HOUSE . . . . . . . No. 4773
The Commonwealth of Massachusetts
______________________________________
HOUSE OF REPRESENTATIVES, June 18, 2024.
The committee on Ways and Means, to whom was referred the Bill
promoting access to midwifery care and out-of-hospital birth options
(House, No. 4566), reports recommending that the same ought to pass
with an amendment substituting therefor the accompanying bill (House,
No. 4773).
For the committee,
AARON MICHLEWITZ.
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FILED ON: 6/18/2024
HOUSE . . . . . . . . . . . . . . . No. 4773
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
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:
1 SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2022
2Official Edition, is hereby amended by inserting after the word “counselors”, in line 7, the
3following words:- the board of registration in midwifery.
4 SECTION 2. Section 11A of said chapter 13, as so appearing, is hereby amended by
5striking out the first paragraph and inserting in place thereof the following paragraph:-
6 There shall be a board of allied health professions, hereinafter called the board, which
7shall consist of 15 members who are residents of the commonwealth to be appointed by the
8governor. Three of such members shall be qualified athletic trainers licensed in accordance with
9section 23B of chapter 112; 2 of such members shall be occupational therapists licensed in
10accordance with said section 23B; 1 such member shall be an occupational therapy assistant
11licensed in accordance with said section 23B; 2 of such members shall be physical therapists
12licensed in accordance with said section 23B; 1 such member shall be a physical therapist
13assistant licensed in accordance with said section 23B; 3 of such members shall be lactation 2 of 29
14consultants licensed in accordance with said section 23B; 2 of such members shall be a physician
15licensed in accordance with section 2 of chapter 112; and 1 such member shall be selected from
16and shall represent the general public.
17 SECTION 3. Said section 11A of said chapter 13, as so appearing, is hereby further
18amended by striking out the words “or physical therapy”, in lines 51 and 52, and inserting in
19place thereof the following words:- physical therapy or lactation consulting.
20 SECTION 4. Said chapter 13 is hereby further amended by adding the following section:-
21 Section 110. (a) There shall be within the department of public health a board of
22registration in midwifery, hereinafter called the board. The board shall consist of 9 members who
23are residents of the commonwealth to be appointed by the governor: 5 of whom shall be
24midwives licensed under section 293 of chapter 112 with not less than 5 years of experience in
25the practice of midwifery; 1 of whom shall be an obstetrician-gynecologist licensed to practice
26medicine under section 2 of said chapter 112 with experience working with midwives; 1 of
27whom shall be a maternal-fetal medicine specialist licensed to practice medicine under said
28section 2 of said chapter 112 with experience working with midwives; 1 of whom shall be a
29certified nurse-midwife licensed under section 80B of said chapter 112 and authorized to practice
30nurse midwifery under section 80C of said chapter 112; and 1 of whom shall be a member of the
31public. When making the appointments, the governor shall consider members with experience
32working on the issue of racial disparities in maternal health. The appointed members shall serve
33for terms of 3 years. Upon the expiration of a term of office, a member shall continue to serve
34until a successor has been appointed and qualified. A member shall not serve for more than 2
35consecutive full terms; provided, however, that a person who is chosen to fill a vacancy in an 3 of 29
36unexpired term of a prior board member may serve for 2 consecutive full terms in addition to the
37remainder of such unexpired term. A member may be removed by the governor for neglect of
38duty, misconduct, malfeasance or misfeasance in the office after a written notice of the charges
39against the member and sufficient opportunity to be heard thereon. Upon the death, resignation,
40or removal for cause of a member of the board, the governor shall fill the vacancy for the
41remainder of that member’s term.
42 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
43serve until their successors have been elected and qualified. The board shall meet not less than 4
44times annually and may hold additional meetings at the call of the chair or upon the request of
45not less than 5 members. A quorum for the conduct of official business shall be a majority of
46those appointed. Board members shall serve without compensation but shall be reimbursed for
47actual and reasonable expenses incurred in the performance of their duties. The members shall be
48public employees for the purposes of chapter 258 for all acts or omissions within the scope of
49their duties as board members.
