Bill S.1415

SENATE DOCKET, NO. 2401 FILED ON: 1/20/2023

SENATE . . . . . . . . . . . . . . No. 1415

By Ms. Miranda, a petition (accompanied by bill, Senate, No. 1415) of Liz Miranda, Lindsay N. Sabadosa, Paul W. Mark, Tram T. Nguyen and other members of the General Court for legislation relative to birthing justice in the Commonwealth. Public Health.

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 relative to birthing justice in the Commonwealth.

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. Chapter 118E of the General Laws, as appearing in the 2014 Official 2 Edition, is hereby amended by inserting after Section 10L the following: -

Section 10M. 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 2. 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 3. Section 9 of chapter 13 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the following words:- , the board of registration in midwifery.

SECTION 4. 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 5. Section 1E of chapter 46 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Physician” the following definition:-

“Licensed midwife,” 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 2020 Official Edition, is hereby amended by inserting after the definition of “Isomer” the following definition:-

“Licensed midwife,” 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 2020 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 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 15. 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 16. 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 17. Chapter 112 of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by adding the following new 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; or

(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 18. Chapter 118E of the General Laws, as appearing in the 2020 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 19. 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 20. 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 21. 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.

SECTION 22. The department of public health shall promulgate regulations within 1 year from the effective date of this act, governing birth centers, consistent with standards set forth by the American Association of Birth Centers, including without limitation authorizing licensed professional midwives to practice in birth centers as primary birth attendants, director of birth centers, and director of clinical affairs. Licensed professional midwives practicing in licensed birth centers shall not be required to enter into any agreement for supervision or collaboration with any other healthcare provider or hospital.

SECTION 23. Chapter 118E of the General Laws is hereby amended by inserting after section 10N the following section:-

Section 10O: Medicaid Coverage for Doula Services.

(A) For purposes of this section, the term “doula services” shall have the following meaning:

“Doula Services” are physical, emotional, and informational support, but not medical care, provided by trained doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:

(1) continuous labor support;

(2) prenatal, postpartum, and bereavement home or in-person visits throughout the perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage;

(3) accompanying pregnant individuals to health care and social services appointments;

(4) providing support to individuals for loss of pregnancy or infant from conception

through one year postpartum;

(5) connecting individuals to community-based and state- and federally-funded resources, including those which address social determinants of health;

(6) making oneself available (being on-call) around the time of birth or loss as well as providing support for any concerns of pregnant individuals throughout pregnancy and until one year after birth, pregnancy loss, stillbirth, or miscarriage.

(7) providing support for other individuals providing care for a birthing parent, including a birthing parent’s partner and family members.

(B) Coverage of Doula Services:

(1) The Division shall provide coverage of doula services to pregnant individuals and postpartum individuals up to 12 months following the end of the pregnancy who are eligible for medical assistance under this chapter and/or through Title XIX or Title XXI of the Social Security Act. The Division shall provide the same coverage of doula services to pregnant and postpartum individuals who are not otherwise eligible for medical assistance under this chapter or Titles XIX or XXI of the Social Security Act solely because of their immigration status.

(2) The Division must cover continuous support through labor and childbirth, and at least up to six doula visits across the prenatal and one year postpartum period, including at least two postpartum visits, without the need for prior authorization. The Division must also establish a procedure to cover additional doula visits as needed.

(1) The committee shall consist of 10-12 members to be appointed by the commissioner of public health, or designee.

(a) All but 2 of the members must be practicing doulas from the community; the remaining 2 members must be individuals from the community who have experienced pregnancy as a MassHealth member and are not practicing doulas.

(b) Among the members described in (a) above:

(i) at least 1 member must be a person who identifies as belonging to the LGBTQIA+ community;

(iii) at least 1 member must be a person who has experienced a severe maternal morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant or in maternity care;

(iv) at least 1 member must be a person who identifies as a person with disabilities or disabled person;

(c) The members of the committee shall represent a diverse range of experience levels- from doulas new to the practice to more experienced doulas.

(d) The members of the committee shall be from areas within the Commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s most current perinatal data available at the time the member is appointed.

(e) The members of the committee shall represent an equitable geographic distribution from across the Commonwealth.

(2) The committee must be convened within six months of passage of this law.

(3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as practicable.

