Committee Report

aollputuoD Committee aollputuoD

poda H H Report- CONSENT CALENDARCALENDAR

April 4,4, 20182018

HOUSE OF REPRESENTATIVES

EPORT OF COMMITTEE

The CommitteeCommittee on on Health, Health, Human Human Services Services and and Elderly Elderly

Affairs toto whichwhich was was referred referred SB SB 549-FN-A, 549-FN-A,

AN ACTACT (New(New Title) Title) relative relative to to plans plans of of safe safe care care for for infants affectedaffected by by substance substance abuse abuse or orwithdrawal withdrawal symptoms from from prenatal prenatal drug drug exposure exposure or fetalor fetal alcohol alcohol spectrum disorder. disorder. Having Having considered considered the the same, same, report report the samesame withwith the the following following amendment, amendment, and and the the recommendation that that the the bill bill OUGHT OUGHT TO TO PASS PASS WITH WITH

AMENDMENT.

FOR THE COMMITTEE

Original: House House Clerk Clerk Cc: CommitteeCommittee Bill Bill File File COMMITTEE REPORT Committee: Health, Human Services and Elderly Affairs 'BillBill Number:Number SBB5549417NAZEI 549-FN-A Title: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrumspectrum disorder. Date: 'April4,April 4, 20182018 Consent Calendar: CONSENT Recommendation:Recommendation. OUGHT TO PASS WITH AMENDMENT 2018-1339h

STATEMENT OF INTENT

The Department of Health and Human Services reported to the Committee on Health, Human Services and Elderly Affairs that this bill was required to meet federal reporting requirements. The committee amendment removes any motivation for at-risk mothers to give birth outside of a hospital setting where appropriate care can be given, addresses medications prescribed for legitimate medical reasons, and attaches the plan of safe care to mandatory reports of abuse. The committee recommends Ought to Pass with Amendment.

Vote 13-0.

Rep. William Marsh FOR THE COMMITTEE

Original: House Clerk Cc: Committee Bill File CONSENT CALENDARCALENDAR

Health, Human Services and Elderly Affairs SB 549-FN-A,549-FN--A, (New (New Title) Title) relative relative to to plans plans of of safesafe carecare forfor infantsinfants affectedaffected byby substancesubstance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder. OUGHT TOTO PASS WITHWITH AMENDMENT. AMENDMENT. Rep. William Marsh for Health, Human Services and Elderly Affairs. The Department of Health and Human Services reported to the Committee on Health, Human Services and Elderly Affairs that this bill was required to meet federal reporting requirements. The committee amendment removes any motivation for at-risk mothers to give birth outside of a hospital setting where appropriate care can be given, addresses medications prescribed for legitimate medical reasons, and attaches the plan of safe care to mandatory reports of abuse. The committee recommends Ought to Pass withwith Amendment.Amendment. Vote 13-0.

Original: House Clerk Cc: Committee Bill File

Rep. M. MacKay, Hills. 30 Rep. W. Marsh, Carr. 8 April 3, 2018 2018-1339h 05/04

Amendment to SB 549-FN-A

1 Amend the bill by replacing all after the enacting clause with the following: 2 3 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 4 inserting after section 10-d the following new sections: 5 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 6 care of infants born with and identified as being affected by substance abuse or withdrawal 7 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 8 the department of health and human services of the occurrence of such condition in the manner 9 prescribed by the department, irrespective of whether the infant was born in the hospital or other 10 setting. 11 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 12 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 13 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 14 cooperation with the infant's parents or guardians and the department of health and human 15 services, division of public health services, as appropriate, to ensure the safety and well-being of the 16 infant, to address the health and substance use treatment needs of the infant and affected family 17 members or caregivers, and to ensure that appropriate referrals are made and services are 18 delivered to the infant and affected family members or caregivers. The plan shall take into account 19 whether the infant's prenatal drug exposure occurred as the result of medication assisted 20 treatment, or medication prescribed for the mother by a health care provider and whether the 21 infant's mother is or will be actively engaged in ongoing substance use disorder treatment following 22 discharge that would mitigate the future risk of harm to the infant. A copy of the plan of safe care 23 shall be included in the instructions for the infant upon discharge from the hospital or from the 24 health care provider involved in the development of the plan of safe care. The plan of safe care 25 shall not be submitted to the department unless it is pursuant to RSA 132:10-g or the department 26 makes an official request for a copy of the plan in compliance with confidentiality requirements. 27 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 28 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 29 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 30 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 31 2 Effective Date. This act shall take effect upon its passage. SB 549-FN-A relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

OTP/A 2%-61"351'119'1) 15-0 Consent Calendar

The Department of Health and Human Services reported to the Committee on Health, Human Services and Elderly Affairs that this bill was required to meet federal reporting requirements. The committee amendment removes any motivation for at-risk mothers to give birth outside of a hospital setting where appropriate care can be given; addresses medications prescribed for legitimate medical reasons; and attaches the plan of safe care to mandatory reports of abuse. The committee recommends Ought to Pass with Amendment.

Rep. William Marsh for the Committee

COMMITTEE REPORT REPORT

COMMITTEE: S

BILL NUMBER:NUMBER: 9-/q,C Y ri\) TITLE: 6C&e.144-)uke e I 4,F)w O'T-r Sce671(e- CC /V_ e

DATE: CONSENT CALENDAR:CALENDAR: YES YES 14 NONO ElEl

111 OUGHTOUGHT TOTO PASS PASS r Amendment No. No. SOUGHTOUGHT TO TO PASS PASS W/ W/ AMENDMENT AMENDMENT 2“')2 (')/.1 ) 1212 1/ 74 El111 INEXPEDIENTINEXPEDIENT TO TO LEGISLATE LEGISLATE Li INTERIM STUDY (Available(Available only only 2nd 2nd year year of of biennium) biennium)

STATEMENT OF OF INTENT: INTENT:

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COMMITTEE VOTE: VOTE: rs 00

RESPECTFULLY SUBMITTED • Copy to Committee Bill File • Use Another Report for Minority Report Rep. For thethe Committee Committee l(A)Aht.L.-rte) t- Mr440-14--CLI1V---Cli Rev. 02/01/07 - Yellow

Rep. M. MacKay, Hills. 30 Rep. LeBrun, Hills. 32 March 23, 2018 2018-1206h 05/04

Amendment to SB 549-FN-A

1 Amend the bill by replacing all after the enacting clause with the following: 2 3 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 4 inserting after section 10-d the following new sections: 5 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 6 care of infants born with and identified as being affected by substance abuse or withdrawal 7 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 8 the department of health and human services of the occurrence of such condition in the manner 9 prescribed by the department. 10 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 11 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 12 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 13 cooperation with the infant's parents or guardians and the department of health and human 14 services, division of public health services, as appropriate, to ensure the safety and well-being of the 15 infant, to address the health and substance use treatment needs of the infant and affected family 16 members or caregivers, and to ensure that appropriate referrals are made and services are 17 delivered to the infant and affected family members or caregivers. The plan shall take into account 18 whether the infant's prenatal drug exposure occurred as the result of medication assisted treatment 19 provided to the infant's mother under the care of a physician and whether the infant's mother is or 20 will be actively engaged in ongoing substance use disorder treatment following discharge that 21 would mitigate the future risk of harm to the infant. A copy of the plan of safe care shall be 22 included in the instructions for the infant upon discharge from the hospital or from the health care 23 provider involved in the development of the plan of safe care. The plan of safe care shall not be 24 submitted to the department unless it is pursuant to RSA 132:10-g or the department makes an 25 official request for a copy of the plan in compliance with confidentiality requirements. 26 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 27 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 28 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 29 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 30 2 Effective Date. This act shall take effect upon its passage. Amendment to SB 549-FN-A - Page 2 -

2018-1206h AMENDED ANALYSIS

Rep. W. Marsh, Carr. 8 Rep. Knirk, Carr. 3 March 27, 2018 2018-1247h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e and 132:10-f as inserted by section 1 of the bill by replacing them with the 2 following: 3 4 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 5 care of infants born with and identified as being affected by substance abuse or withdrawal 6 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 7 the department of health and human services of the occurrence of such condition in the manner 8 prescribed by the department, irrespSctiveirrespective of whether the infant was born in the hospital or other 9 setting. 10 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 11 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 12 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 13 cooperation with the infant's parents or guardians and the department of health and human 14 services, division of public health services, as appropriate, to ensure the safety and well-being of the 15 infant, to address the health andand subStancesubstance useuse treatmenttreatment needsneeds of the infant and affected family 16 members or caregivers, and to ensure that appropriate referrals are made and services are 17 delivered to the infant and affected family members or caregivers. The plan shall take into account 18 whether the infant's prenatal drug.drug, exposure occurred as the result of medication assisted 19 treatment, or medication prescribed forfar the mother by a health care provider and whether the 20 infant's mother is or will be actively engaged in ongoing substance use disorder treatment following 21 discharge that would mitigate the future risk of harm to the infant. A copy of the plan of safe care 22 shall be included in the instructions for the infant upon discharge from the hospital or from the 23 health care provider involved in the development of the plan of safe care. The plan of safe care 24 shall not be submitted to the department unless it is pursuant to RSA 132:10-g or the department 25 makes an official request for a copy of the plan in compliance with confidentiality requirements.

S IS IS aaT T IWA IWA

Voting aU Sheets HOUSE COMMITTEECOMMITTEE ON ON HEALTH, HEALTH, HUMAN HUMAN SERVICES SERVICES AND AND ELDERLY ELDERLY AFFAIRS AFFAIRS

EXECUTIVE SESSIONSESSION on on SB SB 549-FN-A 549-FN-A

BILL TITLE:TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 4, 2018

LOB ROOM:ROOM: 205

MOTIONS: OUGHT TOTO PASS PASS WITH WITH AMENDMENT AMENDMENT

Moved by Rep. W. Marsh Seconded by Rep. M. MacKay AM Vote: 13-0

Amendment # 2018-1339h

(2018-1339h is the Combined Amendment of 2018-1206h and 2018-1247h)

CONSENT CALENDAR:CALENDAR: YES YES

Statement of of Intent: Intent: Refer to Committee Report

Respectfullyiubmitte ,

1177,1,1-4 Ll0 _eazi..404-F- Rep Mark Pearson, Clerk

STATE OFOF NEW NEW HAMPSHIRE HAMPSHIRE 3/14/2018 12:12:24 PMPM OFFICE OF OF THE THE HOUSE HOUSE CLERK CLERK Roll Call CommitteeCommittee Registers Registers Report 2018 SESSION vorl-VOTE- edo,v(zozms7O NF.-/ Roils 744-r-7-114-7- HHS&EA aOle - 1330,1 ttsS "nt-L'

Cl/Yr-cc&Cityr-c /ivy)fiyys e /7 dvn civri eeels- n-t7 Bill #: 66-721 g"'9' r—FAMA/74 Title: Title:

PH Date:Date: Exec Session Date:Date: 0 q / Ooc/c-/ 0, E Motion: 6 rtr-P7 Amendment #: #:

MEMBER YEAS NAYS

Kotowski, FrankFrank R. R. Chariman Chariman i LeBrun, Donald Donald L. L. Vice Vice Chairman Chairman 13FS McMahon, Charles Charles E. E. Nelson, Bill G. rIA. DD Guthrie, Joseph Joseph A. A. L3L.3 Donovan, DanielDaniel A. A.

