Bill H.4566

FILED ON: 4/18/2024

HOUSE . . . . . . . . . . . . . . . No. 4566

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Third General Court
(2023-2024)

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An Act promoting access to midwifery care and out-of-hospital birth options.

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 2022 Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the following words:- the board of registration in midwifery.

SECTION 2. Section 11A of chapter 13 of the General Laws, as so appearing, is hereby amended by striking out the first paragraph and inserting in place thereof the following paragraph:-

There shall be a board of allied health professions, hereinafter called the board, which shall consist of 12 members to be appointed by the governor. Members of the board shall be residents of the commonwealth and citizens of the United States. Three of such members shall be athletic trainers licensed in accordance with section 23B of chapter 112; 2 of such members shall be occupational therapists licensed in accordance with said section 23B; 1 such member shall be an occupational therapy assistant licensed in accordance with said section 23B; 2 of such members shall be physical therapists licensed in accordance with said section 23B; 1 such member shall be a physical therapist assistant licensed in accordance with said section 23B; 1 such member shall be a lactation consultant licensed in accordance with said section 23B; 1 such member shall be a physician licensed in accordance with section 2 of chapter 112; and 1 such member shall be selected from and shall represent the general public.

SECTION 3. Said chapter 13, as so appearing, is hereby further amended by adding the following section:-

Section 110. (a) There shall be within the department of public health a board of registration in midwifery. The board shall consist of 8 members to be appointed by the governor, 5 of whom shall be midwives with not less than 5 years of experience in the practice of midwifery and who shall be licensed under sections 276 to 289, inclusive, 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. Four of the members of the board of registration in midwifery shall have experience working on the issue of racial disparities in maternal health or be a member of a population that is underrepresented in the midwifery profession. When making the appointments, the governor shall consider the recommendations of organizations representing certified professional midwives in the commonwealth. The appointed members shall serve for terms of 3 years. Upon the expiration of a term of office, a member shall continue to serve until a successor has been appointed and qualified. 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, 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. For the initial appointment of the board, the 5 members required to be licensed 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 281 of chapter 112. Members of the board shall be residents of the commonwealth.

(b) Annually, the board shall elect from its membership a chair and a secretary who shall serve until their successors have been elected and qualified. The board shall meet not less than 4 times annually and may hold additional meetings at the call of the chair or upon the request of not less than 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 4. Chapter 38 of the general laws is hereby amended by inserting after section 2A the following section: --

Section 2B. As used in this section, the term below shall have the following meaning: -

“Authorized local health agency”, shall mean a health board, department, or other governmental entity that is authorized by the department of public health to receive timely data relative to fetal and infant deaths for assessing, planning, improving and monitoring the service systems and community resources that support child and maternal health.

The department of public health shall establish a process for designating authorized local health agencies. This process may include reasonable criteria regarding the level of expertise, workforce capacity, or organizational capacity. Authorized local health agencies shall be authorized to conduct in-depth fetal infant mortality review of each individual infant and fetal death occurring within their jurisdiction, in order to identify local factors associated with fetal and infant deaths and inform public health policy programs.

For each case of fetal or infant death to be reviewed, authorized local health agencies are hereby authorized to collect relevant data from a variety of sources, which may include physician and hospital records in addition to relevant community program records. Authorized local health agencies are authorized to collect, and the department is authorized to provide, timely access to vital records and other data reasonably necessary for fetal and infant mortality review.

The department may issue additional guidance through policy or regulation, consistent with this section, regarding the process for conducting fetal infant mortality reviews by authorized local health agencies, which may include guidance from the National Fetal and Infant Mortality Review Program.

SECTION 5. Section 1E of chapter 46 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the definition of “Physician” the following definition:-

“Licensed midwife,” shall mean a midwife licensed to practice by the board of registration in midwifery as provided in sections 276 to 289 of chapter 112.

SECTION 6. Section 3B of said chapter 46, as so appearing, is hereby amended by inserting after the word “physician”, in line 1, the following words:- or licensed midwife.

SECTION 7. Section 1 of chapter 94C of the general laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the definition of “Isomer” the following definition:-

“Licensed midwife,” shall mean a midwife licensed to practice by the board of registration in midwifery as provided in sections 276 to 289 of chapter 112.

SECTION 8. Section 7 of said chapter 94C, as so appearing, is hereby amended by adding the following new subsection:-

(j) The commissioner shall promulgate regulations which provide for the automatic registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written prescriptions in accordance with the provisions of sections 279 of chapter 112 and the regulations issued by the board of registration in midwifery under said section 279 of chapter 112, unless the registration of such licensed midwife has been suspended or revoked pursuant to the provisions of section 13 or section 14 or unless such registration is denied for cause by the commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations, the commissioner shall consult with the board of registration in midwifery.