(4) At least once every 8 weeks, the Division must meet with the Doula Advisory Committee to consult about at least the following:

(a) the scope of doula services covered by MassHealth;

(b) doula competencies required for reimbursement by MassHealth, and standards of proof or demonstration of those competencies;

(d) the development of comprehensive and high quality continuing education and training that is free or low-cost to doulas committed to providing services to MassHealth members, as well as the development of mentorship and career growth opportunities for doulas providing services to MassHealth members;

(e) the performance of any third party administrators of MassHealth’s doula coverage program, and standards and processes around billing for and prompt reimbursement of doula services;

(f) establishing grievance procedures for doulas, MassHealth members, and health care providers about MassHealth’s coverage of doula services and/or the provision of doula services to MassHealth members;

(g) outreach to the public and stakeholders about how to access doula care for MassHealth members, and about the availability of and advantages of doula care;

(h) the evaluation and collection of data on the provision of, outcomes of, access to, and satisfaction with doula care services provided to MassHealth members;

(i) maintaining a reimbursement rate for doula services that incentivizes and supports a diverse workforce representative of the communities served, and establishing a recurring timeframe to review that rate in light of inflation and changing costs of living in the commonwealth;

(j) how to ensure that MassHealth’s doula reimbursement program is directed towards the goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural populations who reside in all areas within the commonwealth, as evidenced by the most current perinatal data supplied by the department of public health.

(5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its members, select an individual to serve as its chairperson for a one year term. The Doula Advisory Committee may replace the chairperson in the same manner mid-term.

(6) The Doula Advisory Committee may, by a majority vote of a quorum of its members, reduce the frequency of meetings with MassHealth to less than once every 8 weeks.

(7) The division and the Department of Public Health shall seek resources to offer reasonable compensation to members of the Doula Advisory Committee for fulfilling their duties, and must reimburse members for actual and necessary expenses incurred while fulfilling their duties.

(8) The division, in partnership with the Doula Advisory Committee, shall conduct at least 1 public hearing or forum each year until three years after passage of this law. The purposes of these hearings or forums shall be to gather feedback from the public and to inform the public about MassHealth’s coverage of doula care.

SECTION 24. Chapter 29 of the Massachusetts General Laws is hereby amended by inserting after section 2QQQQQ the following section:-

Section 2RRRRR. (a) There shall be established and set up on the books of the commonwealth a separate fund known as the Doula Workforce Development Trust Fund, hereinafter called the fund. The fund shall be administered by the department of career services which shall contract with the Commonwealth Corporation to administer the fund. The fund shall be credited with: (i) revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and (iii) funds from public and private sources; and other gifts, grants and donations for the growth, training and continuous support of the doula workforce. Amounts credited to the fund shall not be subject to further appropriation and any money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.

(b) The Commonwealth Corporation shall make expenditures from the fund for the purposes of:

(i) the development and expansion of comprehensive doula training available across the commonwealth. including the development of doula training focused on meeting the needs of MassHealth members;

(ii) ensuring that doulas committed to serving MassHealth members have access to high quality doula training at no- or low-cost to them;

(iii) the recruitment and retention of doulas from communities with high concentrations of MassHealth members, as well as areas within the commonwealth where maternal and infant outcomes are worse than the state average, as evidenced by the MA Department of Public Health’s perinatal data.

(iv) expanding doula mentoring opportunities across the state, which provide new doulas the opportunity to attend births and incentivize experienced practicing doulas to take on mentees.

(v) leveraging funds to secure future federal funding to support doula workforce development in the commonwealth.

(c) The director of career services shall annually, not later than December 31, report to the secretary of administration and finance, the house and senate committees on ways and means and the joint committee on labor and workforce development on the efforts undertaken in support of section (b) above; the number of doulas recruited and trained as a result of activities taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity of such doulas; the amount of grants and identities of grantees awarded in support of section (b) above; and the availability of doula training at no- or low-cost to doulas committed to serving MassHealth members.

SECTION 25. Chapter 111 of the General Laws is hereby amended by inserting in section 70E after “Every patient or resident of a facility shall have the right:”:

(p) to have their birth doula’s continuous presence during labor and delivery. Facilities shall not place an undue burden on a patient’s doula’s access to clinical labor and delivery settings, and shall not arbitrarily exclude a patient’s doula from such settings.

SECTION 26. Notwithstanding any general or special law to the contrary the commissioner of the department of development services shall include neonatal abstinence syndrome under the definition of Closely Related Development Conditions as defined under 115 CMR 2 and 115 CMR 6.06(1).

SECTION 27. Chapter 123B, section 2 is hereby amended by inserting after the first paragraph the following paragraph:-

The department of developmental services shall promulgate regulations to facilitate interagency coordination with agencies including, but not limited to, the department of public health, the department of mental health, and the department of early and secondary education and continuation of care during and in the transition provision of Children’s Supports to support access to health care and other services to improve social determinants of health.

SECTION 28. Chapter 111 of the General Laws is hereby amended by inserting after section 110H the following sections:-

Section 110I: Required Newborn Screening for Congenital Cytomegalovirus

For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Birthing facility”, an inpatient or ambulatory health care facility licensed by the department of public health that provides birthing and newborn care services.

“Congenital Cytomegalovirus (hereinafter referred to as cCMV) screening”, the identification of a newborn who may have congenital CMV infection or has cCMV confirmed through the use of a saliva or urine test.

“Department”, the department of public health.

“Newborn,” any liveborn infant who has not yet attained the age of 21 days from a birth occurring in the commonwealth or from a birth prior to transfer to a hospital in the commonwealth.