Fothergill, John John 4)1'- Bove, Martin N. N. MacKay, MariellenMariellen J. J. 65 Edwards, Jess Jess Fedolfi, JimJim Marsh, William William M. M. ((a0 Pearson, Mark Mark c0oo,Ju-00,J ,) ...,- 7 MacKay, JamesJames R. R. Y Freitas, Mary Mary C. C. Weber, LucyLucy M. M. "/c---/ Gordon, Pamela Pamela S. S. Knirk, Jerry Jerry / O0 Messmer, MindiMindi F. F. I( Salloway, JeffreyJeffrey C. C. Campion, Polly Polly Kent Kent i/ 2--;- Ayala, JessicaJessica Spagnuolo, PhilipPhilip TOTAL VOTE:VOTE: k"I-)--) "AA,

Page: 11 ofof 11

HOUSE COMMITTEECOMMITTEE ON ON HEALTH, HEALTH, HUMAN HUMAN SERVICES SERVICES AND AND ELDERLY ELDERLY AFFAIRS AFFAIRS

EXECUTIVE SESSION SESSION on on SB SB 549-FN-A 549-FN-A

BILL TITLE:TITLE: (New Title) relativerelative to to plans plans of of safe safe care care for for infants infants affected affected by substanceby substance abuse abuse or withdrawalwithdrawal symptoms symptoms from from prenatal prenatal drug drug exposure exposure or fetal or fetalalcohol alcohol spectrum spectrum disorder.

DATE:

LOB ROOM:ROOM: 205

MOTION: (Please (Please check check one one box) box) OOTPT P ❑0 ITLITL CI0 Retain Retain (Is' (Pt year) year) CI0 Adoption Adoption of of Amendment # # •af047e/d" --733733 '97,'4 CIO Interim Interim Study Study (2nd (2nd year) year) (if offered)

Moved byby Rep.Rep. Seconded byby Rep.Rep. Vote:Vote:

MOTION: (Please (Please check check one one box) box)

CIO OTP k/rOTP/A CI0 ITL ITL CI0 Retain Retain (ls' (18' year) year) CI0 Adoption Adoption of of Amendment # # / 33 3 9 9 44 CIO Interim Interim Study Study (2nd (2nd year) year) (if offered) zz Moved byby Rep.Rep. Seconded byby Rep.Rep. Vote:Vote: / ..-5--)

MOTION: (Please (Please check check one one box) box)

❑O OTP 0❑ OTP/AOTP/A 00 ITLITL CI0 Retain Retain (Is' (18' year) year) CI0 Adoption Adoption of of Amendment # # CIO Interim Interim Study Study (2nd (2nd year) year) (if offered)

Moved byby Rep.Rep Seconded byby Rep.Rep. Vote:

MOTION: (Please (Please check check one one box) box)

CIO OTP ❑0 OTP/AOTP/A CI0 ITL ITL CI0 Retain Retain (Is' (18' year) year) 0 Adoption ofof Amendment # # 0O InterimInterim StudyStudy (2nd (2nd year) year) (if offered)

Moved byby Rep.Rep. Seconded byby Rep.Rep. Vote:

CONSENT CALENDAR: CALENDAR: XX YES YES NO

Minority Report? Report? Yes No If yes, author, Rep: Rep: Motion

Respectfully submitted:submitted: 014-- Rep MarkMark Pearson, Pearson, Clerk Clerk

Rep. M. MacKay, Hills. 30 Rep. W. Marsh, Carr. 8 April 3, 2018 2018-1339h 05/04

Amendment to SB 549-FN-A

1 Amend the bill by replacing all after the enacting clause with the following: 2 3 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 4 inserting after section 10-d the following new sections: 5 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 6 care of infants born with and identified as being affected by substance abuse or withdrawal 7 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 8 the department of health and human services of the occurrence of such condition in the manner 9 prescribed by the department, irrespective of whether the infant was born in the hospital or other 10 setting.setting. 11 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 12 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 13 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 14 cooperation with the infant's parents or guardians and the department of health and human 15 services, division of public health services, as appropriate, to ensure the safety and well-being of the 16 infant, to address the health and substance use treatment needs of the infant and affected family 17 members or caregivers, and to ensure that appropriate referrals are made and services are 18 delivered to the infant and affected family members or caregivers. The plan shall take into account 19 whether the infant's prenatal drug exposure occurred as the result of medication assisted 20 treatment, or medication prescribed for the mother by a health care provider and whether the 21 infant's mother is or will be actively engaged in ongoing substance use disorder treatment following 22 discharge that would mitigate the future risk of harm to the infant. A copy of the plan of safe care 23 shall be included in the instructions for the infant upon discharge from the hospital or from the 24 health care provider involved in the development of the plan of safe care. The plan of safe care 25 shall not be submitted to the department unless it is pursuant to RSA 132:10-g or the department 26 makes an official request for a copy of the plan in compliance with confidentiality requirements. 27 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 28 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 29 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 30 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 31 2 Effective Date. This act shall take effect upon its passage. Amendment toto SBSB 549-FN-A 549-FN-A - Page 22 --

2018-1339h AMENDED ANALYSISANALYSIS

This billbill directsdirects health health care care providers providers to developto develop a plan a plan of safe of safe care care for infants for infants affected affected by by substance abuse, abuse, prenatal prenatal drug drug exposure, exposure, or aor fetal a fetal alcohol alcohol spectrum spectrum disorder. disorder. The bill The also bill also provides thatthat if if the the health health care care provider provider makes makes a report a report of possible of possible abuse abuse or neglect, or neglect, the provider the provider shall submitsubmit the the plan plan of of safe safe care care to tothe the department department of health of health and humanand human services. services. HOUSE COMMITTEECOMMITTEE ON ON HEALTH, HEALTH, HUMAN HUMAN SERVICES SERVICES AND AND ELDERLY ELDERLY AFFAIRS AFFAIRS

EXECUTIVE SESSIONSESSION on on SB SB 549-FN-A 549-FN-A

BILL TITLE:TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 3, 2018

LOB ROOM:ROOM: 205

MOTIONS: OUGHT TOTO PASS PASS WITH WITH AMENDMENT AMENDMENT Moved by Rep. W. Marsh Seconded by Rep. M. MacKay AM Vote: 16-0

Amendments # 2018-1206h and 2018-1247h

Amendment 2018-1206h had already been accepted at public hearing on 3/27 passed 18-0 and will be combined with Amendment 2018-1247h per unanimous agreement of committee. Moved by Rep. W. Marsh Seconded by Rep. M. MacKay Vote: 15-0

CONSENT CALENDAR:CALENDAR: YES YES

Statement of of Intent: Intent: Refer to Committee Report

Respectfully submitted, (2 '/,tad22tati,// s) Rep Mark Pearson, Clerk

HOUSE COMMITTEECOMMITTEE ON ON HEALTH, HEALTH, HUMAN HUMAN SERVICES SERVICES AND AND ELDERLY ELDERLY AFFAIRS AFFAIRS

EXECUTIVE SESSIONSESSION on on SB SB 549-FN-A 549-FN-A

BILL TITLE:TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder. DATE: April 3,3, 20182018

LOB ROOM:ROOM: 205

MOTION: (Please(Please check check one one box) box) 11,2,01,610a h 12**CITP12'6rP 0❑ ITLITL 0 Retain (lst(l' year)year) ❑CI AdoptionAdoption of of j--7 co kk Amendment # 0 Interim Study (2nd year) (if offered)

Moved by Rep. 10IA Seconded by Rep. NIMPaMackcka7 ay VoteVote:- 0

MOTION: (Please(Please check check one one box) box)

❑ OTP alfrIP/A 0 ITLITL 0 Retain (1st(P' year)year) 0 Adoption of Amendment # OCI InterimInterim StudyStudy (2nd year) (if offered) 0 Moved by Rep. 111Wi 0,4.4L(MAL_ Seconded by Rep. r.4IV MacC kakei-,-7i Vote: /37—/3-- 0

MOTION: (Please(Please check check one one box) box)

❑ OTP ❑ OTP/A 0 ITL 0CI Retain Retain (Pt(1st year)year) OCI AdoptionAdoption of Amendment # O0 InterimInterim StudyStudy (2nd(2nd year) (if offered)

Moved by Rep. Seconded by Rep. Vote:

MOTION: (Please(Please check check one one box) box)

❑CI OTP ❑ OTP/A 0 ITL 0CI Retain Retain (Pt(1st year)year) O0 AdoptionAdoption ofof Amendment # OCI InterimInterim StudyStudy (2nd year) (if offered)

Moved by Rep. Seconded by Rep. Vote:

CONSENT CALENDAR:CALENDAR: 'YESYES NO

Minority Report? Report? Yes No If yes, author, Rep: MoMotion on

Respectfully submitted: Rep Mark Pearson, Clerk aa 74 I1,66,/ 26) 6", ka CUAL-4-1:17 Gt ccv---iokcc-c--Ek cif of 34-747

STATE OF NEW HAMPSHIREHAMPSHIRE 3/14/2018 12:12:24 PMPM OFFICE OF THE HOUSE CLERKCLERK Roll CallCall Committee Committee RegistersRegisters Report 2018 SESSION

7 etw 6 HHS&EA (N(Ne4A..) eA,1 /4.) -1-:+1 -1-;+k)- ) 1 ,--eict-iitv-t -fu31-u ipta-A-3otamn-0 7 , V.g. 6( 41:91 bi S JA-b-Ata/v-04 11 CP a 0-&14-:x-PY air w;, ; r .!i ck-O-WO(EPtkr1 ii) tr13-346Tnns4-5 Bill #: 53 Icfctf I Title: AA [chug ca,ca nit ixtz/vcaL1.z/Irk-a-Tai--t- dit,Gti Ctilit, ..)A2 7 vv. PH Date: 1/ 1/ Exec SessionSession Date: 0 (I I/ DD3-3 / on;°m a - AiicveLeLe„_urc(frea,_,,a,.._} Motion: arrp Amendment #: 12-V7/2-V7 )---

MEMBER YEAS NAYS

Kotowski, FrankFrank R. R. Chariman Chariman i/ LeBrun, Donald Donald L. L. Vice Vice Chairman Chairman i/ (0(0 McMahon, Charles Charles E. E. 0, Nelson, Bill Bill G. G. Cirlrk Mk Guthrie, Joseph Joseph A. A. 3 Donovan, DanielDaniel A. A. Fothergill, John John 1-W/*. Bove, Martin N. N. 5 MacKay, MariellenMariellen J. J. & Edwards, Jess Jess Fedolfi, JimJim Marsh, William William M. M. 17 Pearson, Mark Mark Chia.—CLP-^1.— g MacKay, JamesJames R. R. 9 Freitas, Mary Mary C. C. Ii ()0 Weber, LucyLucy M. M. Gordon, Pamela Pamela S. S. 1I t Knirk, Jerry Jerry 13,i (3, Messmer, MindiMindi F. F. 13/ 'S Salloway, JeffreyJeffrey C. C. / LfE-f Campion, Polly Polly Kent Kent I/ /-3 6-- Ayala, JessicaJessica Spagnuolo, PhilipPhilip TOTAL VOTE:VOTE: 1i G(0 e)e>

