pursuant to Title 43, healthcare facilities licensed pursuant to Chapter 7 of Title 31, and pharmacies licensed pursuant to Chapter 4 of Title 26 shall provide reasonable access to the committee to all relevant medical records associated with a case under review by the committee within 30 days of receiving a request for such records.

(2) A healthcare provider, healthcare facility, or pharmacy providing access to medical records pursuant to this Code section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing such records.

(d)(1) Information, records, reports, statements, notes, memoranda, or other data collected pursuant to this Code section shall not be admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person. Such information, records, reports, statements, notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the department or any other person, except as may be necessary for the purpose of furthering the review of the committee of the case to which it relates. No person participating in such review shall disclose, in any manner, the information so obtained except in strict conformity with such review.

(2) All information, records, reports, statements, notes, memoranda, or other data obtained by the department, the committee, and other persons, agencies, or organizations so authorized by the department pursuant to this Code section shall be confidential. (e)(1) All proceedings and activities of the committee under this Code section, opinions of members of such committee formed as a result of such proceedings and activities, and records obtained, created, or maintained pursuant to this Code section, including information, records, reports, statements, notes, memoranda, or other data procured by the department or any other person, agency, or organization acting jointly or under contract with the department in connection with the requirements of this Code section, shall be confidential and shall not be subject to Chapter 14 of Title 50, relating to open meetings, or Article 4 of Chapter 18 of Title 50, relating to open records, or subject to subpoena, discovery, or introduction into evidence in any civil or criminal proceeding; provided, however, that nothing in this Code section shall be construed to limit or restrict the right to discover or use in any civil or criminal proceeding anything that is available from another source and entirely independent of the committee's proceedings.

(2) Members of the committee shall not be questioned in any civil or criminal proceeding regarding the information presented in or opinions formed as a result of a meeting or communication of the committee; provided, however, that nothing in this Code section shall be construed to prevent a member of the committee from testifying to information obtained independently of the committee or which is public information. (f)(1) The data on severe maternal morbidity and on pregnancy related deaths collected pursuant to paragraphs (1) and (2) of subsection (b) of this Code section shall be compiled on a regular basis for distribution. Beginning no later than October 1, 2026, the committee shall submit a detailed annual report to the Office of Health Strategy and Coordination as follows:

(A) The data shall be aggregated by state regions, as defined by the department, to ensure the data reflect how regionalized care systems are or should be collaborating to improve maternal health outcomes or other smaller regional sorting based on standard statistical methods for accurate dissemination of public health data without risking a confidentiality or other disclosure breach; and

(B) The data shall be disaggregated by racial and ethnic identity.

(2) On or before December 1, 2026, the committee shall submit to the Governor, the Speaker of the House of Representatives, the President of the Senate, and the chairpersons of the House Committee on Public Health and the Senate Health and Human Services Committee a report regarding the study conducted pursuant to paragraph (6) of subsection (b) of this Code section, including a summary of the committee's key findings and recommendations, if any, for proposed legislation with respect to improving maternal health outcomes.

(g) Paragraph (6) of subsection (b) of this Code section shall stand repealed by operation of law on December 31, 2026."

SECTION 4-3.

Said title is further amended in Article 1 of Chapter 53, relating to general provisions regarding the Office of Health and Strategy and Coordination by revising subsection (a) of Code Section 31-53-6, relating to compiling of reports and public dissemination of data, as follows:

"31-53-6.

(a) The office shall compile reports received from the following boards, commissions, committees, councils, and offices pursuant to each such entity's respective statutory reporting requirements:

(1) The Maternal Mortality Review Committee;

(2) The Severe Maternal Morbidity Review Committee;

(2)(3) The Hemophilia Advisory Board;

(3)(4) The Georgia Council on Lupus Education and Awareness; (4)(5) The Georgia Palliative Care and Quality of Life Advisory Council; (5)(6) The Georgia Trauma Care Network Commission;

(6)(7) The Behavioral Health Coordinating Council;

(7)(8) The Department of Public Health on behalf of the Georgia Coverdell Acute Stroke Registry;

(8)(9) The Office of Cardiac Care; and

(9)(10) The Brain and Spinal Injury Trust Fund Commission."

SECTION 4-4.

Title 37 of the Official Code of Georgia Annotated, relating to mental health, is amended in Part 2 of Article 6 of Chapter 3, relating to rights and privileges as to manner of care and treatment and as to maintenance and release of clinical records, by revising paragraphs (9) and (10) of and by adding a new paragraph to subsection (a) of Code Section 37-3-166, relating to treatment of clinical records, when release permitted, scope of privileged communications, liability for disclosure, and notice to sheriff of discharge, to read as follows: "(9) Notwithstanding any other provision of law to the contrary, a law enforcement officer in the course of a criminal investigation may be informed as to whether a person is or has been a patient in a state facility, as well as the patient's current address, if known; and

(10) Notwithstanding any other provision of law to the contrary, a law enforcement officer in the course of investigating the commission of a crime on the premises of a facility covered by this chapter or against facility personnel or a threat to commit such a crime may be informed as to the circumstances of the incident, including whether the individual allegedly committing or threatening to commit a crime is or has been a patient in the facility, and the name, address, and last known whereabouts of any alleged patient perpetrator; and

(11) Copies of the record of a deceased patient or deceased former patient may be released to the Maternal Mortality Review Committee and the Severe Maternal Morbidity Review Committee established under Chapter 2A of Title 31, except for matters privileged under the laws of this state."

SECTION 4-5.

Title 45 of the Official Code of Georgia Annotated, relating public officers and employees, is amended in Article 2 of Chapter 16, relating to death investigations, by revising subsection

(b) of Code Section 45-16-24, relating to notification of suspicious or unusual deaths, court ordered medical examiner's inquiry, and written report of inquiry, as follows: "(b) A coroner or county medical examiner who is notified of a death pursuant to subsection (a) of this Code section under circumstances specified in paragraphs (1) through (9) (10) of such subsection shall order a medical examiner's inquiry of that death. A coroner or medical examiner who is notified of a death pursuant to subsection (a) of this Code section under circumstances specified in paragraph (10) of such subsection and which death was not under circumstances specified in paragraphs (1) through (9) of such subsection shall order a medical examiner's inquiry for such death through a regional perinatal center, as identified by the Department of Public Health. This subsection shall not be construed to prohibit a medical examiner's inquiry of a death if a coroner or county medical examiner is notified of a death under circumstances specified in paragraph (11) of subsection (a) of this Code section."

PART 5.

SECTION 5-1.

All laws and parts of laws in conflict with this Act are repealed.