SENATE DOCKET, NO. 1570 FILED ON: 1/18/2019
SENATE . . . . . . . . . . . . . . No. 1332
The Commonwealth of Massachusetts
Rebecca L. Rausch
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to out-of-hospital birth access and safety.
Rebecca L. Rausch
Norfolk, Bristol and Middlesex
Harriette L. Chandler
Cindy F. Friedman
Joanne M. Comerford
Hampshire, Franklin and Worcester
Jason M. Lewis
Patricia D. Jehlen
Joan B. Lovely
James B. Eldridge
Middlesex and Worcester
Sal N. DiDomenico
Middlesex and Suffolk
Michael F. Rush
Norfolk and Suffolk
Michael J. Barrett
Brendan P. Crighton
Jack Patrick Lewis
Jennifer E. Benson
Thomas M. Stanley
Lori A. Ehrlich
David Henry Argosky LeBoeuf
Paul K. Frost
Mathew J. Muratore
Michelle L. Ciccolo
SENATE DOCKET, NO. 1570 FILED ON: 1/18/2019
SENATE . . . . . . . . . . . . . . No. 1332
By Ms. Rausch, a petition (accompanied by bill, Senate, No. 1332) of Rebecca L. Rausch, Kay Khan, Harriette L. Chandler, Jason M. Lewis and other members of the General Court for legislation relative to out-of-hospital birth access and safety. Public Health.
The Commonwealth of Massachusetts
In the One Hundred and Ninety-First General Court
An Act relative to out-of-hospital birth access and safety.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2016 Official Edition, is hereby amended by inserting after the word “counselors”, in line 7, the following words:- “, the board of registration in midwifery, ”.
SECTION 2. Chapter 13 of the General Laws, as so appearing, is hereby amended by adding the following section:-
(a) There shall be within the department a board of registration in midwifery which shall consist of 8 persons appointed by the governor, 5 of whom shall be midwives with at least 5 years of experience in the practice of midwifery and who shall be licensed under sections 275 to 292 of chapter 112, 1 of whom shall be a physician licensed to practice medicine under section 2 of said chapter 112 with experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed to practice midwifery under section 80B of said chapter 112 and 1 of whom shall be a member of the public. For the initial appointment, the 5 members required to be midwives shall be persons with at least 5 years of experience in the practice of midwifery who meet the eligibility requirements set forth in subsection (a) of section 282 of chapter 112. Two of the members of the board of registration in midwifery shall have experience working on racial disparities in maternal health or be a member of a population underrepresented in the midwifery profession. When making such appointments, the governor shall consider the recommendations of organizations representing certified professional midwives in the commonwealth. Board members shall be residents of the commonwealth. The appointed members shall serve for terms of 3 years. A member shall not serve for more than 2 consecutive terms; provided, however, that a person who is chosen to fill a vacancy in an unexpired term of a prior board member may serve for 2 consecutive terms in addition to the remainder of that unexpired term. A member may be removed by the governor for neglect of duty, misconduct or malfeasance or misfeasance in the office after a written notice of the charges against the member and sufficient opportunity to be heard thereon. Upon the death or removal for cause of a member of the board, the governor shall fill the vacancy for the remainder of that member’s term after considering suggestions from a list of nominees provided by organizations representing certified professional midwives in the commonwealth.
(b) The board shall annually elect from its membership a chair and a secretary who shall serve until their successors have been elected and qualified. The board shall meet at least 4 times annually and may hold additional meetings at the call of the chair or upon the request of 4 members. A quorum for the conduct of official business shall be a majority of those appointed. Board members shall serve without compensation, but shall be reimbursed for actual and reasonable expenses incurred in the performance of their duties. The members shall be public employees for the purposes of chapter 258 for all acts or omissions within the scope of their duties as board members.
SECTION 3. Section 3B of Chapter 46 of the General Laws, as so appearing, is hereby amended by inserting in line 1 after the word “physician” the following: - “or licensed midwife”.
SECTION 4. Chapter 112 of the General Laws, as so appearing, is hereby amended by adding the following 18 sections:—
Section 275. As used in sections 275 to 292, inclusive, of this chapter, the following words shall, unless the context requires otherwise, have the following meanings:
“Board”, the Board of Registration in Midwifery, established under section 110 of chapter 13.
“Certified nurse-midwife”, a nurse with advanced training and who has obtained certification by the American Midwifery Certification Board.