Page: 11 ofof 1

STATE OFOF NEW NEW HAMPSHIRE HAMPSHIRE 3/14/2018 12:12:24 PMPM OFFICE OF OF THE THE HOUSE HOUSE CLERK CLERK Roll Call CommitteeCommittee Registers Registers Report 2018 SESSION

01 orA4 q s4e c , HHS&EA (tJadCOAA) -MO Mk) 1a,Faix+^vt-3)^ut +u +0 1oev,44 rrji Seletr prn ra / / simeiznrs Lem ca-at,c1.4ikrit eta i?_jb3 stAir-ofetAACL,r6k-t,---t - a Ar ,c-x- 0-4-cto-e.cy-b-u.,,e. 41c,bocLau)i, ti') I )14/. \ CeA L e St./ hir1741/1-S /1-(1141 Bill #: 5(359151301 Title: inno.v. o-in c, )1-0-ex./12 etuArout J . „Pi pra-o- Q ON,CA/ 64 egfCti,±0.1 0-'etbkfi10-4ol/lc/I Sp-SptenLA•--•-• 1 4,113 Olnet/0 PH Date:Date: / / Exec SessionSession Date: Date: d 6`7 '-/ /1 0o3 3 / c20i0201g g- Motion: OT01- 1p7 AA Amendment #: #: /Le0 4

MEMBER YEAS NAYS

Kotowski, FrankFrank R. R. Chariman Chariman I LeBrun, Donald Donald L. L. Vice Vice Chairman Chairman I/ b6 — McMahon, Charles Charles E. E. aD, Nelson, BillBill G.G. eitiok-eltiole Guthrie, Joseph Joseph A. A. 3 Donovan, DanielDaniel A. A. Fothergill, John John iLI. Bove, Martin N. N. S5 MacKay, MariellenMariellen J. J. 1,to Edwards, Jess Jess Fedolfi, JimJim Marsh, William William M. M. 7 Pearson, Mark Mark &Uc2iJLAL_ 2 MacKay, JamesJames R. R. 9 Freitas, Mary Mary C. C. 1 0 Weber, LucyLucy M. M. Gordon, Pamela Pamela S. S. 1I 1i Knirk, Jerry Jerry ala Messmer, MindiMindi F. F. 13 Salloway, JeffreyJeffrey C. C. 1//1 Campion, Polly Polly Kent Kent Ayala, JessicaJessica Spagnuolo, PhilipPhilip TOTAL VOTE:VOTE: Ich D0

Page: 11 ofof 11

Rep. M. MacKay, Hills. 30 Rep. LeBrun, Hills. 32 March 23, 2018 2018-1206h 05/04

Amendment to SB 549-FN-A

1 Amend the bill by replacing all after the enacting clause with the following: 2 3 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 4 inserting after section 10-d the following new sections: 5 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 6 care of infants born with and identified as being affected by substance abuse or withdrawal 7 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 8 the department of health and human services of the occurrence of such condition in the manner 9 prescribed by the department. 10 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 11 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 12 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 13 cooperation with the infant's parents or guardians and the department of health and human 14 services, division of public health services, as appropriate, to ensure the safety and well-being of the 15 infant, to address the health and substance use treatment needs of the infant and affected family 16 members or caregivers, and to ensure that appropriate referrals are made and services are 17 delivered to the infant and affected family members or caregivers. The plan shall take into account 18 whether the infant's prenatal drug exposure occurred as the result of medication assisted treatment 19 provided to the infant's mother under the care of a physician and whether the infant's mother is or 20 will be actively engaged in ongoing substance use disorder treatment following discharge that 21 would mitigate the future risk of harm to the infant. A copy of the plan of safe care shall be 22 included in the instructions for the infant upon discharge from the hospital or from the health care 23 provider involved in the development of the plan of safe care. The plan of safe care shall not be 24 submitted to the department unless it is pursuant to RSA 132:10-g or the department makes an 25 official request for a copy of the plan in compliance with confidentiality requirements. 26 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 27 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 28 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 29 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 30 2 Effective Date. This act shall take effect upon its passage. Amendment toto SIBSE 549-FN-A549-FN-A - Page 2 -

2018-1206h AMENDED ANALYSIS

Rep. W. Marsh, Carr. 8 Rep. Knirk, Carr. 3 March 27, 2018 2018-1247h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e and 132:10-f as inserted by section 1 of the bill by replacing them with the 2 following; 3 4 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 5. carecare of of infants infants born born with with and and identified identified as as being being affected affected by by substance substance abuseabuse oror withdrawalwithdrawal 6 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 7 the department of health and human services of the occurrence of such condition in the manner 8 prescribed by the department,;department,: irrespective of whether the infant was born in the hospital or other 9 setting.setting. 10 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 11 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 12 or a fetal alcohol spectrum diSorder,disorder, thethe healthhealth carecare provider shall develop a plan of safe care, in 13 cooperation with the infant's, parents or guardians and the department of health and human 14 services, division of public health services, as appropriate, to ensure the safety and well-being of the 15 infant, to address the health and substance use treatment needs of the infant and affected family 16 members or caregivers, and to ensure that appropriate referrals are made and services are 17 delivered to the infant and affected family members or caregivers. The plan shall take into account 18 whether the infant's prenatal drugthug exposure occurred as the result of medication assisted 19 treatment, or medication prescribed for the mother by a health care provider and whether the 20 infant's mother is or will be actively engaged in ongoing substance use disorder treatment following 21 discharge that would mitigate the future risk of harm to the infant. A copy of the plan of safe care 22 shall be included in the instructions for the infant upon discharge from the hospital or from the 23 health care provider involved in the development of the plan of safe care. The plan of safe care 24 shall not be submitted to the department unless it is pursuant to RSA 132:10-g or the department 25 makes an official request for a copy of the plan in compliance with confidentiality requirements. Hearing Minutes

HOUSE COMMITTEECOMMITTEE ON ON HEALTH, HEALTH, HUMAN HUMAN SERVICES SERVICES AND AND ELDERLY ELDERLY AFFAIRS AFFAIRS PUBLIC HEARINGHEARING ON ON SB SB 549-FN-A 549-FN-A BILL TITLE:TITLE: (New (New Title) Title) relative relative to toplans plans of ofsafe safe care care for forinfants infants affected affected by by substance abuse abuse or or withdrawal withdrawal symptoms symptoms from from prenatal prenatal drug drug exposure exposure or fetalfetal alcoholalcohol spectrum spectrum disorder. disorder. DATE: MarchMarch 27, 27, 2018 2018 LOB ROOM:ROOM: 205 205 Time PublicPublic Hearing Hearing Called Called to toOrder: Order: 10:00 a.m.a.m. Time Adjourned:Adjourned: 10:58

Committee Members: Members: Reps. Reps. Kotowski, Kotowski, LeBrun, LeBrun, M. M.Pearson, Pearson, McMahon, McMahon, Guthrie, Guthrie, Nelson, Nelson, Donovan, Fothergill,Fothergill, Bove, Bove, M. M. MacKay, MacKay, J. J.Edwards, Edwards, Fedolfi, Fedolfi, W. Marsh,W. Marsh, J. MacKay, J. MacKay, Freitas, Weber,Weber, P. P. Gordon, Gordon, Knirk, Knirk, Salloway, Salloway, Campion Campion and and Ayala Ayala Bill Sponsors:Sponsors: Sen. GrayGray

TESTIMONY * Use asterisk if if written written testimony testimony and/or and/or amendments amendments are aresubmitted. submitted.

Sen. Gray introduced the the bill. bill. He He is isaware aware of ofamendment amendment 2018-1206h. 2018-1206h. He canHe canaccept accept amendment and. and recognizes recognizes it itmight might need need to tobe betweaked. tweaked.

Q: WillWill thisthis be be a a burden burden on on provider provider (time (time to carryto carry out plan)?out plan)? A: Expects itit will. will. Expects Expects providers providers would would get get additional additional payment. payment.

Discussion followedfollowed onon whatwhat is is already already being being done. done.

Rep. M. MacKayMacKay introducedintroduced Amendment Amendment 2018-1206h. 2018-1206h. Amendment Amendment was was adopted adopted by by committee.

John Williams andand TriciaTricia Tilley. Tilley. DHHS DHHS - -The The Department Department supports supports the bill. the bill. Legislation isis neededneeded per per federal federal legislation. legislation. We We need need something something in place in place or the or statethe state could could lose funds. Ms.Ms. TilleyTilley explained explained how how this this works. works. It Itis ais plana plan for for care. care. Many Many MDs MDs already already do this. ThereThere is is no no distinction distinction between between prescribed prescribed meds meds and and illegal illegal drugs drugs in federal in federal law. law. There isis inconsistencyinconsistency in in what what is is reported reported at thisat this time. time. DHHS DHHS has hasworked worked on a ontemplate a template to to be used. FormsForms have have been been piloted piloted for for this this program program in five in five hospitals. hospitals.

Q: IsIs thisthis enabling enabling legislation? legislation? A: Rules areare not not built built in? in?

Q: OpioidOpioid therapy therapy is is not not in in amended amended copy copy - should - should it be it added?be added? A: It willwill bebe lookedlooked at. at.

Q: WillWill thethe mother mother be be followed followed after after birth? birth? A: Provider can can follow follow the the mother mother afterwards. afterwards.

Q: WouldWould medically medically prescribed prescribed meds meds for for mother mother carry carry any anylegal legal problems problems for mom? for mom? A: This hashas been been looked looked at at by by MD MD on on the the committee. committee. Q: WillWill MDsMDs becomebecome a a law law enforcement enforcement official? official? A: All health care care providers providers are are happy happy with with the thebill billand andrequirements. requirements.

Q: HowHow dodo midwivesmidwives fit fit into into this? this? There There is isa reportinga reporting requirement requirement for them? for them? A: Yes.

Q: IfIf aa childchild is is adopted adopted with with alcohol alcohol syndrome, syndrome, will will adoptive adoptive parents parents be made be made aware aware of of this? A: Most likelylikely itit would would be be up up to to the the adoption adoption agency. agency.

Jake Berry, New FuturesFutures -- supportssupports bill. bill. See See written written testimony. testimony.