SECTION 9. Section 9 of said chapter 94C, as so appearing, is hereby amended by inserting in paragraph (a), after the words “certified nurse midwife as provided in section 80C of said chapter 112” the following words:- , licensed midwife as limited by subsection (j) of said section 7 and section 279 of said chapter 112.

SECTION 10. Section 9 of said chapter 94C, as so appearing, is hereby further amended in paragraph (b), by inserting after the words “midwife” in each place that they appear, the following words:- , licensed midwife.

SECTION 11. Said section 9 of said chapter 94C, as so appearing, is hereby further amended in paragraph (b), by inserting after the words “nurse-midwifery” in each place that they appear, the following words:- , midwifery.

SECTION 12. Section 9 of said chapter 94C is further amended in paragraph (c), by inserting after the words “certified nurse midwife” in each place that they appear, the following words:- , licensed midwife.

SECTION 13. The definition of “medical peer review committee” in section 1 of chapter 111 of the General Laws, as appearing in the 2022 official edition, is hereby amended by adding the following sentence:- “Medical peer review committee” shall include a committee or association that is authorized by a midwifery society or association to evaluate the quality of midwifery services or the competence of midwives and suggest improvements in midwifery practices to improve patient care.

SECTION 14. Section 51 of chapter 111 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by adding after the word “Gynecologists,” in line 106, the following words:- , American College of Nurse Midwives, American Association of Birth Centers.

SECTION 15. Section 202 of said chapter 111, as so appearing, is hereby amended by inserting, in the second and third paragraphs, after the word “attendance”, in each instance, the following words:- or midwife in attendance.

SECTION 16. Said section 202, as so appearing, is hereby further amended by inserting, in the fourth paragraph, after the word “attendance” the following words:- or without the attendance of a midwife,.

SECTION 17. Section 204 of said chapter 111, as so appearing, is hereby amended by inserting, in lines 7, 12 and 28, after the word “medicine”, in each instance, the following word:- , midwifery.

SECTION 18. Chapter 111 of the General Laws is hereby amended by adding the following section:-

Section 244. (a) The commissioner shall develop and disseminate to the public information regarding pregnancy loss, including information on: (i) awareness of pregnancy loss and the incidence and prevalence of pregnancy loss among pregnant people; and (ii) the accessibility of the range of evidence-based treatment options, as medically appropriate, for pregnancy loss, including miscarriage and recurrent miscarriage, including but not limited to comprehensive mental health supports, necessary procedures and medications and culturally responsive supports such as pregnancy-loss doula care.

The commissioner may disseminate information to the public directly or through arrangements with agencies carrying out intra-agency initiatives, nonprofit organizations, consumer groups, community organizations, institutions of higher education or state or local public-private partnerships.

(b) The commissioner shall expand and coordinate programs for conducting and supporting evidence-based research with respect to causes of and current and novel treatment options and procedures for pregnancy loss.

(c) The commissioner shall, in consultation with and in accordance with guidelines from relevant medical societies, develop and disseminate to perinatal health care workers, including midwives, physician assistants, nurse practitioners, clinical nurse specialists and non-clinical perinatal health care workers, information on pregnancy loss for the purpose of ensuring that such perinatal health care workers remain informed about current information regarding pregnancy loss, including miscarriage and recurrent miscarriage, and prioritizing both the physical and mental health care of the patient. For purposes of this subsection, the term “perinatal health care worker” shall include any doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter or navigator.

(d) The commissioner shall, in a manner that protects personal privacy and complies with federal law, collect and assess data regarding pregnancy loss, including information disaggregated by race, ethnicity, health insurance status, disability, income level and geography on the prevalence of, the incidence of and knowledge about pregnancy loss.

SECTION 19. Section 23A of chapter 112 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the definition of “Board” the following definitions:-

“International Board Certified Lactation Consultant (IBCLC)” means a person who holds current certification from the International Board of Lactation Consultant Examiners (IBLCE) as a lactation consultant after demonstrating the appropriate education, knowledge, and experience necessary for independent clinical practice.

“International Board of Lactation Consultant Examiners (IBLCE)” means the international certification body that confers the International Board Certified Lactation Consultant credential. and which is independently accredited by the National Commission of Certifying Agencies.

“Lactation consulting” means the clinical application of scientific principles and a multidisciplinary body of evidence for evaluation, problem identification, treatment, education and consultation to families regarding the course of lactation and infant feeding; including but not limited to: (i) clinical lactation assessment through the systematic collection of subjective and objective data; (ii) analysis of data and creation of a plan of care; (iii) development and implementation of a lactation care plan with demonstration and instruction to parents and communication to the primary health care provider(s); (iv) provision of lactation education to parents and health care providers; and (v) recommendation and use of assistive devices.

