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. Chapter 6A of the General Laws is hereby amended by inserting after section 16FF the following section:-
Section 16GG. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Eligible entity”, a non-profit or community-based organization or health center serving perinatal individuals including, but not limited to: (i) a recognized Indian tribe or tribal organization; (ii) an organization serving individuals from medically underserved populations and other underserved populations; and (iii) a public health agency, including a municipal public health department.
“Medically underserved populations”, a historically underserved population or a population within a geographic area with a lack of access to primary care, behavioral health or perinatal healthcare providers or have a high infant mortality, high poverty or high elderly population, as determined by the secretary.
“Perinatal health outcomes”, health outcomes related to perinatal individuals.
“Perinatal individual”, an individual that: (i) is either pregnant or is within 12 months from the date of giving birth; (ii) is a biological parent or an adoptive or foster parent who is within 12 months from assuming custodial care of a child; or (iii) has lost a pregnancy due to a stillbirth, miscarriage or a medical termination within the previous 12 months.
“Secretary”, the secretary of health and human services.
(b) Subject to appropriation, the secretary shall establish a program to award grants to eligible entities to address mental health conditions and substance use disorders for perinatal individuals.
(c) The secretary shall promulgate regulations and guidelines as necessary to develop and implement the grant application process and eligible uses of grant funds pursuant to this section.
(d) The secretary shall give preference to eligible entities that:
(i) are community-based organizations or entities partnering with community-based organizations to address mental health conditions or substance use disorders in perinatal individuals; and
(ii) operate in areas with high rates of adverse perinatal health outcomes or significant disparities in perinatal health outcomes, as determined by the secretary.
(e) An eligible entity that receives a grant under this section shall use funds for establishing or expanding programs that improve or address mental health, behavioral health or substance use disorders for perinatal individuals with a focus on perinatal individuals from medically underserved populations.
(f) The secretary shall provide, directly or by contract, technical assistance to eligible entities seeking a grant or receiving a grant under this section for the development, use, evaluation and post-grant period sustainability of the program proposed, established or expanded through the grant. The secretary shall advertise or promote such technical assistance to eligible entities to raise awareness about the grants and technical assistance.
(g) The secretary shall promulgate regulations as necessary to implement subsection (f) and for the collection of quantitative and qualitative data, delineated by demographic information, on the activities conducted and individuals served pursuant to such grants.
SECTION 2. Section 9 of chapter 13 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by inserting after the word “counselors”, in line 7, the following words:- , the board of registration in midwifery.
SECTION 3. Section 11A of said chapter 13, 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 15 members who are residents of the commonwealth to be appointed by the governor, 3 of whom shall be qualified athletic trainers licensed pursuant to section 23B of chapter 112, 2 of whom shall be occupational therapists licensed pursuant to said section 23B of said chapter 112, 1 of whom shall be an occupational therapy assistant licensed pursuant to said section 23B of said chapter 112, 2 of whom shall be physical therapists licensed pursuant to said section 23B of said chapter 112, 1 of whom shall be a physical therapist assistant licensed pursuant to said section 23B of said chapter 112, 3 of whom shall be lactation consultants licensed pursuant to said section 23B of said chapter 112, 2 of whom shall be physicians licensed pursuant to section 2 of said chapter 112 and 1 of whom shall be selected from and shall represent the general public.
SECTION 4. Said section 11A of said chapter 13, as so appearing, is hereby further amended by striking out, in lines 51 and 52, the words “or physical therapy” and inserting in place thereof the following words:- physical therapy or lactation consulting.
SECTION 5. Said chapter 13 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, hereinafter called the board. The board shall consist of 9 members who are residents of the commonwealth to be appointed by the governor, 5 of whom shall be midwives licensed under section 293 of chapter 112 with not less than 5 years of experience in the practice of midwifery, 1 of whom shall be an obstetrician-gynecologist licensed to practice medicine under section 2 of said chapter 112 with experience working with midwives, 1 of whom shall be a maternal-fetal medicine specialist licensed to practice medicine under said section 2 of said chapter 112 with experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed under section 80B of said chapter 112 and authorized to practice nurse-midwifery under section 80C of said chapter 112 and 1 of whom shall be a member of the public. When making the appointments to the board, the governor shall consider members with experience working on the issue of racial disparities in maternal health. The appointed members of the board 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 full 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 full terms in addition to the remainder of such 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, resignation or removal for cause of a member of the board, the governor shall fill the vacancy for the remainder of that member’s term.
(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 5 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 6. Chapter 32A of the General Laws is hereby amended by inserting after section 17T, inserted by section 74 of chapter 140 of the acts of 2024, the following 3 sections:-
Section 17U. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 17V. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 17W. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for universal postpartum home visiting services in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
SECTION 7. 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 “Administrator” the following definition:-
“Certified nurse-midwife”, a nurse licensed under section 80B of said chapter 112 and authorized to practice nurse-midwifery under section 80C of said chapter 112.
SECTION 8. Said section 1E of said chapter 46, as so appearing, is hereby further amended by inserting after the definition of “Hospital medical officer” the following definition:-
“Licensed certified professional midwife”, a midwife licensed to practice by the board of registration in midwifery pursuant to section 293 of chapter 112.