50 SECTION 5. Chapter 32A of the General Laws is hereby amended by inserting after
51section 17S the following section:-
52 Section 17T. The commission shall provide to any active or retired employee of the
53commonwealth who is insured under the group insurance commission coverage for postpartum
54depression screenings conducted pursuant to section 247 of chapter 111.
55 SECTION 6. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
56Official Edition, is hereby amended by inserting after the definition of “Administrator” the
57following definition:- 4 of 29
58 “Certified nurse-midwife”, a nurse licensed under section 80B of said chapter 112 and
59authorized to practice nurse midwifery under section 80C of said chapter 112.
60 SECTION 7. Said section 1E of said chapter 46, as so appearing, is hereby further
61amended by inserting after the definition of “Hospital medical officer” the following definition:-
62 “Licensed midwife”, a midwife licensed to practice by the board of registration in
63midwifery pursuant to section 293 of chapter 112.
64 SECTION 8. Section 3B of said chapter 46, as so appearing, is hereby amended by
65inserting after the word “physician”, in line 1, the following words:- certified nurse-midwife or
66licensed midwife.
67 SECTION 9. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
68amended by inserting after the definition of “Isomer” the following definition:-
69 “Licensed midwife”, a midwife licensed to practice by the board of registration in
70midwifery pursuant to section 293 of chapter 112.
71 SECTION 10. Section 7 of said chapter 94C, as so appearing, is hereby amended by
72adding the following subsection:-
73 (j) The commissioner shall promulgate regulations that provide for the automatic
74registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
75prescriptions in accordance with the provisions of section 295 of chapter 112 and the regulations
76issued by the board of registration in midwifery under said section 295 of said chapter 112,
77unless the registration of such licensed midwife has been suspended or revoked pursuant to the
78provisions of section 13 or section 14 or unless such registration is denied for cause by the 5 of 29
79commissioner pursuant to chapter 30A. Prior to promulgating such regulations, the
80commissioner shall consult with the board of registration in midwifery and the department of
81public health.
82 SECTION 11. Section 9 of said chapter 94C, as so appearing, is hereby amended by
83inserting after the figure “112”, in line 7, the following words:- , licensed midwife as limited by
84subsection (j) of said section 7 and section 295 of said chapter 112.
85 SECTION 12. Said section 9 of said chapter 94C, as so appearing, is hereby further
86amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
87instance, the following words:- , licensed midwife.
88 SECTION 13. Said section 9 of said chapter 94C, as so appearing, is hereby further
89amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
90midwifery.
91 SECTION 14. Chapter 111 of the General Laws is hereby amended by inserting after
92section 24O the following section:-
93 Section 24P. (a) As used in this section the following words shall, unless the context
94clearly requires otherwise, have the following meanings:
95 “Fetal death”, as defined in section 202.
96 “Infant death”, the death of an infant that occurs between the birth of the infant and 1
97year of age.
98 (b) The department shall establish a program to conduct an in-depth fetal and infant
99mortality review of each individual fetal or infant death occurring within the commonwealth in 6 of 29
100order to identify social, economic and systems factors associated with fetal and infant deaths and
101inform public health policy programs. For each case of fetal or infant death to be reviewed, the
102department may collect relevant data from a variety of sources, which may include physician and
103hospital records in addition to relevant information from local boards of health and community
104organizations.
105 (c) The department may promulgate regulations, consistent with this section, regarding
106the process for conducting fetal infant mortality reviews, which may include guidance from the
107federal Health Resources and Services Administration’s national fetal, infant and child death
108review program.
109 SECTION 15. Said chapter 111 is hereby further amended by inserting after section 51L
110the following section:-
111 Section 51M. (a) The department shall promulgate regulations relative to the operation
112and maintenance of birth centers licensed as clinics pursuant to section 51, hereinafter referred to
113as “freestanding birth centers.”