“Lactation consultant” means a person who is in good standing as a lactation consultant with the IBLCE, or its successor organization and is duly licensed to practice lactation consulting in accordance with section 23B.

“Perinatal health worker” means a doula, community health worker, peer counselor, WIC (Women Infants and Children) peer counselor, peer supporter, breastfeeding and lactation educator or counselor, childbirth educator, social worker, home visitor and/or any other perinatal educator.

“Practice” means rendering or offering to render, for compensation, lactation consulting to any individual, family, or group of individuals.

SECTION 20. Section 23B of said chapter 112, as so appearing, is hereby amended by striking out, in line 8, the words “and physical therapist assistants” and inserting in place thereof the following words: - , physical therapist assistants and lactation consultants.

SECTION 21. Section 23C of said chapter 112, as so appearing, is hereby amended by inserting after the word “assistant”, in line 4, the following words: - or lactation consultant.

SECTION 22. Said section 23C of said chapter 112, as so appearing, is hereby further amended by inserting after the word “chapter”, in line 11, the following words:- ; as a lactation consultant duly licensed under this chapter.

SECTION 23. Section 23D of said chapter 112, as so appearing, is hereby amended by inserting after the words “physical therapist assistant”, in line 3, the following words:- , or lactation consultant.

SECTION 24. Clause (b) of section 23E of said chapter 112, as so appearing, is hereby amended by inserting after the word “assistant”, in line 8, the following words:- or lactation consultant.

SECTION 25. Clause (c) of said section 23E of said chapter 112, as so appearing, is hereby amended by inserting after the word “therapy”, in line 14, the following words:- or lactation consulting.

SECTION 26. Clause (e) of said section 23E of said chapter 112, as so appearing, is hereby amended by inserting after the words “physical therapy services”, in line 21, the following words:- or lactation consulting.

SECTION 27. Said clause (e) of said section 23E of said chapter 112, as so appearing, is hereby further amended by inserting after the words “physical therapist”, in line 24, the following words:- or lactation consultant.

SECTION 28. Said chapter 112 is hereby amended by inserting after section 23J the following section:-

Section 23J½. An applicant for licensure as a lactation consultant shall be certified by the International Board of Lactation Consultant Examiners as an International Board Certified Lactation Consultant.

SECTION 29. Clause (c) of section 23K of said chapter 112, as appearing in the 2018 Official Edition, is hereby amended by inserting after the words “physical therapy”, in line 9, the following words:- or lactation consulting.

SECTION 30. Section 23L of said chapter 112, as so appearing, is hereby amended by inserting after the words “physical therapist assistant”, in line 3, the following words:- or lactation consultant.

SECTION 31. Said chapter 112 is hereby amended by inserting after section 23P½ the following section:-

Section 23P¾. (a) No person shall hold themselves out to others as a lactation consultant unless they hold a valid license issued in accordance with this chapter.

(b) Nothing shall prevent the practice of lactation consulting by members of other licensed healthcare professions when such practice is consistent with the accepted standards and scope of practice for their respective professions; provided, however, such persons shall not: (1) use the title “licensed lactation consultant” unless licensed pursuant to this chapter; nor (2) use the title “lactation consultant” unless said person is an International Board Certified Lactation Consultant.

(c) Nothing in this chapter shall prevent the practice of lactation consulting by students, interns or persons preparing for the practice of lactation consulting under the supervision of a supervisor or any licensed professional as listed in subsection (a); provided, however, such persons shall not: (1) use the title “licensed lactation consultant” unless licensed pursuant to this chapter; nor (2) use the title “lactation consultant” unless said person is an International Board Certified Lactation Consultant.

(d) Nothing in the chapter shall prevent perinatal health workers from performing breastfeeding education functions consistent with the accepted standards of their respective occupations; provided, however, such persons shall not: (1) use the title “licensed lactation consultant” unless licensed pursuant to this chapter; nor (2) use the title “lactation consultant” unless said person is an International Board Certified Lactation Consultant.

(e) Nothing in this chapter shall prevent a nonresident International Board Certified Lactation Consultant from practicing lactation consulting in the Commonwealth for 6 months without licensure.

SECTION 32. Chapter 112 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by adding the following sections:-

Section 276. As used in sections 276 to 288, inclusive, of this chapter, the following words shall have the following meanings unless the context clearly requires otherwise:

“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.