SECTION 9. Section 3B of said chapter 46, as so appearing, is hereby amended by inserting after the word “physician”, in line 1, the following words:- , certified nurse-midwife or licensed certified professional midwife.
SECTION 10. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Isomer” the following definition:-
“Licensed certified professional midwife”, a midwife licensed to practice by the board of registration in midwifery pursuant to section 293 of chapter 112.
SECTION 11. Section 7 of said chapter 94C, as so appearing, is hereby amended by adding the following subsection:- (j) The commissioner shall promulgate regulations that provide for the automatic registration of licensed certified professional midwives, upon the receipt of the fee as herein provided, to issue written prescriptions in accordance with the provisions of section 295 of chapter 112 and the regulations issued by the board of registration in midwifery under said section 295 of said chapter 112, unless the registration of such licensed certified professional 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 chapter 30A. Prior to promulgating such regulations, the commissioner shall consult with the board of registration in midwifery and the department of public health.
SECTION 12. Section 9 of said chapter 94C, as so appearing, is hereby amended by inserting after the figure “112”, in line 7, the following words:- , licensed certified professional midwife as limited by subsection (j) of said section 7 and section 295 of said chapter 112.
SECTION 13. Said section 9 of said chapter 94C, as so appearing, is hereby further amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each instance, the following words:- , licensed certified professional midwife.
SECTION 14. Said section 9 of said chapter 94C, as so appearing, is hereby further amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- , midwifery.
SECTION 15. Section 24O of chapter 111 of the General Laws, as inserted by section 43 of chapter 28 of the acts of 2023, is hereby amended by striking out subsection (d), the second time the subsection appears, and subsection (e), and inserting in place thereof the following 3 subsections:-
(e)(1) The committee shall consist of the following members: the commissioner, or their designee, who shall serve as chair; the assistant secretary for MassHealth, or their designee, a representative of the department of public health; the executive director of the health policy commission, or their designee; a representative of the Perinatal-Neonatal Quality Improvement Network of Massachusetts; the chief medical examiner, or their designee; the chair of the Massachusetts chapter of the American College of Obstetrics and Gynecology, or their designee; the chair of the Massachusetts chapter of the American College of Nurse Midwives, or their designee; the chair of the Massachusetts chapter of the Association of Women's Health, Obstetric and Neonatal Nurses, or their designee; and the commissioner shall appoint the following members: a medical professional with obstetric and neonatal nursing training; a medical professional with training in cardiology; a medical professional with training in pathology; a medical professional with expertise in substance use prevention and treatment; a psychology, social work or other mental health professional; a representative from academia in a relevant field; a medical professional with formal anesthesiology training; a medical professional with maternal fetal medicine or perinatology training; a medical professional with psychiatric training; a medical professional with family medicine training; the director of a federally-funded Healthy Start program, or their designee; 2 individuals who practice as doulas; 2 community or family members who have been directly affected by a maternal death; a member of a community-based organization; a representative from the department of children and families; and a law enforcement officer.
(2) Each member, other than the commissioner, shall serve for a term of 3 years and until their successor is appointed. Nothing in this section shall prohibit the commissioner from appointing a committee member to serve additional terms. The committee shall convene as deemed necessary by the department. The commissioner shall, to the extent feasible, appoint members representing the racial, ethnic and geographic diversity of the commonwealth and shall prioritize appointing members from communities and groups most impacted by maternal mortality and maternal morbidity.
(f) Not later than December 31 of each even-numbered year, the committee shall submit to the clerks of the house of representatives and the senate, the house and senate committees on ways and means and the joint committee on public health a report, including, but not limited to:
(i) a description of the incidents of maternal mortality and severe maternal morbidity reviewed during the immediately preceding 24 months, provided in a manner that shall not allow for the identification of any person;
(ii) a summary of the disparities identified and reviewed;
(iii) recommendations to reduce maternal mortality and severe maternal morbidity in the commonwealth; and
(iv) recommendations for any legislation or other changes to policy to reduce maternal mortality and severe maternal morbidity or otherwise improve the delivery of health care in the commonwealth.
(g) Notwithstanding any general or special law to the contrary, upon the determination of a majority of the committee that the review of any information or record is necessary to carry out the purpose of this section, the committee shall request and the relevant offices and agencies shall provide requested records or information from any agency, department or office of the commonwealth including, but not limited to: (i) the executive office of health and human services and its constituent agencies; (ii) the executive office of public safety and security; (iii) the center for health information and analysis; (iv) the office of patient protection; (v) a health care facility, state comprehensive health planning agency or acute-care hospital as defined in section 25B; and (vi) a health care provider or professional licensed pursuant to chapter 112. The committee may receive and solicit voluntary information, including oral or written statements relating to any case that may come before the committee from any public or private entity and any person including, but not limited to, a patient in a case of maternal morbidity.
SECTION 16. Said chapter 111 is hereby further amended by inserting after section 24O the following section:-
Section 24P. (a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:
“Fetal death”, as defined in section 202.
“Infant death”, the death of an infant that occurs between the birth of the infant and 1 year of age.
(b) The department shall establish a program to conduct an in-depth fetal and infant mortality review of each individual fetal or infant death occurring within the commonwealth in order to identify social, economic and systems factors associated with fetal and infant deaths and inform public health policy programs. For each case of fetal or infant death to be reviewed, the department may collect relevant data from a variety of sources including, but not limited to, physician and hospital records and relevant information from local boards of health and community organizations.