“Client”, a person under the care of a midwife and such person’s fetus or newborn.
“Department”, the Department of Public Health.
“Licensed midwife”, a person registered by the board to practice midwifery under sections 275 to 292, inclusive.
“MBC”, the Midwifery Bridge Certificate issued by the NARM, or its successor credential.
“MEAC”, the Midwifery Education Accreditation Council or its successor organization.
“Midwifery”, the practice of providing primary maternity care to a client and newborn during the preconception, antepartum, intrapartum and postpartum periods.
“NARM”, the North American Registry of Midwives or its successor organization.
Section 276. Nothing in sections 275 through 292 inclusive, shall limit or regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or advanced emergency medical technician. In addition, sections 275 through 292 inclusive shall not apply to any person who, in good faith, engages in the practice of the religious tenets of any church or in any religious act if no fee is contemplated, charged or received, or to any person rendering aid in an emergency. The practice of midwifery shall not constitute the practice of medicine, certified nurse-midwifery, or emergency medical care to the extent that a midwife advises, attends, or assists a person during pregnancy, labor, natural childbirth, or the postpartum period.
Section 277. The board shall make, amend and rescind such rules and regulations as it may deem necessary for the proper conduct of its duties. The commissioner may review and approve rules and regulations proposed by the board. Such rules and regulations shall be deemed approved unless disapproved within 15 days of submission to the commissioner; provided, however, that any such disapproval shall be in writing setting forth the reasons for such disapproval.
Section 278. The board shall keep a full record of its proceedings and keep a register of all persons registered and licensed by it, which shall be available for public inspection. The register shall contain the name of every living registrant, the registrant’s last known business address and the date and number of the registrant’s registration and certificate as a licensed midwife. The board shall make an annual report containing a full and complete account of all its official acts during the preceding year, including a statement of the condition of midwifery in the commonwealth.
Section 279. The board shall:
(1) establish regulations that:
(A) are consistent with the current job description for midwifery published by the NARM;
(B) create processes for licensure application and renewal and for the granting of temporary permits to practice midwifery pending qualification for licensure;
(C) permit a licensee to obtain for clients appropriate screening and testing, including but not limited to laboratory tests and ultrasounds;
(D) permit a licensee to obtain and administer during the practice of midwifery, antihemorrhagic agents including but not limited to Pitocin (oxytocin), misoprostol and methergine, intravenous fluids for stabilization, vitamin K, eye prophylaxis, oxygen, antibiotics for Group B Streptococcal antibiotic prophylaxis, Rho (D) immune globulin, local anesthetic, epinephrine and other drugs and procedures consistent with the scope of midwifery practice;
(E) do not require a licensee to have a nursing degree;
(F) do not require a licensed midwife to practice under the supervision of or in collaboration with another healthcare provider or to enter into an agreement, written or otherwise, with another healthcare provider;
(G) do not limit the location where a licensee may practice midwifery;
(H) do not allow a licensed midwife to use forceps or a vacuum extractor;
(I) do not allow a licensed midwife to obtain or administer narcotics; and
(J) require a licensed midwife to report a client’s data to the MANA Statistical Registry maintained by the Midwives Alliance of North America, or a similar registry maintained by a successor organization approved by the board, unless the client refuses to consent to the reporting of their data.
(2) examine applicants and issue licenses to those applicants it finds qualified;
(3) renew, suspend, revoke and reinstate licenses;
(4) investigate complaints against persons licensed under this chapter;
(5) hold hearings and order the disciplinary sanction of a person who violates this chapter or a regulation of the board;
(6) adopt professional continuing education requirements for licensed midwives seeking renewal consistent with those maintained by the NARM; and
(7) develop practice standards for licensed midwives that shall include, but not be limited to:
(A) adoption of ethical standards for licensed midwives and apprentice midwives;
(B) maintenance of records of care, including client charts;
(C) participation in peer review; and
(D) development of standardized informed consent, reporting and written emergency transport plan forms.
Section 280. A person who desires to be licensed and registered as a midwife shall apply to the board in writing on an application form prescribed and furnished by the board. The applicant shall include in the application statements under oath satisfactory to the board showing that the applicant possesses the qualifications required by section 282 preliminary to the examination required by section 265. At the time of filing the application, an applicant shall pay to the department a fee which shall be set by the secretary of administration and finance, pursuant to section 3B of Chapter 7. The board, in consultation with the secretary of administration and finance, shall institute a process for applicants to apply for a financial hardship waiver,which may reduce or fully exempt an applicant from paying the fee pursuant to this section.