“Certified professional midwife”, a professional independent midwifery practitioner who has obtained certification by the NARM."

“Client”, a person under the care of a licensed midwife, as described by a written statement pursuant to section 284 of this chapter.

“Licensed midwife”, a person registered by the board to practice midwifery in the commonwealth under sections 276 to 288, inclusive, of this chapter.

“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 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 277. Nothing in sections 276 to 288, inclusive, of this chapter shall limit or regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or advanced emergency medical technician. The practice of midwifery shall not constitute the practice of medicine, certified nurse-midwifery or emergency medical care.

Section 278. (a) The board shall:

(i) adopt rules and promulgate regulations governing licensed midwives and the practice of midwifery to promote public health, welfare and safety, consistent with the essential competencies identified by the NARM;

(ii) administer the licensing process, including, but not limited to:

(A) receiving, reviewing, approving, rejecting and issuing applications for licensure;

(B) renewing, suspending, revoking and reinstating licenses;

(D) holding hearings and ordering the disciplinary sanction of a person who violates sections 276 to 288, inclusive, of this chapter or a regulation of the board;

(iii) establish administrative procedures for processing applications and renewals;

(iv) have the authority to adopt and provide a uniform, proctored examination for applicants to measure the qualifications necessary for licensure;

(v) 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;

(D) development of standardized informed consent, reporting and written emergency transport plan forms;

(vi) establish and maintain records of its actions and proceedings in accordance with public records laws; and

(vii) adopt professional continuing education requirements for licensed midwives seeking renewal consistent with those maintained by the NARM.

(b) Nothing in this section shall limit the board’s authority to impose sanctions that are considered reasonable and appropriate by the board. A person subject to any disciplinary action taken by the board under this section or taken due to a violation of any other law, rule or regulation may file a petition for judicial review pursuant to section 64 of this chapter.

(c) A licensed midwife shall accept and provide care to clients only in accordance with the scope and standards of practice identified in the rules adopted pursuant to this section.

(d) Notwithstanding any other provision in this section, the board shall not issue any regulations that 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.

Section 279. A licensed midwife duly registered to issue written prescriptions in accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess, purchase, and administer pharmaceutical agents consistent with the scope of midwifery practice, including without limitation antihemorrhagic agents including but not limited to oxytocin, misoprostol and methergine; intravenous fluids for stabilization; vitamin K; eye prophylaxes; oxygen; antibiotics for Group B Streptococcal antibiotic prophylaxes; Rho (D) immune globulin; local anesthetic; epinephrine; and other pharmaceutical agents identified by the board, however, that nothing in this section shall be construed to permit a licensed midwife’s use of pharmaceutical agents which are (a) controlled substances as described by Title 21 U.S.C. Section 812 or in chapter 94C, except for those listed in schedule VI; or (b) not identified by rules and regulations promulgated by the board of registration in midwifery as consistent with the scope of midwifery practice.

Section 280. A person who desires to be licensed and registered as a licensed 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 described under section 281 prior to any examination which may be required under section 278. The secretary of administration and finance, pursuant to section 3B of chapter 7, shall establish a license application fee, a license renewal fee and any other fee applicable under sections 276 to 288, inclusive, of this chapter; provided, however, that such license applicant and license renewal fees shall not exceed $200 biennially. 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. 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 281. (a) To be eligible for registration and licensure by the board as a licensed midwife, an applicant shall: (i) be of good moral character; (ii) be a graduate of a high school or its equivalent; and (iii) possess a valid certified professional midwife credential from the NARM.

(b) An applicant for a license to practice midwifery as a certified professional midwife shall submit to the board proof of successful completion of a formal midwifery education and training program as follows:

(i) a certificate of completion or equivalent from an educational program or institution accredited by the MEAC; or

(ii) an MBC, provided that an applicant: (1) is certified as a certified professional midwife within 5 years after the effective date of this section and completed a midwifery education and training program from an educational program or institution that is not accredited by the MEAC; or (2) is licensed as a professional midwife in a state that does not require completion of a midwifery education and training program from an educational program or institution that is accredited by the MEAC.

Section 282. The board may license in a like manner, without examination, any 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, however, that such midwife applies and remits fees as provided for in section 279.

Section 283. (a) The board may, after a hearing pursuant to chapter 30A, revoke, suspend or cancel the license of a licensed midwife, or reprimand or censure a licensed midwife, for any of the reasons set forth in section 61.

(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 providing such information or assistance; provided, however, that the person making the complaint or reporting or providing such information or assistance does so in good faith and without malice.

Section 284. When accepting a client for care, a licensed 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 licensed midwife and the client.