(c) The department shall promulgate regulations consistent with this section regarding the process for conducting fetal infant mortality reviews, which shall include provisions for protecting confidential information and guidance from the federal Health Resources and Services Administration’s National Fetal, Infant, and Child Death Review Program.
SECTION 17. Said chapter 111 is hereby further amended by inserting after section 51L the following section:-
Section 51M. (a) The department shall promulgate regulations relative to the operation and maintenance of birth centers licensed as clinics pursuant to section 51, hereinafter referred to as “freestanding birth centers”.
(b) The regulations shall include, but shall not be limited to, requirements that a licensed freestanding birth center have:
(i) 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) policies and procedures to ensure coordination of ongoing care and transfer when complications occur that render the patient ineligible for birth center care during the antepartum, intrapartum or postpartum period;
(iii) an administrative director responsible for implementing and overseeing the operational policies of the birth center;
(iv) a director of clinical affairs on staff who shall be a certified nurse-midwife, licensed certified professional midwife or physician licensed to practice in the commonwealth 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; and
(v) birth attendants that are certified nurse-midwives, licensed certified professional midwives, physicians or other providers licensed to practice in the commonwealth 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 their professional scope of practice.
(c) The department shall not require a licensed freestanding 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.
(d) In order to be licensed as a freestanding birth center pursuant to subsection (a) and under section 51 by the department, a freestanding birth center shall provide reimbursable services to individuals with public health insurance on a non-discriminatory basis.
(e) Only freestanding birth centers and hospital-affiliated birth centers licensed by the department shall include the words “birth center” or “birthing center” in such center’s name.
SECTION 18. Section 110A of said chapter 111, as appearing in the 2022 Official Edition, is hereby amended by striking out the first paragraph and inserting in place thereof the following paragraph:-
The physician attending a newborn child shall cause said child to be subjected to tests for phenylketonuria, cretinism, Duchenne muscular dystrophy and such other specifically treatable genetic or biochemical disorders or treatable infectious diseases which may be determined by testing as specified by the commissioner. The commissioner shall convene an advisory committee on newborn screening to assist the commissioner in determining which tests are necessary; provided, however, that said advisory committee shall convene not less than twice per year.
SECTION 19. Section 202 of said chapter 111, as so appearing, is hereby amended by inserting after the word “physician”, in line 17, the following words:- , certified nurse-midwife or licensed certified professional midwife.
SECTION 20. Said section 202 of said chapter 111, as so appearing, is hereby further amended by inserting after the word “attendance”, in line 17, the following words:- , or without the attendance of a certified nurse-midwife or licensed certified professional midwife.
SECTION 21. Said chapter 111 is hereby further amended by adding the following 4 sections:-
Section 245. (a) The commissioner shall develop and disseminate to the public, information regarding pregnancy loss, including miscarriage and recurrent miscarriage, which shall include information on: (i) the 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, but not limited to, comprehensive mental health supports, necessary procedures and medications and culturally responsive supports including pregnancy loss doula care. The commissioner shall ensure that information disseminated pursuant to this section is available in multiple languages, including, but not limited to Spanish, Portuguese, Mandarin, Cantonese, Haitian Creole and other spoken languages in the commonwealth.
(b) The commissioner may disseminate information to the public directly through the department’s website 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.
(c) The commissioner shall develop and coordinate programs for conducting and supporting evidence-based research with respect to the causes of pregnancy loss and treatment options.
(d) The commissioner shall, in consultation with and in accordance with guidelines from relevant professional boards of registration, develop and disseminate to perinatal health care workers information on pregnancy loss to ensure that such perinatal health care workers remain informed about current information regarding pregnancy loss and prioritizing both the physical and mental health care of patients experiencing pregnancy loss. For the purposes of this subsection, the term “perinatal health care worker” shall include, but shall not be limited to, a physician, certified nurse-midwife, licensed certified professional midwife, physician assistant, nurse practitioner, clinical nurse specialist, doula, community health worker, peer supporter, licensed lactation consultant, nutritionist or dietitian, childbirth educator, social worker, trained family support specialist or home visitor, and language interpreter or navigator.
(e) 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 246. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Perinatal individual”, an individual that: (i) is either pregnant or is within 12 months from the date of giving birth; (ii) is a biological parent or an adoptive or foster parent who is within 12 months from assuming custodial care of a child; or (iii) has lost a pregnancy due to a stillbirth, miscarriage or a medical termination within the previous 12 months.
“Perinatal mood and anxiety disorders”, a mental health disorder experienced by an individual during the period of time from the beginning of pregnancy up until 12 months following the birth of a child or after the end of pregnancy, including, but not limited to, postpartum depression, or major depressive disorder associated with: (i) the care of a child experienced by a biological parent or an adoptive or foster parent who is within 12 months from assuming custodial care of a child; or (ii) pregnancy loss experienced by an individual who has lost a pregnancy due to a stillbirth, miscarriage or a medical termination within the previous 12 months.
(b) The department shall develop and maintain a comprehensive digital resource center on perinatal mood and anxiety disorders. The digital resource center shall be available to the public at no cost on the department’s website, and shall include information and resources for: (i) health care providers and organizations serving perinatal individuals to aid them in diagnosing, treating or making appropriate referrals for individuals experiencing perinatal mood and anxiety disorders; (ii) perinatal individuals and their families to aid them in understanding and identifying perinatal mood and anxiety disorders and how to navigate available resources and obtain treatment.