(a) The board may adopt an exam for applicants for licensure to measure the qualifications necessary for licensure; provided, however, that the board may accept the exam administered by the NARM in connection with granting a certified professional midwife credential in place of and as an equivalent to its own professional examination. In such case, before registration in pursuance of this section, the applicant therefor shall pay the fees set forth in Section 280. In the event the board determines to adopt a separate examination for applicants, the board shall conduct at least one but not more than two examinations in each calendar year.
(b) The board may adopt an exam for applicants to measure the qualifications necessary in order to safely utilize the pharmaceutical agents provided for in section 290, and in such case, shall conduct at least one but not more than two examinations in each calendar year.
(c) An applicant who has failed an examination administered by the board shall not retake the examination for a period of 6 months. An applicant who has failed an examination more than 1 time may not retake the examination unless the applicant has participated in or successfully competed further education and training programs as prescribed by the board.
(a) To be eligible for registration and licensure by the board as a midwife, an applicant shall:
(1) be at least 21 years of age;
(2) be of good moral character;
(3) be a graduate of a high school or its equivalent; and
(4) possess a valid certified professional midwife credential from the NARM.
(b) In addition, to be eligible for registration and licensure by the board as a midwife,
(1) beginning January 1, 2020, an applicant must obtain certification by completing a program or pathway accredited by the MEAC;
(2) if certification was obtained prior to January 1, 2020, from an education program or pathway not accredited by the MEAC, an applicant must obtain the MBC; or
(3) if licensure has been maintained in a state that does not require an education or pathway accredited by the MEAC, an applicant must obtain the MBC regardless of the date of certification.
Section 283. Notwithstanding the provisions of section 172 of chapter 6, the board shall obtain all available criminal offender record information from the criminal history systems board on an applicant by means of fingerprint checks, and from the Federal Bureau of Investigation for a national criminal history records check. The information obtained thereby may be used by the board to determine the applicant's eligibility for licensing under this chapter. Receipt of criminal history record information by a private entity is prohibited. If the board determines that such information has a direct bearing on the applicant’s ability to serve as a midwife, such information may serve as a basis for the denial of the application.
Section 284. Fees collected by the board shall be deposited into the Quality in Health Professions Trust Fund pursuant to section 35X of chapter 10 to support board operations and administration and to reimburse board members for actual and necessary expenses incurred in the performance of their official duties.
Section 285. The board may license in like manner, without examination, any certified professional midwife who has been licensed in another state under laws which, in the opinion of the board, require qualifications and maintain standards substantially the same as those of this commonwealth for licensed midwives, provided such certified professional midwife applies and remits fees as provided for in section 264.
(a) The Board may, after a hearing pursuant to chapter 30A, revoke, suspend or cancel the license of a midwife, or reprimand or censure a licensed midwife, for any of the reasons set forth in section 61 of chapter 112.
(b) No person filing a complaint or reporting information pursuant to this section or assisting the board at its request in any manner in discharging its duties and functions shall be liable in any cause of action arising out of receiving such information or assistance, provided the person making the complaint or reporting or providing such information or assistance does so in good faith and without malice.
Section 287. When accepting a client for care, a midwife shall obtain the client’s informed consent, which shall be evidenced by a written statement in a form prescribed by the board and signed by both the midwife and the client. The form shall certify that full disclosure has been made and acknowledged by the client as to each of the following items, with the client’s acknowledgement evidenced by a separate signature adjacent to each item in addition to the client’s signature and the date at the end of the form:
(1) the name, business address, telephone number and license number of the Licensed Midwife;
(2) a description of the midwife’s education, training and experience in midwifery;
(3) the nature and scope of the care to be given, including a description of any antepartum, intrapartum and/or postpartum conditions for which consultation, transfer of care or transport to a hospital is recommended or required;
(4) a copy of the medical emergency or transfer plan particular to each client as required by section 288;
(5) the right of the client to file a complaint with the board and instructions on how to file a complaint with the board;
(6) a statement indicating that the client's records and any transaction with the licensed midwife are confidential;
(7) a disclosure of whether the licensed midwife carries malpractice or liability insurance; and
(8) any further information as required by the board.