114 (b) The regulations shall include, but shall not be limited to, a licensed freestanding birth
115center having:
116 (i) a detailed and written plan on the premises for transfer of a client to a nearby hospital
117providing obstetrical and newborn services as needed for emergency treatment beyond that
118provided by the birth center; 7 of 29
119 (ii) policies and procedures to ensure coordination of ongoing care and transfer when
120complications occur that render the patient ineligible for birth center care during the antepartum,
121intrapartum or postpartum period;
122 (iii) an administrative director responsible for implementing and overseeing the
123operational policies of the birth center;
124 (iv) a director of clinical affairs on staff who shall be a certified nurse-midwife or
125physician licensed to practice in the commonwealth whose professional scope of practice
126includes preconception, prenatal, labor, birth and postpartum care and early care of the newborn
127and who may be the primary attendants during the perinatal period; and
128 (v) birth attendants that are certified nurse midwives, licensed midwives, physicians or
129other providers licensed to practice in the commonwealth whose professional scope of practice
130includes preconception, prenatal, labor, birth and postpartum care and early care of the newborn
131and who may be the primary attendants in accordance with their professional scope of practice.
132 (c) No regulations shall require a licensed freestanding birth center or the directors and
133providers on staff to practice under the supervision of a hospital or another health care provider
134or to enter into an agreement, written or otherwise, with another hospital or health care provider,
135or maintain privileges at a hospital.
136 (d) In order to be licensed as freestanding birth centers pursuant to subsection (a) and
137under section 51 by the department, a freestanding birth center shall provide reimbursable
138services to individuals with public health insurance on a non-discriminatory basis. 8 of 29
139 SECTION 16. Section 202 of said chapter 111, as appearing in the 2022 Official Edition,
140is hereby amended by inserting after the word “physician”, in line 17, the following words:- ,
141certified nurse-midwife or licensed midwife.
142 SECTION 17. Said section 202 of said chapter 111, as so appearing, is hereby further
143amended by inserting after the word “attendance”, in line 17, the following words:- , or without
144the attendance of a certified nurse-midwife or licensed midwife,.
145 SECTION 18. Said chapter 111 is hereby further amended by adding the following 3
146sections:-
147 Section 245. (a) The commissioner shall develop and disseminate to the public,
148information regarding pregnancy loss, including miscarriage and recurrent miscarriage, which
149shall include information on: (i) the awareness of pregnancy loss and the incidence and
150prevalence of pregnancy loss among pregnant people; and (ii) the accessibility of the range of
151evidence-based treatment options, as medically appropriate, for pregnancy loss, including, but
152not limited to, comprehensive mental health supports, necessary procedures and medications and
153culturally responsive supports including as pregnancy-loss doula care.
154 (b) The commissioner may disseminate information to the public directly through the
155department’s website or through arrangements with agencies carrying out intra-agency
156initiatives, nonprofit organizations, consumer groups, community organizations, institutions of
157higher education or state or local public-private partnerships.
158 (c) The commissioner shall develop and coordinate programs for conducting and
159supporting evidence-based research with respect to the causes of and current and novel treatment
160options and procedures for pregnancy loss. 9 of 29
161 (d) The commissioner shall, in consultation with and in accordance with guidelines from
162relevant professional boards of registration, develop and disseminate to perinatal health care
163workers information on pregnancy loss to ensure that such perinatal health care workers remain
164informed about current information regarding pregnancy loss and prioritizing both the physical
165and mental health care of patients experiencing pregnancy loss. For purposes of this subsection,
166the term “perinatal health care worker” shall include, but shall not be limited to, a licensed
167midwife, physician assistant, nurse practitioner, clinical nurse specialist, doula, community
168health worker, peer supporter, licensed lactation consultant, nutritionist or dietitian, childbirth
169educator, social worker, trained family support specialist or home visitor, and language
170interpreter or navigator.
171 (e) The commissioner shall, in a manner that protects personal privacy and complies with
172federal law, collect and assess data regarding pregnancy loss, including information
173disaggregated by race, ethnicity, health insurance status, disability, income level and geography
174on the prevalence of, the incidence of and knowledge about pregnancy loss.