Respectfully submitted,submitted, r

Rep. BillBill Nelson,Nelson, ClerkClerk

HOUSE COMMITTEE ON HEALTH, HUMAN SERVICES AND ELDERLY AFFAIRS

PUBLIC HEARING ON SB 549-FN-A

BILL TITLE:TITLE: (New(New Title) Title) relative relative to to plans plans of of safe safe carecare forfor infantsinfants affectedaffected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: _; Y

ROOM: 205205 Time Public Hearing CalledCalled toto Order:Order: ///4947.• er-61--25)d..°

Time Adjourned: lo f C8

(please circle if present)

Committee Members: Reps. Kotowski, LeBrun, Nelson, McMahon, Guthrie, Donovan, Fothergill, Bove, M. MacKay, J. Edwards, Fedolfi, W. Marsh, M. Pearson, J. MacKay, Freitas, Weber, P. Gordon, Knirk, Messmer, Salloway, Campion, Ayala and Spagnuolo

Bill Sponsors: Sen. Gray

TESTIMONY

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Rep. M. MacKay, Hills. 30 Rep. LeBrun, Hills. 32 March 23, 2018 2018-1206h 05/04

Amendment to SB 549-FN-A

1 Amend the bill by replacing all after the enacting clause with the following: 2 3 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 4 inserting after section 10-d the following new sections: 5 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 6 care of infants born with and identified as being affected by substance abuse or withdrawal 7 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 8 the department of health and human services of the occurrence of such condition in the manner 9 prescribed by the department. 10 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 11 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 12 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 13 cooperation with the infant's parents or guardians and the department of health and human 14 services, division of public health services, as appropriate, to ensure the safety and well-being of the 15 infant, to address the health and substance use treatment needs of the infant and affected family 16 members or caregivers, and to ensure that appropriate referrals are made and services are 17 delivered to the infant and affected family members or caregivers. The plan shall take into account 18 whether the infant's prenatal drug exposure occurred as the result of medication assisted treatment 19 provided to the infant's mother under the care of a physician and whether the infant's mother is or 20 will be actively engaged in ongoing substance use disorder treatment following discharge that 21 would mitigate the future risk of harm to the infant. A copy of the plan of safe care shall be 22 included in the instructions for the infant upon discharge from the hospital or from the health care 23 provider involved in the development of the plan of safe care. The plan of safe care shall not be 24 submitted to the department unless it is pursuant to RSA 132:10-g or the department makes an 25 official request for a copy of the plan in compliance with confidentiality requirements. 26 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 27 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 28 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 29 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 30 2 Effective Date. This act shall take effect upon its passage. Amendment toto SBSB 549-FN549-FN-A -A - Page 2 -

2018-1206h AMENDED ANALYSIS

This bill directs health care providers to develop a plan of safe care for infants born with, or affected by substance abuse, prenatal drug exposure, or a fetal alcohol spectrum disorder and addresses the circumstances under which the plan may be submitted to the department of health and human services. SIGN UP SHEET 1/D./ 4 go/ a../7) To RegisterRegister Opinion Opinion If If Not Not Speaking Speaking Bill # S15 ~yy Date 3/'W/ 7 Committee

** Please PrintPrint All All Information Information ** **

(check one)one) Name Address Phone Representing Pro Con ii:9-t AA /11/0 ( r 6 :9 __ /Voir 6 1i .iric/AFTR.,67. it icia.:77,b1f 1)/11-1,SAWIS Y ay\r\e_anry_ 1;e__Peicio-ri;ep,),Nor--P--P Ai-{/V1-4 (-1-A- (-I A-- Kk" (6,'f'f •-__ _ (2 (2 S/eSk,f 00 -6-E1'E-12-24- <--24 r-AJr-vt-/ ---R)c«RocK -7e'-76- sK.sr< TestimonyTestimony advocate • educate • collaborate newfuturernewfuturer to improve thethe healthhealth and wellness of all GraniteGranite StatersStaters

March 27, 27, 2018 2018 The HonorableHonorable Frank Frank Kotowski, Kotowski, Chair Chair Health, HumanHuman Services Services and and Elderly Elderly Affairs Affairs Committee Committee Legislative OfficeOffice Building,Building, Room Room 205 205 33 North StateState Street Street Concord, NH NH 03301 03301 Re: NewNew FuturesFutures Testimony Testimony on on SB SB 549-FN 549-FN (relative (relative to toinfants infants born born with with substance substance abuse abuse or or withdrawal symptoms symptoms resulting resulting from from prenatal prenatal drug drug exposure exposure or fetal or fetalalcohol alcohol spectrum spectrum disorder), disorder), Dear RepresentativeRepresentative Kotowski Kotowski and and Honorable Honorable Members Members of the of Committee,the Committee, New Futures appreciates appreciates the the opportunity opportunity to testifyto testify on SBon 549-FN,SB 549-FN, relative relative to infants to infants born bornwith with substance misuse misuse or or withdrawal withdrawal symptoms symptoms resulting resulting from from prenatal prenatal drug drugexposure exposure or fetal or alcohol fetal alcohol spectrum disorder. disorder. New New Futures Futures is ais nonpartisan, a nonpartisan, nonprofit nonprofit organization organization that advocates, that advocates, educates educates and collaboratescollaborates to to improve improve the the health health and and wellness wellness of allof Newall New Hampshire Hampshire residents. residents. In this In role, this werole, we work extensivelyextensively with with policy policy makers, makers, service service providers providers and and families families afflicted afflicted by addiction by addiction to prevent to prevent and reducereduce alcohol alcohol and and drug drug problems problems in ourin our state. state. New Futures stands stands strongly strongly in in support support of thisof this bill, bill, which which would would direct direct health health care providerscare providers to to work withwith families families and and the the N.H. N.H. Division Division of of Public Public Health Health to developto develop a safe a safe plan plan of care, of care, as required as required by federal law, law, for for any any child child born born with with substance substance misuse misuse or withdrawal or withdrawal symptoms symptoms resulting resulting from from prenatal drug drug exposure exposure or or a fetala fetal alcohol alcohol spectrum spectrum disorder. disorder. The numbernumber of of children children and and families families affected affected by bythe the disease disease of addiction of addiction continues continues to rise to sharply rise sharply in in our state.state. A A report report released released recently recently by bythe the Carsey Carsey School School of Public of Public Policy Policy at the at University the University of New of New Hampshire, and and commissioned commissioned by by New New Futures, Futures, shows shows the the number number of babies of babies diagnosed diagnosed with with neonatal abstinence abstinence syndrome syndrome increased increased fivefold fivefold in 10in 10years'. years'. The The report report shows shows that 269that babies 269 babies were were diagnosed withwith NAS NAS in in 2015 2015 — — up up from from 52 52 in in 2005, 2005, and and those those numbers numbers are arelikely likely underreported. underreported. In 2016,2016, thethe passagepassage of of the the federal federal Comprehensive Comprehensive Addiction Addiction and and Recovery Recovery Act Actrevised revised health health provider and and state state obligations obligations to todevelop develop safe safe plans plans of careof care for infantsfor infants experiencing experiencing withdrawal withdrawal symptoms. TheThe State State designated designated the the Division Division of ofChild, Child, Youth Youth and and Families Families (DCYF) (DCYF) as the as division the division within thethe N.H. N.H. Department Department of of Health Health and and Human Human Services Services (DHHS) (DHHS) responsible responsible for collecting for collecting and and monitoring all all safe safe plans plans of of care care developed developed in inthe the state. state. Around Around this thistime, time, the New the New Hampshire Hampshire state state legislature passed passed SB SB 515, 515, which which made made parental parental opioid opioid drug drug abuse abuse or dependence or dependence prima prima facie facie evidence ofof "neglect""neglect" under under the the N.H. N.H. Child Child Protection Protection Act. Act. Though Though SB 515 SB 515intended intended to protect to protect children from from the the potential potential neglect neglect and and encouraged encouraged parents parents suffering suffering from fromaddiction addiction to seek to seek treatments, its its implementation implementation has has been been flawed. flawed. Providers Providers documenting documenting safe planssafe plans of care of tocare DCYF, to DCYF, as required by by CARA, CARA, were were erroneously erroneously told told they they were were also also now now required required to report to report these thesesame same families forfor abuseabuse and and neglect. neglect. This This confusion confusion has has deterred deterred numerous numerous women women from from seeking seeking essential essential prenatal and and obstetric obstetric care care out out of fearof fear of triggeringof triggering an investigation an investigation by DCYF. by DCYF.

1 "As OpioidOpioid UseUse Climbs,Climbs, NeonatalNeonatal AbstinenceAbstinence Syndrome Rises inin NewNew Hampshire," Carsey SchoolSchool ofof PublicPublic Policy,Policy, University ofof NewNew Hampshire,Hampshire, available at http://www.new-futures.org/17NAS

New Futures • 10 Ferry Street, Suite 307307 Concord,Concord, NH 0330103301 • (603) 225-9540 • www.new-futures.org PagePage 2 of 2

Rather than leaving families in fear of investigation and punitive action, SB 549 would instead compel health care providers to work with the Division of Public Health, as opposed to DCYF, to develop a safe plan of care that has the children's well-being truly at heart. This distinction is further clarified by the amendment introduced by Sen. James Gray, which in New Futures' view, further strengthens the bill and ensures the protection and well-being of mothers, children and families across our state. In short, SB 549-FN would address a significant obstacle preventing women and families from coming forward to seek the treatment and comprehensive services they and their children so desperately need. For this reason and those outlined above, New Futures feels this bill must be passed to support those suffering from substance misuse now and into the future. We respectfully request that the Committee recommend this bill Ought to Pass. Please do not hesitate to contact me if you have questions or need additional information. Respectfully submitted,

Jake Berry Vice President of Policy New Futures

New Futures • 10 Ferry Street, SuiteSuite 307307 Concord,Concord, NHNH 03301 03301 • (603) 225-9540 • www.new-futures.org

see mg Billmg as see pa onp aqui Introducedaqui onp pa SB 549-FN-A - AS AMENDED BYBY THETHE SENATE SENATE 02/01/2018 0310s 2018 SESSION 18-2874 05/04

SENATE BILLBILL 54 9-FN-A AN ACT relative toto plans plans of of safe safe care care for for infants infants affected affected by bysubstance substance abuse abuse or or withdrawal symptoms symptoms from from prenatal prenatal drug drug exposure exposure or fetal or fetal alcohol alcohol spectrum spectrum disorder.

SPONSORS: Sen. Gray, Dist Dist 6 6

COMMITTEE: Health Health and and Human Human Services Services

AMENDED ANALYSISANALYSIS

This billbill directsdirects health health care care providers providers to develop,to develop, in conjunction in conjunction with with the department the department of health of health and humanhuman services services and and the the child's child's parent parent or guardian, or guardian, a plan a planof safe of caresafe forcare a childfor a bornchild with born with substance abuse abuse or or withdrawal withdrawal symptoms symptoms resulting resulting from from prenatal prenatal drug drugexposure exposure or a fetal or aalcohol fetal alcohol spectrum disorder. disorder.

Explanation: Matter added added to to current current law law appears appears in bold in italics. Matter removed removed from from current current law law appears appears [in [inbrackets brackets and andatruchthroughl otruckthrough.1 Matter which which is is either either (a) (a) all all new new or or(b) (b) repealed repealed and and reenacted reenacted appears appears in regular in regular type. type.