(c) Prior to developing the comprehensive digital resource center, the department shall consult with: (i) health care professionals, including, but not limited to, obstetricians, gynecologists, pediatricians, primary care providers, certified nurse-midwives, licensed certified professional midwives, psychiatrists, and other mental health clinicians; (ii) organizations serving perinatal individuals; and (iii) health insurance carriers.
(d) The department shall develop and implement a public information campaign to promote awareness of perinatal mood and anxiety disorders, which shall promote the digital resource center developed pursuant to this section.
Section 247. (a) For the purposes of this section, “postnatal individual” shall refer to an individual who: (i) is within 12 months of giving birth; (ii) is a biological parent or an adoptive or foster parent that is within 12 months from assuming custodial care of a child; or (iii) has lost a pregnancy due to a stillbirth, miscarriage or a medical termination within the previous 12 months.
(b) Every postnatal individual who receives health care services from a primary care provider, obstetrician, gynecologist, certified nurse-midwife or licensed certified professional midwife shall be offered a screening for postpartum depression or major depressive disorder and, if the postnatal individual does not object to such screening, such primary care provider, certified nurse-midwife or licensed certified professional midwife shall ensure that the postnatal individual is appropriately screened for postpartum depression or major depressive disorder in line with evidence-based guidelines.
(c) Every postnatal individual whose infant receives health care services from a pediatrician shall be offered a screening for postpartum depression or major depressive disorder by the infant’s pediatrician, and, if the postnatal individual does not object to such screening, such pediatrician shall ensure that the postnatal individual is appropriately screened for postpartum depression or major depressive disorder in accordance with evidence-based guidelines.
(d) If a health care professional administering a screening in accordance with this section determines, based on the screening methodology administered, that the postnatal individual is likely to be suffering from postpartum depression or major depressive disorder, such health care professional shall discuss available treatments for postpartum depression or major depressive disorder, including pharmacological treatments, and provide an appropriate referral to a mental health clinician.
Section 248. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:
“Programs”, entities or providers qualified by the department to provide universal postpartum home visiting services.
“Provider”, an entity or individual that provides universal postpartum home visiting services.
“Universal postpartum home visiting services”, evidence-based, voluntary home or community-based services for birthing people and caregivers with newborns, including, but not limited to: (i) screenings for unmet health needs including reproductive health services; (ii) maternal and infant nutritional needs; and (iii) emotional health supports, including postpartum depression supports.
(b) The department shall establish and administer a statewide system of programs providing universal postpartum home visiting services; provided, however, that the department may contract with third-party service providers. Services shall be delivered by a qualified health professional with maternal and pediatric health training, as defined by the department; provided, however, that at least 1 visit shall occur at the patient’s home or a mutually agreed upon location within 8 weeks postpartum.
(c) A provider of universal postpartum home visiting services shall determine whether a recipient of its services is covered or may be eligible for coverage through an alternative source. A provider shall request payment for services it provides from third-party payers pursuant to chapters 32A, 118E, 175, 176A, 176B or 176G before payment is requested from the department.
(d) The department shall monitor and assess the effectiveness of universal postpartum home visiting services. Programs which are in receipt of state or federal funding for said services shall report such information as requested by the department for the purpose of monitoring, assessing the effectiveness of such programs, initiating quality improvement and reducing health disparities.
SECTION 22. Chapter 112 of the General Laws is hereby amended by inserting after section 2D the following section:- Section 2E. A person shall not provide ultrasound services pertaining to a possible or actual pregnancy except under the supervision of a provider or other licensed health care professional who, acting within their scope of practice, provides medical care for people who are pregnant or may become pregnant.
SECTION 23. Section 23A of said chapter 112, as appearing in the 2022 Official Edition, is hereby amended by striking out, in lines 1 and 2, the words “twenty-three A to twenty-three P” and inserting in place thereof the following words:- 23A to 23P¾.
SECTION 24. Said section 23A of said chapter 112, as so appearing, is hereby further amended by inserting after the definition of “Board” the following 4 definitions:-
“International board-certified lactation consultant”, a person who holds current certification from the International Board of Lactation Consultant Examiners as a lactation consultant after demonstrating the appropriate education, knowledge and experience necessary for independent clinical practice.
“International Board of Lactation Consultant Examiners”, the international certification body that confers the International Board Certified Lactation Consultant credential and which is independently accredited by the National Commission for Certifying Agencies.
“Lactation consulting”, 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; (iv) provision of lactation education to parents and health care providers; and (v) recommendation and use of assistive devices.
“Licensed lactation consultant”, a person licensed to practice lactation consulting in accordance with section 23B.
SECTION 25. 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 26. The first paragraph of said section 23B of said chapter 112, as so appearing, is hereby amended by striking out the fourth sentence and inserting in place thereof the following sentence:- An applicant who furnishes satisfactory proof that they are of good moral character and that they have met the educational and clinical practice requirements set forth in section 23F, 23G, 23H, 23I, 23J or 23J½ shall, upon payment of a fee determined by the secretary of administration and finance, be examined by the board and, if the applicant is found to be qualified and passes the examination, the applicant shall be licensed to practice.