175 Section 246. (a) As used in this section, the following words shall, unless the context
176clearly requires otherwise, have the following meanings:
177 “Perinatal individual”, an individual that is either pregnant or is within 12 months from
178the date of giving birth.
179 “Perinatal mood and anxiety disorders”, any mental health disorder experienced by a
180perinatal individual during the period of time from the beginning of pregnancy up until 1 year
181following the birth of a child, including, but not limited to, postpartum depression. 10 of 29
182 (b) The department shall develop and maintain a comprehensive digital resource center
183on perinatal mood and anxiety disorders. The digital resource center shall be available to the
184public at no cost on the department’s website, and shall include information and resources for: (i)
185health care providers and organizations serving perinatal individuals to aid them in diagnosing,
186treating or making appropriate referrals for individuals experiencing perinatal mood and anxiety
187disorders; (ii) perinatal individuals and their families to aid them in understanding and
188identifying perinatal mood and anxiety disorders and how to navigate available resources and
189obtain treatment.
190 (c) Prior to developing the comprehensive digital resource center, the department shall
191consult with: (i) health care professionals, including, but not limited to, obstetricians,
192gynecologists, pediatricians, primary care providers, certified nurse-midwives, licensed
193midwives, psychiatrists, and other mental health clinicians; (ii) organizations serving perinatal
194individuals; and (iii) health insurance carriers.
195 (d) The department shall develop and implement a public information campaign to
196promote awareness of perinatal mood and anxiety disorders, which shall promote the digital
197resource center developed pursuant to this section.
198 Section 247. (a) For the purposes of this section, “postnatal individual” shall refer to an
199individual who is within 12 months of giving birth.
200 (b) Every postnatal individual who receives health care services from a primary care
201provider, obstetrician, gynecologist, certified nurse-midwife, or licensed midwife shall be offered
202a screening for postpartum depression, and, if the postnatal individual does not object to such
203screening, such primary care provider, certified nurse-midwife, or licensed midwife shall ensure 11 of 29
204that the postnatal individual is appropriately screened for postpartum depression in line with
205evidence-based guidelines.
206 (c) Every postnatal individual whose infant receives health care services from a
207pediatrician shall be offered a screening for postpartum depression by the infant’s pediatrician,
208and, if the postnatal individual does not object to such screening, such pediatrician shall ensure
209that the postnatal individual is appropriately screened for postpartum depression in line with
210evidence-based guidelines.
211 (d) If a health care professional, administering a screening in accordance with this section
212determines, based on the screening methodology administered, that the postnatal individual is
213likely to be suffering from postpartum depression, such health care professional shall discuss
214available treatments for postpartum depression, including pharmacological treatments, and
215provide an appropriate referral to a mental health clinician.
216 SECTION 19. Section 23A of chapter 112 of the General Laws, as appearing in the 2022
217Official Edition, is hereby amended by striking out, in lines 1 and 2, the words “twenty-three A
218to twenty-three P” and inserting in place thereof the following words:- 23A to 23P¾.
219 SECTION 20. Said section 23A of said chapter 112, as so appearing, is hereby further
220amended by inserting after the definition of “Board” the following 4 definitions:-
221 “International board certified lactation consultant”, a person who holds current
222certification from the International Board of Lactation Consultant Examiners as a lactation
223consultant after demonstrating the appropriate education, knowledge and experience necessary
224for independent clinical practice. 12 of 29
225 “International Board of Lactation Consultant Examiners”, the international certification
226body that confers the International Board Certified Lactation Consultant credential and which is
227independently accredited by the National Commission for Certifying Agencies.
228 “Lactation consulting”, the clinical application of scientific principles and a
229multidisciplinary body of evidence for evaluation, problem identification, treatment, education
230and consultation to families regarding the course of lactation and infant feeding; including but
231not limited to: (i) clinical lactation assessment through the systematic collection of subjective
232and objective data; (ii) analysis of data and creation of a plan of care; (iii) development and
233implementation of a lactation care plan with demonstration and instruction to parents and
234communication to the primary health care provider; (iv) provision of lactation education to
235parents and health care providers; and (v) recommendation and use of assistive devices.