SB 549-FN-A - AS AMENDED BY THE SENATE SB 549-FN-A - AS AMENDED BY THE SENATE 02/01/2018 0310s 18-2874 05/04

STATE OFOF NEW NEW HAMPSHIRE HAMPSHIRE

In the Year of Our Lord Two Thousand Eighteen AN ACT relative toto plans plans of of safe safe care care for for infants infants affected affected by bysubstance substance abuse abuse or or withdrawal symptoms symptoms from from prenatal prenatal drug drug exposure exposure or fetal or fetal alcohol alcohol spectrum spectrum disorder.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 1 New Section; ProtectionProtection for for Maternity Maternity and and Infancy; Infancy; Plan Plan of Safe of Safe Care. Care. Amend Amend RSA RSA132 by 132 by 2 inserting after after section section 10-d 10-d the the following following new new section: section: 3 132:10-e Notification and and Development Development of of a aPlan Plan of ofSafe Safe Care. Care. Health Health care care providers providers involved involved 4 in the deliverydelivery or or care care of of infants infants born born with with and and identified identified as being as being affected affected by substance by substance abuse abuse or or 5 withdrawal symptoms symptoms resulting resulting from from prenatal prenatal drug drug exposure exposure or a fetalor a alcoholfetal alcohol spectrum spectrum disorder disorder 6 shall notifynotify thethe department department of of health health and and human human services services of the of occurrencethe occurrence of such of suchcondition. condition. The The 7 health carecare provider provider shall shall develop develop a plana plan of safeof safe care, care, in cooperation in cooperation with with the department the department of health of health 8 and humanhuman services, services, division division of of public public health health services services and and division division for children,for children, youth youth and families, and families, 9 as appropriate, and and with with the the infant's infant's parents parents or guardians or guardians to ensure to ensure the infant's the infant's safety andsafety well- and well- 10 being followingfollowing releaserelease from from the the care care of of the the health health care care provider. provider. The Theplan planshall shalltake intotake account into account 11 whether the the infant's infant's prenatal prenatal substance substance exposure exposure is a isresult a result of the of use the of use medication of medication prescribed prescribed for for 12 the mothermother by by a ahealth health care care provider. provider. Such Such exposure exposure shall shall not formnot form the basis the basisfor a referralfor a referral to the to the 13 department for for potential potential abuse abuse or orneglect, neglect, but but shall shall be included be included in the in plan the ofplan safe of care safe provided care provided to to 14 the departmentdepartment to to ensure ensure the the safety safety and and well-being well-being of the of theinfant, infant, to address to address health health and substance and substance 15 use treatment needs needs of of the the infant infant and and affected affected family family member member or caregiver, or caregiver, and to and ensure to ensure that that 16 appropriate referrals referrals are are made made and and services services are deliveredare delivered to the to infant the infant and affected and affected family familymember member 17 or caregiver.caregiver. 18 2 Effective Date.Date. ThisThis act act shall shall take take effect effect upon upon its itspassage. passage. Fiscal NoteNote LBAO 18-2874 1/3/18

SB 549-FN-A- FISCAL NOTE AS INTRODUCED AN ACT making an appropriation to the department of health and human services for the Sununu health services center and relative to infants born with substance abuse or withdrawal symptoms resulting from prenatal drug exposure or fetal alcohol spectrum disorder.

FISCAL IMPACT:IMPACT: [X][X State [ ] County [ ]Local Local [ ]None None

Estimated Increase / (Decrease) STATE: FY 2018 FY 2019 FY 2020 FY 2021 Appropriation $1 $0 $0 $0 Revenue $0 $0 $0 $0 Expenditures Indeterminable Indeterminable Indeterminable Indeterminable Increase Increase Increase Increase Funding Source: [X] General [ ] Education [ ] Highway [ ] Other

METHODOLOGY: This bill appropriates $1 to the Department of Health and Human Services in FY 2018 for the purpose of addressing budget shortfalls at the Sununu Youth Services Center. In addition, the bill requires providers involved in the delivery or care of infants born with and affected by prenatal drug or alcohol exposure to notify the Department of such condition. Providers are also required to cooperate with the Department in the development of a plan of safe care. The Department assumes that monitoring, tracking, and implementing plans of safe care will result in an indeterminable increase in expenditures. The Department further notes that this section is necessary in order for the State to remain compliant with the federal Child Abuse Prevention and Treatment Act (CAPTA) and Comprehensive Addiction and Recovery Act (CARA). The Department expects to administer a combined $130,000 per year of funds from these acts in FY 2018 and FY 2019.

AGENCIES CONTACTED: Department of Health and Human Services Committee Report REGULAR CALENDAR

April 25, 2018

HOUSE OF REPRESENTATIVES

REPORT OF COMMITTEE

The Committee on Finance to which was referred SR

549-FN-A,

AN ACT (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder. Having considered the same, report the same with the following amendment, and the recommendation that the bill OUGHT TO PASS WITH

AMENDMENT.

Original: House Clerk Cc: Committee Bill File COMMITTEE REPORT

Committee: Finance Bill Number: Title: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder. :Date: April 25;`2018` Consent Calendar: REGULAR Recommendation: OUGHT TO PASS WITH AMENDMENT 2018-1688h

STATEMENT OF INTENT

SB-549 was submitted at the request of the department of health and human services department of public health. This bill changes state law to satisfy federal requirements in order for the department to continue to obtain a grant of approximately $130,000. The bill also detailed the collection of data on the birth statistics of children born suffering substance abuse or withdrawal symptoms from prenatal drug exposure of fetal alcohol spectrum disorder. The committee was informed that the children's medical birth records are being transmitted by hospitals and birth locations and stored by the secretary of state's office of vital records. The information is then transferred to the department of public health for compilation of the statistical data required for the federal grant. The committee was significantly concerned by the storage of this sensitive information. The amendment would send the child's and mother's medical information only to the department of public health. While the bill's approval would secure for the state the federal grant, no money was appropriated for any personnel costs associated with the implementation of the new data transfer methodology.

Vote 22-4.

Rep. David Danielson FOR THE COMMITTEE

Original: House Clerk Cc: Committee Bill File REGULAR CALENDAR

Finance SB 549-FN-A, (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder. OUGHT TO PASS WITH AMENDMENT. Rep. David Danielson for Finance. SB-549 was submitted at the request of the department of health and human services department of public health. This bill changes state law to satisfy federal requirements in order for the department to continue to obtain a grant of approximately $130,000. The bill also detailed the collection of data on the birth statistics of children born suffering substance abuse or withdrawal symptoms from prenatal drug exposure of fetal alcohol spectrum disorder. The committee was informed that the children's medical birth records are being transmitted by hospitals and birth locations and stored by the secretary of state's office of vital records. The information is then transferred to the department of public health for compilation of the statistical data required for the federal grant. The committee was significantly concerned by the storage of this sensitive information. The amendment would send the child's and mother's medical information only to the department of public health. While the bill's approval would secure for the state the federal grant, no money was appropriated for any personnel costs associated with the implementation of the new data transfer methodology. Vote 22-4.

Original: House Clerk Cc: Committee Bill File SB 549-FN-A

OTPA (Regular)

22-4

(1688h)

Danielson

The committee was informed that the children's medical birth records are being transmitted by hospitals and birth locations and stored by the secretary of state's office of vital records. The information is then transferred to the department of public health for compilation of the statistical data required for the federal grant.

The committee was significantly concerned by the storage of this sensitive information. The amendment would send the child's and mother's medical information only to the department of public health. While the bill's approval would secure for the state the federal grant, no money was appropriated for any personnel costs associated with the implementation of the new data transfer methodology. Voting Sheets HOUSE COMMITTEE ON FINANCE

EXECUTIVE SESSION on SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 25, 2018

LOB ROOM: 210-211

MOTIONS: OUGHT TO PASS WITH AMENDMENT Moved by Rep. Danielson Seconded by Rep. Rosenwald AM Vote: 17-9

Amendment # 1688 Moved by Rep. Danielson Seconded by Rep. Rosenwald Vote: 22-4

CONSENT CALENDAR: YES

Statement of Intent: Refer to Committee Report

Respectfully submitted,

Rep Kenneth Weyler, Clerk

HOUSE COMMITTEE ON FINANCE

EXECUTIVE SESSION on SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE:

LOB ROOM: 210-211

MOTION: (Please check one box) O OTP 0 ITL 0 Retain (Pt year) °sQ- Adoption of //-1,T.E Amendment # '"'" O Interim Study (2nd year) (if offered) Moved by Rep. (12;1/; e-645n Seconded by Rep. cf" 5-' —'11 a-W Vote: 7-

MOTION: (Please check one box)

O OTP OTP/A 0 ITL O Retain (1st year) O Adoption of Amendment # O Interim Study (2nd year) (if offered) 'f( 22-'4( Moved by Rep.(47//e-Ple Seconded by Rep A ti& Vote:

MOTION: (Please check one box)

❑ OTP 0 OTP/A 0 ITL 0 Retain (1st year) O Adoption of Amendment # O Interim Study (2nd year) (if offered)

Moved by Rep. Seconded by Rep. Vote:

MOTION: (Please check one box) O OTP 0 OTP/A 0 ITL 0 Retain (1st year) O Adoption of Amendment # 0 Interim Study (2nd year) (if offered)

Moved by Rep. Seconded by Rep. Vote:

CONSENT CALENDAR: ?CYES. NO

Minority Report? Yes No If yes, author, Rep: Motion

Respectfully submitted:

STATE OF NEW HAMPSHIRE 1/5/2018 10:28:56 AM OFFICE OF THE HOUSE CLERK Roll Call Committee Registers Report 2018 SESSION

FINANCE

Bill #: 531 Title:

PH Date: Exec Session Date: / ("T

Motion: 0 713-A- Amendment #: (57P

MEMBER YEAS NAYS

Kurk, Neal M. Chariman /72 Ober, Lynne M. Vice Chairman t Weyler, Kenneth L. Clerk Allen, Mary M. Umberger, Karen C. Twombly, Timothy L. Byron, Frank A. 3 Danielson, David J. Y Emerick, J. Tracy --- Spanos, Peter J. Renzullo, Andrew 7 Theberge, Robert L. Bates, David M. V Hen nessey-i-Erip-1. /it j_ 7 Griffin, Gerald / 0 Wallner, Mary Jane /7 Nordgren, Sharon /2 Eaton, Daniel A. /3 Smith, Marjorie K. i7( Rosenwald, Cindy /ri.- ' Leishman, Peter R. /C Buco, Thomas L. / 7 Hatch, William A. a Rogers, Katherine D. /9 WalshiRobert-Ivh--, (6,!,80'en „Fe? Lovejoy, Patricia T. / TOTAL VOTE: .2'2 4/

Page: 1 of 1 Work Session Minutes HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 20, 2018

ROOM: 210-211 Time Work Session Called to Order: 1:04

Time Adjourned: 1:52

(please circle if present)

Committee Members: Byron, Kurk, Danielson, Bates, Renzullo, Wallner, Nordgren and Rosenwald

Bill Sponsors: Sen. Gray

TESTIMONY

Chairman Byron called the session to order at 1:04pm

Byron offered Amendment # 2018-1674h with language change suggested by DHHA specifically stating info to be delineated to be sent to worksheet for Vital records office of Vital records Dept. Secretary of State.

