During the 2023 General Assembly session, Delegate Samuel Rasoul introduced and the legislature passed HB 1567, which directed the Virginia Department of Health (VDH), in collaboration with the Virginia Neonatal Perinatal Collaborative (VNPC), the Virginia Maternal Quality Care Alliance (MQCA), and Urban Baby Beginnings (UBB), to convene a work group to evaluate strategies to reduce maternal and infant mortality rates and make recommendations to enhance maternal health and public health support systems through expansion of the perinatal health hub model. The bill, enacted as Chapter 654 of the 2023 Virginia Acts of the Assembly, required VDH to submit a report to the General Assembly by December 1, 2023, communicating the results and recommendations of the work group.

The work group convened three times during the months of November and December 2023 to review perinatal health hub definitions, discuss related efforts by community-based organization (CBOs) and VDH, and gather input from the public and the work group members on expanding and funding the perinatal health hub model in the Commonwealth of Virginia. The recommendations of the work group are listed below.

RECOMMENDATIONS

The perinatal health hub model provides a framework for administering and managing services for pregnant and post-partum women that is client-centered and responsive to community needs. Work through the perinatal health hub model is already happening across the Commonwealth; this report identifies mechanisms to expand it and the resources that are needed to do so. Expansion of the model would allow the Commonwealth to organize pregnant and post-partum care services and maximize the services’ impact on improving maternal and infant health outcomes.

In examining existing perinatal health hubs in Virginia and in other states, the work group concluded that, although perinatal health hubs share common characteristics, there is no singular, accepted definition of a ‘perinatal health hub’ in the maternal and child health field. Additionally, hubs function and are funded in a variety of ways. To ensure clarity in Virginia, the work group therefore initially recommends that the Commonwealth adopt the following definition of a perinatal health hub:

A perinatal health hub serves as a community-based multidisciplinary care model that values and prioritizes perinatal health outcomes related to a reduction in maternal and infant mortality and morbidity. These spaces are dedicated to delivering a spectrum of comprehensive culturally responsive perinatal support services from trusted community providers. Hubs provide care during the period before, during, and for no less than 1 year following pregnancy. These hubs provide vital support to the community, perinatal health providers, and hospital systems through their access to a diverse workforce collaborating to improve outcomes via coordinated wraparound care (e.g. doulas, Community Health Workers (CHWs), peer support specialists, birth workers, and other perinatal specialists). A perinatal health hub can come in a variety of forms that is tailored to the unique needs of the community it serves.

The work group developed several additional recommendations in response to the three work group mandates outlined in the language of Chapter 654 of the 2023 Virginia Acts of the Assembly. Summaries of the work group’s recommendations are below; more detailed recommendation language is located at the end of this report:

Mandate (i) – Analyze federal and state regulations and funding mechanisms impacting establishment of perinatal health hubs:

The work group recommends that the Department of Medical Assistance Services (DMAS) review their current funding streams and provide suggestions for how DMAS can reallocate existing funding to support perinatal health hubs, as well as explore how Medicaid can provide reimbursement for quality perinatal health hub services. The group also recommends that VDH report how VDH’s Maternal and Child Health Services Title V Block Grant (Title V) funding currently supports local health districts and community-based organizations doing perinatal health work, in an effort to identify how VDH could best support hub-based work moving forward. In addition, the work group recommends that the Healthcare Insurance Reform Commission (HIRC) consider coverage for perinatal health hubs, doula care services, and Community Health Workers (CHWs) as essential health benefits, as defined in code § 38.2-3406.1.

Mandate (ii) – Review evidence-based strategies for the implementation of perinatal health hubs and the community impact of existing perinatal health hubs

Recommendations for this mandate include proposing that VDH produce annual reporting to demonstrate effectiveness of the hub model, define performance metrics that hubs would be required to track, and provide technical assistance and data support to hubs. Initial funding could also specifically support technical assistance from VDH to CBOs to help them identify what metrics to track as well as provide support to the CBOs for managing data collection and sharing this data back to VDH in order to contribute to building an evidence base for work happening in the Commonwealth. The work group also recommends that any perinatal health hubs that receive state funding be required to participate in a state learning collaborative in order to provide opportunities for continual education.

Mandate (iii) – Project estimated costs of implementing the work group's recommendations for the next five years

The work group recommends that the General Assembly provide an initial general fund appropriation in the amount of $2.5 million per year in the next biennial budget to support three pilot sites for perinatal health hubs, with the understanding that the hubs would need additional funding after this initial appropriation to ensure the sustainability of pilot sites and future expansion. Following the work group's recommendation for funding, VDH intends to explore submitting an agency budget request for this work in the next fiscal year.