SECTION 27. 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 28. 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:- ; or as a licensed lactation consultant.
SECTION 29. 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 a licensed lactation consultant.
SECTION 30. 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 31. Said section 23E of said chapter 112, as so appearing, is hereby further amended by inserting after the word “therapy”, in line 14, the following words:- or lactation consulting.
SECTION 32. Said section 23E of said chapter 112, as so appearing, is hereby further amended by inserting after the words “physical therapy services”, in line 21, the following words:- or lactation consulting services.
SECTION 33. 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 licensed lactation consultant.
SECTION 34. Said chapter 112 is hereby further amended by inserting after section 23J the following section:- Section 23J½. An applicant for licensure as a lactation consultant shall:
(i) be not less than 18 years of age;
(ii) have submitted a completed application upon a form and in such manner as the board prescribes, accompanied by applicable fees;
(iii) have met the education and clinical standards established for international board-certified lactation consultants by the International Board of Lactation Consultant Examiners or its successor organization;
(iv) have passed an examination adopted or administered by the board; provided, however, that the board may adopt a standardized national exam, including the examination required for certification by the International Board of Lactation Consultant Examiners or a successor or equivalent entity; and
(v) have completed such other requirements as may be prescribed by the board.
SECTION 35. Section 23K of said chapter 112, as appearing in the 2022 Official Edition, is hereby amended by inserting after the words “physical therapy”, in line 9, the following words:- or lactation consulting.
SECTION 36. Section 23L of said chapter 112, as so appearing, is hereby amended by striking out, in line 3, the words “or physical therapist assistant” and inserting in place thereof the following words:- physical therapist assistant or licensed lactation consultant.
SECTION 37. Said chapter 112 is hereby further amended by inserting after section 23P½ the following section:-
Section 23P¾. (a) Except as otherwise provided in this section and sections 23C and 23E, no person shall hold themselves out to others as a licensed lactation consultant unless they hold a valid license issued in accordance with section 23B.
(b) Nothing in this section shall be construed to prevent the practice of lactation consulting by members of other licensed health care professions when such practice is consistent with the accepted standards and scope of practice for their respective professions; provided, however, that such persons shall not use the title “licensed lactation consultant” unless licensed pursuant to this chapter.
(c) Nothing in this 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 use the title “licensed lactation consultant” unless licensed pursuant to this chapter. For the purposes of this subsection, “perinatal health worker” shall mean any perinatal educator and support provider, including, but not limited to, a doula, community health worker, peer counselor, peer supporter, breastfeeding and lactation counselor, breastfeeding and lactation educator or peer counselor within the Women, Infants, and Children Program, childbirth educator or social worker.
SECTION 38. Said chapter 112 is hereby further amended by adding the following 8 sections:-
Section 290. As used in sections 291 to 297, inclusive, 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 licensed under section 80B and authorized to practice nurse-midwifery under section 80C.
“Client”, a person under the care of a licensed certified professional midwife.
“Licensed certified professional midwife”, a person registered by the board to practice midwifery in the commonwealth under section 293.
“Low-risk pregnancy”, a pregnancy with no maternal or fetal factors that place the pregnancy at significantly increased risk for complications, as determined through regulation by the board in consultation with the department of public health, including, but not limited to, factors related to maternal or fetal health conditions likely to affect the pregnancy and the gestational age and presentation of the fetus at the time of labor and delivery.
“MEAC”, the Midwifery Education Accreditation Council or its successor organization.
“NARM”, the North American Registry of Midwives or its successor organization.
Section 291. (a) The practice of midwifery by a licensed certified professional midwife shall include, but shall not be limited to:
(i) the practice of providing maternity care to a client during the preconception period and the antepartum, intrapartum and postpartum periods of a low-risk pregnancy;
(ii) the practice of providing newborn care; and
(iii) prescribing, dispensing or administering pharmaceutical agents consistent with section 295.
(b) A licensed certified professional midwife shall accept and provide care to clients only in accordance with the scope and standards of practice under this section and regulations promulgated by the board pursuant to section 292.
(c) The practice of midwifery shall not constitute the practice of medicine, certified nurse-midwifery or emergency medical care.
(d) Nothing in this section shall regulate, restrict or prohibit 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, including, but not limited to, the practice of a licensed physician, certified nurse-midwife or certified emergency medical technician; provided, however, that such person does not represent to the public, directly or indirectly, that such person is licensed under section 293 and that such person does not use any name, title or designation indicating that such person is licensed under said section 293;
(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 to a client that has cultural or religious birth traditions that have historically included the attendance of traditional birth attendants; provided, however, that no fee for the traditional birth attendant’s services is contemplated, charged or received and the birth attendant serves only individuals and families in a 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 292. (a) The board shall:
(i) adopt rules and promulgate regulations governing licensed certified professional midwives and the practice of midwifery to promote the public health, welfare and safety consistent with the essential competencies identified by NARM;
(ii) administer the licensing process, including, but not limited to: (A) receiving, reviewing, approving and rejecting applications for licensure; (B) issuing, renewing, suspending, revoking and reinstating licenses; (C) investigating complaints against persons licensed under section 293; and (D) holding hearings and ordering disciplinary sanctions against a person who violates sections 290 to 297, inclusive, or any regulation promulgated by the board;
(iii) establish administrative procedures for processing applications and renewals;
(iv) adopt and provide a uniform, proctored examination for applicants to measure the qualifications necessary for licensure; provided, however, that the board may adopt a standardized national exam, including the examination required for certification by NARM or a successor or equivalent entity;
(v) develop practice standards for licensed certified professional midwives that shall include, but not be limited to: (A) the adoption of ethical standards for licensed certified professional midwives; (B) the maintenance of records of care, including client charts; (C) the participation in peer review; (D) the development of standardized informed consent forms; and (E) the development of a standardized written emergency transport plan forms relative to the timely transfer of a newborn or client to a hospital;
(vi) promulgate regulations that may require licensed certified professional midwives to have professional malpractice liability insurance or a suitable bond or other indemnity against liability for professional malpractice in such an amount as may be determined by the board;
(vii) establish and maintain records of its actions and proceedings in accordance with public records laws; and
(viii) adopt professional continuing education requirements for licensed certified professional midwives seeking renewal consistent with those maintained by NARM.