Kurk - what is the bare minimum we need to do to get the federal monies

M's. Tilley - DHHS - The number of infants affect by substance use of FASD the number for whom a safe plan of care was developed and the number for who a referral was made

Kurk - you are getting more info then the number of children you want the names the Feds just want the number

Tilley - we do need the name for child welfare where there is a potential for abuse and neglect

Kurk - I understand there is a good reason to know everything but I am asking what is the bare minimum to do- I am trying to find out what this thing is going to cost - can we pare this back to reduce the cost to the state

Byron - is there an additional cost to the state

Tilley - no

Kurk - in section 2 you require a doctor to take time and produce information is that required by the Feds

Tilley - yes they require there is developed a safe plan of care

Kurk - so to give us 130K they require us to force a private institution take time Tilley - yes to insure the safety and well being of infant and care giver

Kurk - how long would it take a doctor to prepare one of these plans

Tilley - the process when a women enters into pre-natal care starts in the pre-natal care as with any other condition and once infant is born with the input of the info is developed with the social worker

Kurk - this is not an additional requirement because the current practice is that they are already doing this

Tilley - the consistency is who gets reported to DCYF and who isn't we would like to add some clarity

Rosenwald - this is all new required policy according to what DHHS has told us the form does not include the check box and the way you came up with 269 births with drug exposure is thru comprehensive you could come up with that info that way

Tilley - we need to have that annually and there is a lag on that we can not do that timely that is one of the considerations is the lack of timeliness

Danielson - motion approve amendment 1674h, Bates seconded Danielson - withdraws his motion

Danielson - motion 1669h, Rosenwald seconded with addition of word only at end of line 5 after word notify

Renzullo - would prefer to see this sunset after 1 year so policy committee could look at this policy

Bates - by inserting the word only is this to prohibit from notifying medical providers from reporting those abnormal birth conditions from vital records- any concern about the conflict being created by that

Kurk - if you have any concern about the scope of vital records - if you think vital records should only have births deaths or if you think it should have a larger purpose

Bates - if that question were before us I might agree with you but that is not what this bill is about and you are indirectly trying to change the requirements of what the vital records requirements are if you want to change the requirements of what vital records are there is another time or place to do that that statute is over ten years old.How much is it going to cost rather than using the existing system that is in place I want to know what that cost is going to be at some point there is a diminishing return on this.

Tilley - the other piece when it says the symptoms the alcohol exposure is already on the worksheet in addition we would have to change the existing worksheet

Nordgren - to clarify the birth registration forms is what goes to vital records now have you looked at all the information there is no reason for vital records to have all this info ai don't see any reason for them to have all this info

Bates - that is not what the bill is about

Wanner - right now someone must be charged with getting this info from vital records so someone is collecting this data so there is already someone doing it

Tilley - we have one who has Access we have one day source we do not have the resources to create a new system and the partners do not want to do paper forms they want to do it electronically this comes thru an electronic system we do not have a dollar amount today there will be a cost associated by doing a separate system Rosenwald - if a woman is taking illegal drugs that haven't even prescribed that would be abnormal in the infant if a doctor is prescribing pain killers you would expect to see some evidence in the baby so that wouldn't be abnormal you would be expecting that and you would take that into account

Tilley - abnormal I the way the baby presents the physical condition is not normal the condition may be expected but not normal

Byron - while I am as concerned about confidentiality - the information should have been debated earlier but this bill does not consider recodifying the bureau of vital records it should be addressed another time

Motion to adopt Amendment 1669h

Yes-5 No-4

Motion on amended bill Danielson OTP/A, Rosenwald seconds Yes - Kurk, Danielson, Renzullo, Wallner, Nordgren, Rosenwald, No - Byron, Bates, Rogers

Motion carries - 6 to 3

Session adjourns at 1:52pm

Respectfully Submitted,

Rep Katherine D. Rogers Clerk, Division III

STATE OF NEW HAMPSHIRE 1/5/2018 10:29:31 AM OFFICE OF THE HOUSE CLERK Roll Call Committee Registers Report 2018 SESSION

FIN-DIV3

Bill #: .517(9 Title: r tolcr/i p cy1- Q-4.9 4.1grk- —

PH Date: Exec Session Date: /47,-,//// 6>0:7 / 67&

Motion: J --2/ I CO (o Ct 11\ Amendment #: I20(

MEMBER YEAS NAYS

Byron, Frank A. Chariman Hennessey, Erin T. Vice Chairman ft-b 'cm'+ Kurk, Neal M. ____ Danielson, David J.

Bates, David M. A- Renzullo, Andrew Waliner, Mary Jane Nordgren, Sharon Rosenwald, Cindy Rogers, Katherine D. Clerk 2._ TOTAL VOTE:

Page: 1 of 1 Rep. Byron, Hills. 20 April 20, 2018 2018-1674h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e as inserted by section 1 of the bill by replacing it with the following: 2 3 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 4 care of infants born with and identified as being affected by substance abuse or withdrawal 5 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 6 the department of health and human services, division of public health services, of the occurrence of 7 such condition by including the information on the birth worksheet submitted to the department of 8 state, division of vital records administration, irrespective of whether the infant was born in the 9 hospital or other setting. HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 20, 2018

ROOM: 210-211 Time Work Session Called to Order: IPA Time Adjourned:

(please circle if present)

Committee Memberki_'a3yro Z?Hennesse Ku r4 (Nordgrej-friw Id‘

Bill Sponsors: Sen. Gray

TESTIMONY

* Use asterisk if written testimony and/or amendments are submitted.

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to-3 Work Session Minutes HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 19, 2018

ROOM: 210-211 Time Work Session Called to Order: 2:07

Time Adjourned: 3:07

(please circle if present)

Committee Members: Byron, Hennessey, Kurk, Danielson, Bates, Renzullo, Wallner, Nordgren, Rosenwald and Rogers

Bill Sponsors: Sen. Gray

TESTIMONY Chairman Byron called the work session to order at 2:05pm One of the things talked about was on the confidentiality matter on records the Sec of State and archives/vital records are here to explain the maintenance and storage of records

Stephen Wurtz - Registrar of Vital Records Director - our mission is the collection of vital data we collect all vital records and information and we protect the confidentiality of that information at time of collection and where and how we disseminate that information. The DHHS is a data user of the confidential info that we collect by statute we share with them and we break down as to the level of info we share with an MOU our mission with the Sec of State and State Registrar is to only allow that level of info is to those with vital access to this and DHHS doesn't get the entire file thru the MOU they have certain agencies that only get the data they request. A child support level only gets the information they are allowed for what they need and we protect the confidentiality of the individuals. We use all sorts of technology of this information. Use state of arts technology weather at hospital it is data entry into the information there are no pieces of paper. We are guided by the CDC as one of our partners as to the type and nature of the questions we ask. We are always reviewing our data to see it is being used This year we had 5 our 6 pieces of data we no longer collect. I don't necessarily get into the types of questions we facilitate the collection of the data therefore we support our systems to do so accurately, timely and successfully

Byron - concerns as to why is this info in the possession of vital records and how is it being protected and why are we collecting this at all.

Wurtz - Dept of state has the constitutional authority to collect records in that chapter RSA 5C 3 is our charge to collect the confidentiality of that information it allows us to share the date with DHHS and any other agency that statutorily has access to the records. We run only with statutes not rules. If an agency comes to us and they are not identified in statue we require them to go to legislature and obtain that Statute change. Most people are familiar with HIPPA we are HIPPA compliment times 10 because we have a statutory commitment to comply right down to the hospitals and medical directors comply with HIPPA we don't put identifying information even with letters back to the medical examiners office. We use unique identifying numbers we don't use word death certificate etc. We are real careful and try to be as compliant as we know to be. Everything we do internally is encrypted. Rosenwald - you said you had stopped collecting some birth information in last few years what

Wurtz - we would file a house bill the next session to remove those statutes in the next year to require in the next year to add if we require to remove we would do the same

Rosenwald - you have stopped collecting info you are require

Wurtz - we stopped sharing that info but we have been collecting until we have the change in the statue change to modify

Rosenwald - you said you were HIPPA complaint X 10 are you an HIPPA component of DHHS

Wurtz - we are an agency under the statues limitations and that has far more penalties than HIPPA authoiryt but everything we do with our data is all by statue that comes with its own penalties

Rosenwald - so you are not subject to the federal penalties of HIPPS

Wurtz - I would say we excess the HIPPA requirements because of our Statutorily requirements

Hennessey - how would you rad this as a stature that allows you to collect this information

Wurtz - the health care provider would collect on the standard form authorizes the to collect it and share with us I was surprised that we were involved in this bill cause I didn't see us when I review bills each year

Ken essay - so as you read us this doesn't give you authority

Wurtz - we have authority to collect for DHHS I would say if it is identified on that collection form we have the right to collect it and protect it

Kurk - are you providing any personally identifiable info to CDC

Wurtz - possibly depending on the request

Bates - it is still not clear to me the logistics of this process you mentioned earlier that certain providers have access to records and we have also heard of a worksheet that people are providing and filing in things

Wurtz - a child is born combination of medical records star extra info from the chart so that reform at the hospital physician then certifies and it is entered into form electronically inured by medical records Dept with in facility

Bates - we heard yesterday from Public health there is a worksheet there was a check box in that data box is that in your data point

Wurtz - the system itself is part of it the only variable is if the physicians selected other then ai have no direct correlation with the statute

Bates - this specific info in this bil I don't see mentioned in RSA 18 is there a statute somewhere that refers to this information

Wurtz - closest if RSA 5-c- 19 breakdown of the birth worksheet question

Renzullo - what is a vital record Wurtz - RSA 5 - c birth marriage death divorce etc that is where we get the definition of vital records

Rosenwald - closest is 5-C-19 is closest what autopsies you to collect birth information

Wurtz - RSA 5-c-19 Rosenwald - should this language to be transparent refer to the div of vital records in the chain of custody in this vital information it is clear the provider shall notify to DHHS and vital record is no where in there would you prefer it be in there or not Wurtz - the public should know and we should probably be listed in that statute Byron - the actual chain of this event there is a form that gets filed out at the hospital and you don't get that you have a imputed system the hospital gets logged into keyboards in top that systems from the hospital a Wurtz - the worksheet is a tool for the institution to collect whatever info they have and it is complete and they do the data entry directly into our system and that worksheet is retained at that hospital Byron - the authority to collect that information - what authority is granted to vital records to collect info that the mother and/or infant is addicted

Wurtz-RSA 5-c-19 Byron - my understanding is the RSA 5-c-19 is moot on those records Wurtz - without examine the entire document - 5-c-19 #6 statistical info from the mother, medical reports and the physician medical reports and the child the hospital is part of the collection process so items they regularly collect you are going to find on that worksheet Bates - further down in the chapter section 8f- it lists any abnormal conditions of the newborn it would arguably cover this condition Kurk - is there some statutorily language that gives you the authority to cover fetal alcohol as abnormal conditions of the newborn or is that something the hospital decide Wurtz - we are collecting the information - if it is specific Ido but if not it would be other Kurk - 3-8 defines the other even thou it doesn't refer to 5-c-19 - so you won't get the inf because of this statute but only if they decide to define as an abnormal birth condition Renzullo - you talked about what you can collect are there additional that talk about what you can disseminate and how Wurtz- gives us the right to determine who and what gets disseminated Dave Scanlan Dept S o S - calls for MOU with DHHS and if any academic or research groups there is a commission that looks at the projects and makes decision - The Vital Records Privacy Board. Renzullo - the focus is you can supply statistical date without having individual names attached in order to separate the name from the problem is what I am looking at Wurtz - if an agency require statistical data with out information that is all we do most info required byDHHS that I all we do Nordgren - if we clarified in this section lines 4-7 that one the statistic and not the name were given would that clarify the issue

Wurtz - I carry out the intent of the legislation

Byron - I think Kurk-Rosewald had a proposed amendment

distributes Amendment # 2018-1669h

Rosenwald • heard that DHHS was very clear they did not want the info reported to DCYF only to health services but not clear in bill where it was going to go ow made clear on line 6, Clarifies it goes to Public Health

Nordgren - still wondering if the name of the child/mother will be given

Rosenwald - I don't have a concern about the Div of Public health they are also covered by HIPPA but the Dept of State I don't know

Patricia Tilley - DHHA

Wanner - why did bill come to us and why to DHHD not to Sec of State

Tilley - we understand that would have been a better way and we are comfortable putting that into the bill and it would have been a better solution - intent was to get information in the easiest way possible.