Section 285. A licensed midwife shall prepare, in a form prescribed by the board, a written plan for the appropriate delivery of emergency care. The plan shall include, but not be limited to: (i) consultation with other health care providers; (ii) emergency transfer; and (iii) access to neonatal intensive care units and obstetrical units or other patient care areas.

Section 286. 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.

Section 287. (a) The board may petition any court of competent jurisdiction for an injunction against any person practicing midwifery or any branch thereof without a license granted pursuant to sections 276 to 288, inclusive, of this chapter. Proof of damage or harm sustained by any person shall not be required for issuance of such injunction. Nothing in this section shall relieve a person from criminal prosecution for practicing without a license.

(b) Nothing in this section shall prevent or restrict the practice, service or activities of:

(i) a 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, however, that such person does not represent to the public, directly or indirectly, that such person is licensed under sections 276 to 289, inclusive, and that such person does not use any name, title or designation indicating that such person is licensed under said sections 276 to 289, inclusive;

(ii) a 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;

(iii) a traditional birth attendant who provides midwifery services if no fee is contemplated, charged or received, and such person has cultural or religious traditions that have historically included the attendance of traditional birth attendants at birth, and the birth attendant serves only individuals and families in that distinct cultural or religious group;

(iv) persons who are members of Native American communities and provide traditional midwife services to their communities; or

(v) any person rendering aid in an emergency.

Section 288. A licensed midwife, registered by the board of registration in midwifery pursuant to sections 276 to 288, inclusive, of this chapter, 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 33. Chapter 118E of the General Laws, as appearing in the 2022 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 sentence:- 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 34. Chapter 118E of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after Section 10N the following: -

Section 10O. The division shall provide coverage of screenings by pediatricians for postpartum depression in mothers of newly born children during any visit to a pediatrician’s office taking place for up to one year from the date of the child’s birth.

SECTION 35. (a) The department of public health shall promulgate revised regulations under the Code of Massachusetts Regulations 105 CMR 140.000 and 142.000 governing the facility and operation of licensed birth centers in consultation with Seven Sisters Birth Center, Neighborhood Birth Center, American College of Nurse Midwives Massachusetts Affiliate, and other entities operating or planning to open birth centers in Massachusetts to bring the regulations in accordance with chapter 111 of the General Laws and the standards of the American Association of Birth Centers or any successor organization, and to ensure safe, equitable and accessible birth options for birth center clients.

(b) The regulations shall include, but not be limited to, the following provisions:

(i) a licensed free-standing birth center shall have a detailed and written plan on the premises for transfer of a client to a nearby hospital providing obstetrical and newborn services as needed for emergency treatment beyond that provided by the birth center;

(ii) a licensed free-standing birth center shall develop policies and procedures to ensure coordination of ongoing care and transfer when complications occur which render the patient ineligible for birth center care during the antepartum, intrapartum or postpartum period;

(iii) the department shall not require a licensed free-standing birth center or the directors and providers on staff to practice under the supervision of a hospital or another health care provider or to enter into an agreement, written or otherwise, with another hospital or health care provider, or maintain privileges at a hospital;

(iv) a licensed free-standing birth center shall have an administrative director responsible for implementing and overseeing the operational policies of the birth center;

(v) a licensed free-standing birth center shall have a director of clinical affairs on staff who shall be a nurse midwife or physician licensed and in good standing in Massachusetts whose professional scope of practice includes preconception, prenatal, labor, birth, and postpartum care and early care of the newborn and who may be the primary attendants during the perinatal period in accordance with chapter 112 of the General Laws; and

(vi) birth attendants at licensed free-standing birth centers shall be midwives, physicians, or other providers licensed and in good standing in Massachusetts whose professional scope of practice includes preconception, prenatal, labor, birth, and postpartum care and early care of the newborn and who may be the primary attendants in accordance with chapter 112 of the General Laws.

(b) The department shall issue the revised regulations no later than 180 days after the effective date of this act.

SECTION 36. The board established pursuant to section 110 of chapter 13 of the General Laws shall adopt rules and promulgate regulations pursuant to this act within 1 year from the effective date of this act.

SECTION 37. The board established pursuant to section 110 of chapter 13 of the General Laws shall promulgate regulations for the licensure of individuals practicing midwifery prior to the date on which the board commences issuing licenses; provided, however, that individuals practicing midwifery in the commonwealth as of the date on which the board commences issuing licenses shall have 2 years from that date to complete the requirements necessary for licensure.

SECTION 38. Subsection (a) of section 23P¾ of chapter 112, as inserted by section 31, shall take effect 3 years after the effective date of this act.

SECTION 39. Nothing in this act shall preclude a 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 this act.