(b) Nothing in this section shall be construed to authorize the board to promulgate regulations that require a licensed certified professional midwife to practice under the supervision of or in collaboration with another health care provider.
Section 293. (a) A person seeking licensure as a midwife under this section shall apply to the board in writing on an application form prescribed and furnished by the board. The application shall include a sworn statement and contain information satisfactory to the board to demonstrate that the applicant possesses the qualifications necessary for licensure under this section.
(b) The initial license and renewal fee shall be established pursuant to section 3B of chapter 7; provided, however, that such 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 reasonable expenses incurred in the performance of their official duties.
(c) An applicant for licensure under this section shall: (i) be of good moral character; (ii) be a graduate of a high school or its equivalent; (iii) have completed a formal midwifery education and training program consistent with subsection (d); (iv) possess a valid certified professional midwife credential from NARM; and (v) have satisfactorily completed the examination required by the board.
(d) An applicant for a license to practice midwifery as a licensed certified professional midwife shall submit to the board as proof of successful completion of a formal midwifery education and training program either:
(i) a certificate of completion, or its equivalent, from an educational program or institution accredited by MEAC; or
(ii) a midwifery bridge certificate issued by NARM or a successor credential; provided, however, that the applicant: (A) received such bridge certification on or after September 1, 2019 and completed a midwifery education and training program from an educational program or institution that is not accredited by MEAC; or (B) 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 MEAC.
(e) 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 certified professional midwives; provided, however, that such midwife applies and remits to the board the appropriate application fee under this section.
(f) The board may petition a court of competent jurisdiction for an injunction against any person practicing midwifery without a license granted pursuant to this section. Proof of damage or harm sustained by any person shall not be required for issuance of such an injunction. Nothing in this section shall relieve a person from criminal prosecution for practicing midwifery without a license.
Section 294. (a) The board may, after a hearing pursuant to chapter 30A, suspend or revoke the license of a licensed certified professional midwife or reprimand, censure or otherwise discipline a licensed certified professional 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 such information or providing such assistance does so in good faith.
(c) A person subject to any disciplinary action taken by the board pursuant to this section may file a petition for judicial review pursuant to section 64.
Section 295. (a) A licensed certified professional 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: (i) antihemorrhagic agents, including, but not limited to, oxytocin, misoprostol and methergine; (ii) intravenous fluids for stabilization; (iii) vitamin K; (iv) eye prophylaxes; (v) oxygen; (vi) antibiotics for Group B Streptococcal; (vii) antibiotic prophylaxes; (viii) Rho(D) immune globulin; (ix) local anesthetic; (x) epinephrine; and (xi) other pharmaceutical agents identified by the board through rules or regulations in consultation with the department of public health.
(b) Nothing in this section shall be construed to permit a licensed certified professional midwife’s use of pharmaceutical agents which are: (i) controlled substances as defined in chapter 94C, except for those listed in schedule VI; or (ii) not identified by the board of registration in midwifery as consistent with the scope of midwifery practice pursuant to subsection (a).
Section 296. When accepting a client for care, a licensed certified professional 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 certified professional midwife and the client. The signed form shall be included in the client’s record of care. The form shall include, but not be limited to, the following: (i) an acknowledgement that the licensed certified professional midwife is not authorized to practice medicine; (ii) a description of written practice guidelines, services provided and the risks and benefits of birth in the client’s chosen environment; and (iii) disclosure that the client may be referred for a consultation with or have their care transferred to a physician if the client requires care that is outside the midwife’s scope of practice.
Section 297. (a) A licensed certified professional midwife shall only provide care to a client in the case of a low-risk pregnancy. If at any point during pregnancy, childbirth or postpartum care a client or the newborn’s condition deviates from normal, it shall be the duty of the licensed certified professional midwife to immediately refer or transfer the client or newborn to a physician. If a physician determines that the client’s condition has been resolved such that the risk factors presented by a client’s disease or condition are not likely to significantly affect the course of pregnancy or childbirth, the licensed certified professional midwife may resume care of the client and resume assisting the client during their pregnancy, childbirth or postpartum care. A licensed certified professional midwife shall not provide or continue to provide midwifery care to a client whose pregnancy is no longer low-risk; provided, however, in such circumstances nothing in this section shall prohibit a licensed certified professional midwife from remaining present in a supportive capacity throughout pregnancy and childbirth, in accordance with the client’s wishes. If at any point after delivery, the newborn’s condition deviates from normal, the licensed certified professional midwife shall immediately refer or transfer the client to a physician.