The name on these allows us to insure the quality of that data we also use the data to link to other things that same epidemiologist to link to make sure we do not miss one single baby

Kurk - what happens if vital records gave you a case number if everyone with an abnormal situation so you could track and ever know who the human being is

Tilley - currently we don't have that system so we could not track - sometimes in pubic health we have the time to wax on in newborn screening we have to have info within 72 hours

Kurk - you make recommendations not the provider

Tilley - we make the recommendations to the provider

Kurk - my child has one of these tests and the doctor doesn't get these tests

Tilley - we get it faster

Kurk - the idea that the state would get in the middle of my relationship with my doctor is striking

Byron - any thought how aRosenwald amendment would affect you

Tilley - we would add the Dept state and vital records Byron • are you suggesting to take out reference to DHHS and then Vital records

John Williams • DHHS would be to insert after page 1 line 6 strike the following in the manner prescribed by the Dept and insert on line 6 thru the NH did of vital records admin, Dept of State

Tilley - we are happy to design the div of vital Records as well

Byron • ask Kurk and Rosenwald to work with Mr Williams to try and come up with wording we could use and have work session tomorrow at 1pm April 20 Recess at 3:07pm

Respectfully Submitted,

Rep Katherine D. Rogers Clerk, Division III

HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 19, 2018 ROOM: 210-211 Time Work Session Called to Order:2

Time Adjourned: 2 ?"_7fro

(please circle if present)

Committee Members: By * ottnness aniers d Roge

Bill Sponsors: Sen. Gray

TESTIMONY

* Use asterisk if written testimony and/or amendments are submitted. ,c*cp \r\pn W Rep. Rosenwald, Hills. 30 Rep. Kurk, Hills. 2 April 19, 2018 2018-1669h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e as inserted by section 1 of the bill by replacing it with the following: 2 3 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 4 care of infants born with and identified as being affected by substance abuse or withdrawal 5 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 6 the department of health and human services division of public health services of the occurrence of 7 such condition, irrespective of whether the infant was born in the hospital or other setting. Work Session Minutes HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 18, 2018

ROOM: 210-211 Time Work Session Called to Order: 9:08

Time Adjourned: 10:07

(please circle if present)

Committee Members: Byron, Hennessey, Kurk, Danielson, Bates, Renzullo, Wanner, Nordgren, Rosenwald and Rogers

Bill Sponsors: Sen. Gray

TESTIMONY Chairman Byron called the work session to order at 9:08am He alerted committee that it has gone thru three separate committees that had different idea of what the bill meant

John Williams Dir of leg affairs DHHS Patricia Tilley - Dep Dir DHHS Abby Shockley - Senior Policy Analyst - SUD DHHS

Byron - Comm has bill as amended by HHS Committee

Kurk. Fiscal note as introduced

Byron - as is accurate per LBA

DHHS - senate removed section of bill re: Sununu Center have experts to explain back=ground From fiscal is straight forward there is a requirement from FEDs of funding to receive 130k annually need to have in place by June 30

Tilley Opioid epidemic consequence has been number of infants born with a drug withdrawal from mother has significant issues on birth up to 12 days in hospital need to be managed medically these babies continue to be problematic for next few months in about 2005 about 52 in a year now risen to 269 in 2015 larger now can't say how many now. After all data thru hospital in two years can get diagnosis to tell actual numbers - that is the data set we are using now. This has been a collaboration for the bill with medical providers and hospital and prevention and treatment community. Section 1 talks about health care providers shall notify DHHS about where born language comes from Federal CAFTA and CARA that requires Div have a number on hand born and have a safe plan of care for each one of those infants, this is where things got complicated in the state - some may be born as a result of prescribed medication there are lots of reasons that mother may be using opioids this is where the public health and the child care community have worked together - we took two paths - worked with hospital on the plan of care and the notification and we have come to agreement that we will use a notification on the birth certificate so all infants who are born with exposure will be a check box on the birth certificate - the medical worksheet on the confidential side of the vital records. The first step is the baby is diagnosed with the new-natal syndrome they put this in the check box at that time if the provider is convened there is a potential for abuse or neglect they would pick up the phone and call but if there is o concern it will be part of the aggregate data. That data can then be submitted to receive 130k in fed funds Byron - you said 52 in 2005 the hospital puts together the treatment plan

Tilley - safe plan of care is a discharge summary - this plan is a little bit more complex - if using opioids pre-natal that safe plan of care is done prior to release with resources and referrals needed Byron - one for child and one for woman

Tilley - no one Byron - almost a HIPPA like document - what role does DHHS play in this whole process other than receiving the statistical information

Tilley - the statistical collection and aggregation the only other role is if there is a concern of abuse and neglect

Byron - so if there is the law we are trying to address is the federal law is trying to deal with the statistical information collection

Tilley - they are trying to capture in a real time way is what is the number born and ensure they all have a safe plan of care Byron. And what expenditures are you looking to make Tilley - no additional expenditure on the Public Health side it is part of what DHHS is already doing

Nordgren - there complication at Dartmouth where Mother's are leaving babies in the hospital and Foster parents are taking them home so Mothers and Fosters are getting plan

Tilley - so in that case both get a plan Wallner whe you refer to Haleigh care providers is that babies born outside hospital

Tilley - yes Kurk - could you explain what the word combined means in fiscal note

Shockley - that would be the combination from CAPTOR and other fed funds Byron - does LBA

LBA I think that is correct it is fed sources Kurk - what happens to the 130k

Tilley - it is not tied to safe plans of care it is used for other prevention items Kurk - and those amounts are budgeted

Tilley - yes Kurk - this is an ongoing situation we are formalizing in statute so as a result of putting this in statute will anyone else be incurring any expenses Tilley - not to my knowledge

Kurk - you said the access to medical records is not discoverable are you telling us that is some civil ligation these records are not discoverable Tilley - it is my understanding from Sec of State it is not available

Kurk - are you telling me in a civil case a court could order these records available to the defendant Williams - hypothetically anything could happen but it is out understanding no

Rosenwald - since the Sec of state is not covered by HIPPA could we assume that any info given to them is not ID

Tilley - the only persons that have access to that record is public health and Sec of state Rosenwald - what else are they getting

Tilley - there is an operational worksheet Williams - more than happy to provide blank forms of these documents to the committee Hennessey - the way I read the bill in line 16-20

Shockley - it is not the intention for mandatory reporting to DCYF so we made it clear in the language that the plan should take into account if the woman is not willing to engage in treatment and it be reflected in the plan.

Hennessey but you recognize that the women has chosen not to participate in the program Byron - if that needs to be written we need to address that now Shockley - we can address that now if that needs to be made clear now

Williams - we have representatives in the gallery that can assist in this and regroup with a short recess and address these concerns Byron - this is April 18 which is get your records in order day and Rep Danielson is well in order in that

Danielson - not clear for me what this money is used for where does the money come from in treating the children dependent on this does this money have anything to do with treatment

Tilley - the 130K require us to have clarification in our law in the treatment of care and that money is used for other prevention activity the data piece can be absorbed in other areas but the cost of care is taken in other areas such as Medicaid

Renzullo - so far all I understand is that a simple check off sheet would meet the federal requirements

Tilley - CAPTR requires a safe plan of care and some notification to the DHHS and data be aggregated and Identified Byron - the state needs to enact RSAs to cover this Renzullo - in order to meet the minimum to the federal government a simple form the hospital keeps beyond that what else is there to meet the minimum of the federal government

Byron - am I correct you have to enact legislation

Tilley - yes and you have to provide clarity in enacting a safe plan of care Rosenwald - do these grants require that vital records be notified

Tilley - no Byron - ten minute recess at 9:45am

Byron called session back into order at 9:54am Alison Wyman - Atty. for Health Policy and Practice

Hennessey - concern platform infant if mother choose not to be in treatment but line 9-11 health care provider shall have plan for infant Byron - so you believe that addresses your concern

Hennessey - yes Byron - Rosenwald and Kurk had concern to vital records

Rosenwald - if concern to ID drug use to vital records people to sec of state office what would DHHS recommendations as another way Tilley - this has been part of discussion for part of two years and we understand the reluctance and we come to this recommendation because all other plans would require notifications directly to the DCYF weather or not illicit use and we worry that would have chilling effect on pre-natal care so vital records was determine as an appropriate place because we already have a use that is done already a third option would require data notification that would require something new and resources that we do not have. Rosenwald - Medicaid is the payer for 80% of these someone asked what the DHHS involvement was they have access to the entire information set Tiley - we have access to the administrative records we got previous sets of data thru that but those not designed to have clean set of info and not timely and is very complex

Kurk - the only way to protect privacy is not to collect information the reality is all of this info will be available to central data base in WDC is it possible it can be sent to you in a de-identified form

Tilley - yes at a cost Kurk - why at a cost

Tilley - because that is not how it exist at this time we would have to treat a new system Kurk - to take the existing info and simply deleting field 1,2,3, and transmitting wold cost money

Tilley - yes I would have to defer to my colloquies and vital records Kurk - would you give us the statutory sites that refer to this I was told it was RSA 5c

Byron - currently a program that we test children for various diseases is that also become part of these records

Tilley - those are actually linked to the vital records new born screening to make sure we miss no baby

Rosenwald - it also has an opt out

Byron - I think the issue raised by Rep Hennessy has been address the confidentiality has been addressed the confidentiality is a question will discuss tomorrow and Friday so everyone is comfortable.

Byron recesses work session at 10:06 to Thursday April 19, 2018 one hour after close of House session or 1prn whichever is later.

Respectfully Submitted,

Rep Katherine D. Rogers Clerk, Division III HOUSE COMMITTEE ON Finance

DIVISION III WORK SESSION ON SB 549-FN-A

BILL TITLE: (New Title) relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

DATE: April 18, 2018 ROOM: 210-211 Time Work Session Called to Order: q 08

Time Adjourned: /)/,

(please circle if present) Committee Me. s: By o ennesse Kur an elson Bat::, Renzul b, aline Nordgre osenwal a

Bill Sponsors: Sen. Gray

TESTIMONY

* Use asterisk if written testimony and/or amendments are submitted.