The department, in consultation with the perinatal advisory committee, shall develop regulations for all hospitals and birthing facilities requiring cCMV screening within one year of the passage of this legislation. These regulations shall consider evidence-based guidance.

The cCMV screening shall be performed using a saliva PCR test unless one is unavailable in which case a urine PCR test may be used. If positive, a saliva PCR test would require a confirmatory urine PCR test. The department may approve another test to conduct cCMV screening; provided, however, that the test shall be, at the discretion of the department, at least as accurate, widely available and cost-effective as a saliva or urine PCR test. A screening shall be performed within 21 days from the date of birth and before the newborn infant is discharged from the birthing facility to the care of the parent or guardian; provided, however, that the screening shall not be performed if the parent or guardian of the newborn infant objects to the screening based upon a sincerely held religious belief of the parent or guardian. The cCMV educational materials outlined in section 70I(b) shall be provided to the parent or guardian of the infant at the time of cCMV screening.

A hospital that provides birthing and newborn services or a birthing facility shall adopt protocols for cCMV screening using a saliva or urine PCR test or another test approved by the department under this section for all newborns prior to discharge, and not to exceed 21 days from the date of birth, based on the department’s regulations, on or before January 1, 2023.

The cost of providing the newborn cCMV screening shall be a covered benefit reimbursable by all health insurers, except for supplemental policies that only provide coverage for specific diseases, hospital indemnity, Medicare supplement or other supplemental policies. In the absence of a third-party payer, the charges for the newborn cCMV screening shall be paid by the Commonwealth.

A hospital or birthing facility shall report annually to the department data including, but not limited to, the number of cCMV tests administered and the outcomes of said tests. The hospital or birthing facility shall inform, orally and in writing, a parent or guardian of the newborn infant the result of the cCMV screening test regardless of its outcome. This information shall also be provided in writing to the newborn infant's primary care physician and to the department through its electronic birth certificate system or such mechanism as specified by the department.

The department shall review the protocols required under this section and the implementation of these protocols as part of its birthing facility licensure review processes.

The department shall promulgate regulations to implement the cCMV screening program.

Nothing in this statute shall preclude newborns born at home from obtaining said cCMV screening.

Section 110J: Advisory Committee for CMV Screening Program

There is hereby established an advisory committee for the purpose of implementing the provisions of Section 110I. The advisory committee shall consist of the following members to be appointed by the commissioner of the department: a representative of the hospital industry; a primary care pediatrician or family practitioner; an otolaryngologist; a neonatologist; an infectious disease specialist; a clinician representing newborn nurseries; an audiologist; an ophthalmologist; an obstetrician-gynecologist; a representative of the commonwealth's early intervention program; 2 parents and/or guardians of a child impacted by cCMV; 2 medical professionals; a developer of preventative and/or therapeutic interventions for cCMV; a teacher of the deaf; and a representative of the department.

The advisory committee shall advise the department regarding the validity and cost of proposed cCMV regulations and/or cCMV screening, and shall recommend standards for performing and interpreting screening tests based on the most current technological methods, for documenting test results and follow-up, and for facilitating interaction between professionals and agencies that participate in follow-up care. Members of the advisory committee shall serve without compensation. The advisory committee shall be provided support services by the department.

SECTION 29. Chapter 111 of the General Laws is hereby further amended by inserting after Section 70H the following section:-

Section 70I: Congenital cytomegalovirus; public information program; annual report

(a) The commissioner of the department shall establish, promote, and maintain a public information program regarding congenital cytomegalovirus, hereinafter referred to as cCMV. Such program shall be conducted throughout the commonwealth, and under said program, a hospital or birthing facility as defined in section 70E or any healthcare provider, physician assistant, nurse or midwife who renders prenatal or postnatal care shall give expectant or new parents or guardians information provided by the department under subsection (b). Such information shall be made available at the first prenatal appointment or at a preconception visit if applicable, whichever is earliest.

(b) The department shall make available to any healthcare provider, physician assistant, nurse or midwife who renders prenatal or postnatal care or offers fertility counseling or care to a parent or guardian the following: (i) up-to-date evidence-based, written information about cCMV and universal cCMV screening that has been vetted by an appropriate group of medical experts as determined by the department in conjunction with the advisory committee as established in section 110J of said Chapter 111; provided, however, that the written information provided shall include preventative measures that can be taken throughout pregnancy, and (ii) contact or other referral information for additional educational and support resources. The department may also make such information available to any other person who seeks information about cCMV infections.

SECTION 30. Section 17C of chapter 32A of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the words “coverage for”, in line 3, the following words:- abortion and abortion-related care,.

SECTION 31. Said section 17C of said chapter 32A, as so appearing, is hereby further amended by inserting after the second paragraph the following paragraphs:-

Coverage provided under this section shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement. Coverage offered under this section shall not impose unreasonable restrictions or delays in the coverage.