(b) A licensed certified professional 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 to a hospital; and (iii) access to neonatal intensive care units and obstetrical units or other patient care areas.
(c) A health care provider that consults with or accepts a transport, transfer or referral from a licensed certified professional midwife, or that provides care to a client of a licensed certified professional midwife or such client’s newborn, shall not be liable in a civil action for personal injury or death resulting solely from an act or omission by the licensed certified professional midwife.
SECTION 39. Section 10A of chapter 118E of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by striking out, in lines 17 and 21, the words “or certified nurse midwife” and inserting in place thereof, in each instance, the following words:- certified nurse-midwife or licensed certified professional midwife.
SECTION 40. Said section 10A of said chapter 118E, as so appearing, is hereby further amended by inserting after the first paragraph the following 2 paragraphs:-
The division shall provide coverage for services rendered by a certified nurse-midwife designated to engage in the practice of nurse-midwifery by the board of registration in nursing pursuant to section 80C of chapter 112, and the payment rate for a service provided by a certified nurse-midwife that is within the scope of the certified nurse-midwife’s authorization to practice shall be equal to the payment rate for the same service if performed by a physician.
The division shall provide coverage for midwifery services, including prenatal care, childbirth and postpartum care, provided by a licensed certified professional midwife regardless of the site of services.
SECTION 41. Said chapter 118E is hereby further amended by inserting after section 10Q the following 5 sections:-
Section 10R. (a) For the purposes of this section, “noninvasive prenatal screening” shall mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal chromosomal aneuploidy; provided, however, that such screening shall include, but not be limited to, an analysis of chromosomes 13, 18 and 21.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician shall provide coverage under all benefit plans for noninvasive prenatal screening and shall not limit availability and coverage for such screening based on the age of the pregnant patient or any other risk factor, unless the limitation is part of the generally accepted standards of professional practice as recommended by the American College of Obstetricians and Gynecologists.
Section 10S. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 10T. (a) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 10U. (a) For purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:
“Maternal and infant health outcomes”, outcomes arising for the gestational parent and the gestational parent’s offspring during the pregnancy including pregnancy complications, maternal morbidity, infant mortality and preterm births.
“Doula services”, physical, emotional and informational support provided by trained doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage, stillbirth, adoption or pregnancy loss, as determined appropriate by the division; provided, however, that “doula services” shall not constitute medical care.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage of doula services to pregnant individuals and postpartum individuals up to 12 months following the end of the pregnancy and adoptive parents of infants until the infants reach 1 year of age; provided, however, that the division shall cover not less than 6 doula visits across the prenatal and 1-year postpartum period or until an adopted infant reaches 1 year of age.
(c) In determining the scope of doula services, the division shall consult with the department of public health and bureau of family health and nutrition.
Section 10V. The division and its and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan or other entities contracting with the division to administer benefits shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
SECTION 42. Subsection (c) of section 148C of chapter 149 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by striking out clauses (3) and (4) and inserting in place thereof the following 3 clauses:-
(3) attend the employee’s routine medical appointment or a routine medical appointment for the employee’s child, spouse, parent or parent of spouse;
(4) address the psychological, physical or legal effects of domestic violence as defined in subsection (g1⁄2) of section 1 of chapter 151A, except that the definition of employee in subsection (a) will govern for purposes of this section; or
(5) address the employee’s own physical and mental health needs, and those of their spouse, if the employee or the employee’s spouse experiences pregnancy loss or a failed assisted reproduction, adoption or surrogacy.
SECTION 43. Section 47C of chapter 175 of the General Laws, as so appearing, is hereby amended by striking out, in line 62, the word “annually” and inserting in place thereof the following words:- once per calendar year.
SECTION 44. Said chapter 175 is hereby further amended by inserting after section 47VV, inserted by section 145 of chapter 140 of the acts of 2024, the following 3 sections:-
Section 47WW. Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 47XX. (a) Any policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 47YY. An individual policy of accident and sickness insurance issued pursuant to section 108 that provides hospital expense and surgical expense insurance or a group blanket or general policy of accident and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments, coinsurance or deductibles for these services.
SECTION 45. Chapter 176A of the General Laws is hereby amended by inserting after section 8WW, inserted by section 148 of chapter 140 of the acts of 2024, the following 3 sections:-
Section 8XX. Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 8YY. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 8ZZ. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments, coinsurance or deductibles for these services.
SECTION 46. Chapter 176B of the General Laws is hereby amended by inserting after section 4WW, inserted by section 149 of chapter 140 of the acts of 2024, the following 3 sections:-
Section 4XX. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 4YY. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth, which is considered creditable coverage under section 1 of chapter 111M, shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 4ZZ. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments, coinsurance or deductibles for these services.
SECTION 47. Chapter 176G of the General Laws is hereby amended by inserting after section 4OO, inserted by section 150 of chapter 140 of the acts of 2024, the following 3 sections:-
Section 4PP. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.
Section 4QQ. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that:
(i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health;
(ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
(iii) the covered infant is:
(1) under the age of 6 months;
(2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and
(3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density.
(b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.