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April 18, 2018

Relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder

Present: Byron, Hennessey, Kurk, Danielson, Bates, Renzullo, Wallner, Nordgren, Rosenwald, Rogers

Absent:

Chairman Byron called the work session to order at 9:08am He alerted committee that it has gone thru three separate committees that had different idea of what the bill meant

John Williams Dir of leg affairs DHHS Patricia Tilley - Dep Dir DHHS Abby Shockley - Senior Policy Analyst - SUD DHHS

Byron - Comm has bill as amended by HHS COmmittee

Kurk. Fiscal note as introduced

Byron - as is is accurate per LBA

Tilley - Opioid epidemic consequence has been number of infants born with a drug withdrawal from mother has significant issues on birth up to 12 days in hospital need to be managed medically these babies continue to be problematic for next few months in about 2005 about 52 in a year now risen to 269 in 2015 larger now can't say how many now. After all data thru hospital in two years can get diagnosis to tell actual numbers - that is the data set we are using now. This has been a collaboration for the bill with medical providers and hospital and prevention and treatment community. Section 1 talks about health care providers shall notify DHHS about where born language comes from Federal CAFTA and CARA that requires Div have a number on hand born and have a safe plan of care for each one of those infants, this is where things got complicated in the state - some may be born as a result of prescribed medication there are lots of reasons that mother ay be using opioids this is where the public health and the child care community have worked together - we took two paths - worked with hospital on the plan of care and the notification and we have come to agreement that we will use a notification on the birth certificate so all infants who are born with exposure will be a check box on the birth certificate - the medical worksheet on the confidential side of the vital records. The first step is the baby is diagnosed with the new-natal syndrome they put this in the checkbox at that time if the provider is convened there is a potential for abuse or neglect they would pick up the phone and call but if there is o concern it will be part of the aggregate data. That data can then be submitted to receive 130k in fed funds Byron - you said 52 in 2005 the hospital puts together the treatment plan

Byron - one for child and one for woman

Tilley - no one

Byron - almost a HIPPA like document - what role does DHHS play in this whole process other than receiving the statistical information

Tilley - the statistical collection and aggregation the only other role is if there is a concern of abuse and neglect

Byron - so if there is the law we are trying to address is the federal law is trying to deal with the statistical information collection

Tilley - they are trying to capture in a real time way is what is the number born and ensure they all have a safe plan of care

Byron. And what expenditures are you looking to make

Tilley - no additional expenditure on the Public Health side it is part of what DHHS is already doing

Nordgren - there complication at Dartmouth where Mother's are leaving babies in the hospital and Foster parents are taking them home so Mothers and Fosters are getting plan

Tilley - so in that case both get a plan

Wallner whe you refer to Raleigh care providers is that babies born outside hospital

Tilley - yes

Kurk could you explain what the word combined means in fiscal note

Shockley - that would be the combination from CAPTOR and other fed funds

Byron - does LBA

LBA - I think that is correct it is fed sources

Kurk - what happens to the 130k

Tilley - it is not tied to safe plans of care it is used for other prevention items

Kurk - and those amounts are budgeted

Tilley - yes Kurk - this is an ongoing situation we are formalizing in statute so as a result of putting this in statute will anyone else be incurring any expenses

Tilley - not to my knowledge

Kurk - you said the access to medical records is not discoverable are you telling us that is some civil ligation these records are not discoverable

Tilley - it is my understanding from Sec of State it is not available

Kurk - are you telling me in a civil case a court could order these records available to the defendant

Williams - hypothetically anything could happen but it is out understanding no

Rosenwald - since the Sec of state is not covered by HIPPA could we assume that any info given to them is not ID

Tilley - the only persons that have access to that record is public health and Sec of state

Rosenwald - what else are they getting

Tilley - there is an operational worksheet

Williams - more than happy to provide blank forms of these documents to the committee

Hennessey the way I read the bill in line 16-20

Hennessey but you recognize that the women has chosen not to participate in the program

Byron - if that needs to be written we need to address that now

Shockley - we can address that now if that needs to be made clear now

Williams - we have representatives in the gallery that can assist in this and regroup with a short recess and address these concerns

Byron - this is April 18 which is get your records in order day and Rep Danielson is well in order in that

Danielson - not clear for me what this money is used for where does the money come from in treating the children dependent on this does this money have anything to do with treatment Tilley - the 130K require us to have clarification in our law in the treatment of care and that money is used for other prevention activity the data piece can be absorbed in other areas but the cost of care is taken in other areas such as Medicaid

Renzullo - so far all I understand is that a simple check off sheet would meet the federal requirements

Tilley - CAPTR requires a safe plan of care and some notification to the DHHS and data be aggregated and Identified

Byron - the state needs to enact RSAs to cover this

Renzullo - in order to meet the minimum to the federal government a simple form the hospital keeps beyond that what else is there to meet the minimum of the federal government

Byron - am I correct you have to enact legislation

Tilley - yes and you have to provide clarity in enacting a safe plan of care

Rosenwald - do these grants require that vital records be notified

Tilley - no

Byron - ten minute recess at 9:45am

Byron called session back into order at 9:54am

Alison Wyman - Atty. for Health Policy and Practice

Hennessey - concern platform infant if mother choose not to be in treatment but line 9-11 health care provider shall have plan for infant

Byron - so you believe that addresses your concern

Hennessey - yes

Byron - Rosenwald and Kurk had concern to vital records

Rosenwald - if concern to ID drug use to vital records people to sec of state office what would DHHS recommendations as another way

Tilley - this has been part of discussion for part of two years and we understand the reluctance and we come to this recommendation because all other plans would require notifications directly to the DCYF weather or not illicit use and we worry that would have chilling effect on pre-natal care so vital records was determine as an appropriate place because we already have a use that is done already a third option would require data notification that would require something new and resources that we do not have.

Rosenwald - Medicaid is the payer for 80% of these someone asked what the DHHS involvement was they have access to the entire information set Tiley - we have access to the administrative records we got previous sets of data thru that but those not designed to have clean set of info and not timely and is very complex

Tilley - yes at a cost

Kurk - why at a cost

Tilley - because that is not how it exist at this time we would have to creat a new system

Kurk - to take the existing info and simply deleting field 1,2,3, and transmitting wold cost money

Tilley - yes I would have to defer to my colloquies and vital records

Kurk - would you give us the statutory sites that refer to this I was told it was RSA 5c

Byron - currently a program that we test children for various diseases is that also become part of these records

Tilley - those are actually linked to the vital records new born screening to make sure we miss no baby

Rosenwald - it also has an opt out

Byron - I think the issue raised by Rep Hennessy has been address the confidentiality has been addressed the confidentiality is a question will discuss tomorrow and Friday so everyone is comfortable.

Byron recesses work session at 10:06 to Thursday April 19, 2018 one hour after close of House session or 1pm whichever is later. As Amended by the House SB 549-FN-A - AS AMENDED BY THE HOUSE 02/01/2018 0310s 12Apr2018... 1339h 2018 SESSION 18-2874 05/04

SENATE BILL 54 9-FN-A AN ACT relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

SPONSORS: Sen. Gray, Dist 6

COMMITTEE: Health and Human Services

AMENDED ANALYSIS

This bill directs health care providers to develop a plan of safe care for infants affected by substance abuse, prenatal drug exposure, or a fetal alcohol spectrum disorder. The bill also provides that if the health care provider makes a report of possible abuse or neglect, the provider shall submit the plan of safe care to the department of health and human services.

Explanation: Matter added to current law appears in bold italics. Matter removed from current law appears [in brackets and struathrough.] Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

SB 549-FN-A - AS AMENDED BY THE HOUSE 02/01/2018 0310s 12Apr2018... 1339h 18-2874 05/04

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Eighteen AN ACT relative to plans of safe care for infants affected by substance abuse or withdrawal symptoms from prenatal drug exposure or fetal alcohol spectrum disorder.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 1 New Sections; Protection for Maternity and Infancy; Plan of Safe Care. Amend RSA 132 by 2 inserting after section 10-d the following new sections: 3 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 4 care of infants born with and identified as being affected by substance abuse or withdrawal 5 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 6 the department of health and human services of the occurrence of such condition in the manner 7 prescribed by the department, irrespective of whether the infant was born in the hospital or other 8 setting. 9 132:10-f Development of a Plan of Safe Care. When an infant is born with and identified as 10 being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure 11 or a fetal alcohol spectrum disorder, the health care provider shall develop a plan of safe care, in 12 cooperation with the infant's parents or guardians and the department of health and human 13 services, division of public health services, as appropriate, to ensure the safety and well-being of the 14 infant, to address the health and substance use treatment needs of the infant and affected family 15 members or caregivers, and to ensure that appropriate referrals are made and services are 16 delivered to the infant and affected family members or caregivers. The plan shall take into account 17 whether the infant's prenatal drug exposure occurred as the result of medication assisted 18 treatment, or medication prescribed for the mother by a health care provider and whether the 19 infant's mother is or will be actively engaged in ongoing substance use disorder treatment following 20 discharge that would mitigate the future risk of harm to the infant. A copy of the plan of safe care 21 shall be included in the instructions for the infant upon discharge from the hospital or from the 22 health care provider involved in the development of the plan of safe care. The plan of safe care 23 shall not be submitted to the department unless it is pursuant to RSA 132:10-g or the department 24 makes an official request for a copy of the plan in compliance with confidentiality requirements. 25 132:10-g Mandatory Reporting. When a health care provider suspects that an infant has been 26 abused or neglected pursuant to RSA 169-C:3, the provider shall report to the department of health 27 and human services in accordance with RSA 169-C:29. If the infant has a plan of safe care 28 developed under RSA 132:10-f, a copy of the plan shall accompany the report. 29 2 Effective Date. This act shall take effect upon its passage. LBAO 18-2874 1/3/18

SB 549-FN-A- FISCAL NOTE AS INTRODUCED

AN ACT making an appropriation to the department of health and human services for the Sununu health services center and relative to infants born with substance abuse or withdrawal symptoms resulting from prenatal drug exposure or fetal alcohol spectrum disorder.

FISCAL IMPACT: [ X ] State ] County [ ] Local [ ] None

Estimated Increase / (Decrease) STATE: FY 2018 FY 2019 FY 2020 FY 2021 Appropriation $1 $0 $0 $0 Revenue $0 $0 $0 $0 Indeterminable Indeterminable Indeterminable Indeterminable Expenditures Increase Increase Increase Increase Funding Source: [X] General [ ] Education [ ] Highway [ ] Other

AGENCIES CONTACTED: Department of Health and Human Services Amendments House Finance April 23, 2018 2018-1688h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e as inserted by section 1 of the bill by replacing it with the following: 2 3 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 4 care of infants born with and identified as being affected by substance abuse or withdrawal 5 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify 6 only the department of health and human services division of public health services of the 7 occurrence of such condition, irrespective of whether the infant was born in the hospital or other 8 setting. Rep. Rosenwald, Hills. 30 Rep. Kurk, Hills. 2 April 19, 2018 2018-1669h 05/04

Amendment to SB 549-FN-A

1 Amend RSA 132:10-e as inserted by section 1 of the bill by replacing it with the following: 2 3 132:10-e Notification of Substance Exposure. Health care providers involved in the delivery or 4 care of infants born with and identified as being affected by substance abuse or withdrawal 5 symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder shall notify CA 1G{ 6 the department of health and human services division of public health services of the occurrence of 7 such condition, irrespective of whether the infant was born in the hospital or other setting.