Section 288. A midwife shall prepare, in a form prescribed by the board, a written plan for the appropriate delivery of emergency care. The plan shall address the following:
(1) consultation with other health care providers;
(2) emergency transfer; and
(3) access to neonatal intensive care units and obstetrical units or other patient care areas.
Section 289. The midwife shall only accept and provide care to clients in accordance with the scope and standards of practice identified in the rules adopted pursuant to section 279.
Section 290. A midwife (i) qualified by examination under the provisions of subsection (b) of section 281, if the board elects to adopt such examination, or (ii) who has appropriate pharmacology training as otherwise established by rule by the board pursuant to section 279, may obtain and administer prophylactic ophthalmic medication, anti-hemorrhagic medications including but not limited to Pitocin (oxytocin), misoprostol and methergine, vitamin K, eye prophylaxis, antibiotics for Group B Streptococcal antibiotic prophylaxis, Rho (D) immune globulin, intravenous fluids, oxygen for maternal or fetal distress and infant resuscitation, epinephrine and local anesthetic and may administer such other drugs or medications as prescribed by a physician or certified nurse-midwife or otherwise consistent with the scope of midwifery practice. A pharmacist who dispenses such drugs to a licensed midwife shall not be liable for any adverse reactions caused by any method of use by the midwife.
Section 291. A health care provider that consults with or accepts a transport, transfer or referral from a licensed midwife, or that provides care to a client of a licensed midwife or such client’s newborn, shall not be liable in a civil action for personal injury or death resulting from an act or omission by the licensed midwife, unless the professional negligence or malpractice of the health care provider was a proximate cause of the injury or death.
(a) Other than as set forth in the second sentence of section 276, any person who practices midwifery in the commonwealth without a license granted pursuant to sections 275 to 292, inclusive, shall be punished by a fine of not less than $100 nor more than $1,000, or by imprisonment for not more than 3 months, or by both. The board may petition in any court of competent jurisdiction for an injunction against any person practicing midwifery or any branch thereof without a license. Such injunction may be issued without proof of damage sustained by any person. Such injunction shall not relieve such person from criminal prosecution for practicing without a license.
(b) Nothing in this section shall be construed to prevent or restrict the practice, service or activities of (1) any person licensed in the commonwealth from engaging in activities within the scope of practice of the profession or occupation for which such person is licensed, provided that such person does not represent to the public, directly or indirectly, that such person is licensed under sections 275 to 292, inclusive, and that such person does not use any name, title or designation indicating that such person is licensed under said sections 275 to 292, inclusive; or (2) any person employed as a midwife by the federal government or an agency thereof if that person provides midwifery services solely under the direction and control of the organization by which such person is employed.
Section 293. A licensed midwife, registered by the board of registration in midwifery pursuant to sections 275 to 293, inclusive, who provides services to any person or beneficiary covered by Title XIX of the Social Security Act or MassHealth pursuant to section 9A of chapter 118E, may accept the Medicaid or MassHealth approved rate as payment in full for such services; provided, that a licensed midwife who accepts the Medicaid or MassHealth approved rate pursuant to this section shall be reimbursed at said rate for such services.
SECTION 5. Chapter 118E in the General Laws, as appearing in a 2016 Official Edition, is hereby amended in section 10A by adding the words “ licensed midwife,” after the word “physician,” in line 15 and after the word “pediatrician,” in line 20, and by inserting at the end of the section the following words: - “The division shall provide coverage for midwifery services including prenatal care, childbirth and postpartum care provided by a licensed midwife regardless of the site of services.”
SECTION 6. The board shall adopt rules and regulations pursuant to section 279 of chapter 112 of the General Laws within 365 days after the effective date of this act. Within 180 days after the board adopts the rules and regulations pursuant to said section 279 of said chapter 112, the board may commence the issuing of licenses.
SECTION 7. Nothing in this act shall preclude any person who was practicing midwifery before the effective date of this act from practicing midwifery in the commonwealth until the board establishes procedures for the licensure of midwives pursuant to sections 275 to 292, inclusive, of chapter 112 of the General Laws.
SECTION 8. The board, established pursuant to section 110 of chapter 13 of the General Laws, shall establish regulations for the licensure of individuals practicing midwifery prior to the date on which the board commences issuing licenses, provided that individuals practicing out-of-hospital midwifery in the commonwealth as of the date on which the board commences issuing licenses shall have 2 years from the date on which the board commences issuing licenses to provide proof of passage of a licensing examination recognized by the board and proof of completion of any continuing education requirements necessary for re-licensure.