Section 4RR. Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments, coinsurance or deductibles for these services.
SECTION 48. (a) There shall be a task force on maternal health access and birthing patient safety. The task force shall consist of: the commissioner of public health or a designee, who shall serve as co-chair; the executive director of the health policy commission or a designee, who shall serve as co-chair; the executive director of the center for health information and analysis or a designee; the executive director of the Betsy Lehman center for patient safety and medical error reduction or a designee; and 5 members appointed by the secretary of health and human services, 1 of whom shall be a representative of the Massachusetts Health and Hospital Association, Inc., 1 of whom shall be a representative of the Massachusetts Nurses Association, 1 of whom shall be a representative of the Massachusetts Medical Society, 1 of whom shall be representative of the Perinatal-Neonatal Quality Improvement Network of Massachusetts and 1 of whom shall be a representative of the Neighborhood Birth Center, Inc.
(b) The task force shall study and report maternal health access and birthing patient safety. The task force shall: (i) study the current availability of and access to maternal health services and maternal health care across regions of the commonwealth and among birthing patient populations, including the essential service closure process, the adequacy of the maternal health care workforce and other topics identified in subsection (c); (ii) identify methods to increase the financial investment in and patient access to maternal health care across the commonwealth and ensure equitable access for the most vulnerable birthing patient populations; and (iii) issue a report on the task force’s findings and policy recommendations.
(c) The task force shall study: (i) past essential services closures for inpatient maternity units and acute-level birthing centers and closures of community-based, office-based and preventative maternal health care, including family planning services, obstetrics and gynecology services and midwifery services;
(ii) patient quality and safety considerations of essential service closures of maternal care units, including quality, safety and staffing regulatory requirements promulgated by the department of public health that inform acute level maternal care essential service closures; and (iii) demographic information on patient populations whose access has been most affected by past closures of or current limitations on the availability of maternal care services, including, but not limited to, geography, type of insurance coverage, age, race, ethnicity, income status, LGBTQIA+ status and immigration status.
(d) Not later than September 1, 2025, the task force shall submit its report to the clerks of the senate and house of representatives, the joint committee on health care financing and the joint committee on public health.
SECTION 49. Notwithstanding any general or special law to the contrary, for the initial appointments by the governor to the board of registration in midwifery pursuant to section 110 of chapter 13 of the General Laws, inserted by section 5, the 5 members required to be licensed certified professional midwives shall be persons with at least 5 years of experience in the practice of midwifery who hold a certificate of completion or equivalent from an educational program or institution accredited by the Midwifery Education Accreditation Council.
SECTION 50. The board of registration in midwifery established pursuant to section 110 of chapter 13 of the General Laws, inserted by section 5, shall issue temporary licensure for individuals practicing midwifery and shall promulgate regulations for the temporary licensure of individuals practicing midwifery within 180 days of the effective date of this act. Such temporary licenses shall be valid until the date established by the board pursuant to section 55 by which individuals practicing midwifery shall be licensed.
SECTION 51. The board of registration in midwifery established pursuant to section 110 of chapter 13 of the General Laws, inserted by section 5, except as provided in section 50, shall adopt rules and promulgate regulations pursuant to this act within 1 year from the effective date of this act.
SECTION 52. (a) The department of public health shall promulgate regulations pursuant to section 51M of chapter 111 of the General Laws, inserted by section 17, not later than 180 days after the effective date of this act.
(b) Prior to promulgating initial regulations pursuant to said section 51M of said chapter 111, the department shall consider, when developing regulations, the standards adopted by the American Association of Birth Centers and consult with Seven Sisters Birth Center LLC, Neighborhood Birth Center, Inc., the Massachusetts Affiliate of ACNM, Inc. and other entities operating or planning to open birth centers in the commonwealth.
SECTION 53. The department of public health shall implement newborn screening protocols for Duchenne muscular dystrophy pursuant to section 110A of chapter 111 of the General Laws, as amended by section 18, not later than 18 months after the effective date of this act.
SECTION 54. All individuals practicing lactation consulting required to be licensed pursuant to section 23B of chapter 112 of the General Laws, as amended by sections 25 and 26, shall be licensed not later than January 1, 2026.
SECTION 55. The board of registration in midwifery established pursuant to section 110 of chapter 13 of the General Laws, inserted by section 5, shall establish a date not later than 1 year after said board adopts rules and promulgates regulations pursuant to this act by which individuals practicing midwifery consistent with section 291 of chapter 112 of the General Laws, inserted by section 38, shall be licensed.
SECTION 56. The governor shall convene the first meeting of the board of registration in midwifery established under section 110 of chapter 13 of the General Laws within 90 days from the effective date of this act. At such meeting, the board shall elect a chair and a secretary for its membership whose duties shall be established by the board.
SECTION 57. The department of public health shall promulgate regulations pursuant to subsection (j) of section 7 of chapter 94C of the General Laws, inserted by section 11, providing for the automatic registration of licensed certified professional midwives to issue written prescriptions within 180 days of the effective date of this act.
SECTION 58. The department of public health shall promulgate regulations pursuant to subsection (b) of section 248 of chapter 111 of the General Laws, inserted by section 21, for the establishment and administration of a statewide system of programs providing universal postpartum home visiting services within 90 days of the effective date of this act.
Approved, August 23, 2024.