236 “Licensed lactation consultant”, a person licensed to practice lactation consulting in
237accordance with section 23B.
238 SECTION 21. Section 23B of said chapter 112, as so appearing, is hereby amended by
239striking out, in line 8, the words “and physical therapist assistants” and inserting in place thereof
240the following words:- , physical therapist assistants and lactation consultants.
241 SECTION 22. The first paragraph of said section 23B of said chapter 112, as so
242appearing, is hereby amended by striking out the fourth sentence and inserting in place thereof
243the following sentence:- An applicant who furnishes satisfactory proof that they are of good
244moral character and that they have met the educational and clinical practice requirements set
245forth in section 23F, 23G, 23H, 23I, 23J or 23J½, shall, upon payment of a fee determined by the 13 of 29
246secretary of administration and finance, be examined by the board, and if found qualified, and if
247the applicant passes the examination, shall be licensed to practice.
248 SECTION 23. Section 23C of said chapter 112, as so appearing, is hereby amended by
249inserting after the word “assistant”, in line 4, the following words:- or lactation consultant.
250 SECTION 24. Said section 23C of said chapter 112, as so appearing, is hereby further
251amended by inserting after the word “chapter”, in line 11, the following words:- ; as a licensed
252lactation consultant.
253 SECTION 25. Section 23D of said chapter 112, as so appearing, is hereby amended by
254inserting after the words “physical therapist assistant”, in line 3, the following words:- , or a
255licensed lactation consultant.
256 SECTION 26. Section 23E of said chapter 112, as so appearing, is hereby amended by
257inserting after the word “assistant”, in line 8, the following words:- or lactation consultant.
258 SECTION 27. Said section 23E of said chapter 112, as so appearing, is hereby further
259amended by inserting after the word “therapy”, in line 14, the following words:- or lactation
260consulting.
261 SECTION 28. Said section 23E of said chapter 112, as so appearing, is hereby further
262amended by inserting after the words “physical therapy services”, in line 21, the following
263words:- or lactation consulting services.
264 SECTION 29. Said section 23E of said chapter 112, as so appearing, is hereby further
265amended by inserting after the words “physical therapist”, in line 24, the following words:- or
266licensed lactation consultant. 14 of 29
267 SECTION 30. Said chapter 112 is hereby further amended by inserting after section 23J
268the following section:-
269 Section 23J½. An applicant for licensure as a lactation consultant shall:
270 (i) be at least 18 years of age;
271 (ii) have submitted a completed application upon a form and in such manner as the board
272prescribes, accompanied by applicable fees;
273 (iii) have met the education and clinical standards established for international board
274certified lactation consultants by the International Board of Lactation Consultant Examiners, or
275its successor organization;
276 (iv) have passed an examination adopted or administered by the board; provided,
277however, that the board may adopt a standardized national exam, including the examination
278required for certification by the International Board of Lactation Consultant Examiners or a
279successor or equivalent entity; and
280 (v) have completed such other requirements as may be prescribed by the board.
281 SECTION 31. Section 23K of said chapter 112, as so appearing, is hereby amended by
282inserting after the words “physical therapy”, in line 9, the following words:- , or lactation
283consulting.
284 SECTION 32. Section 23L of said chapter 112, as so appearing, is hereby amended by
285striking out, in line 3, the words “or physical therapist assistant” and inserting in place thereof
286the following words:- physical therapist assistant, or licensed lactation consultant. 15 of 29
287 SECTION 33. Said chapter 112 is hereby further amended by inserting after section
28823P½ the following section:-
289 Section 23P¾. (a) Except as otherwise provided in this section and sections 23C and 23E,
290no person shall provide lactation consulting services unless they are licensed to practice as a
291lactation consultant pursuant to section 23B.
292 (b) Nothing in this section shall be construed to prevent the practice of lactation
293consulting by members of other licensed health care professions when such practice is consistent
294with the accepted standards and scope of practice for their respective professions; provided,
295however, that such persons shall not use the title “licensed lactation consultant” unless licensed
296pursuant to this chapter.
297 (c) Nothing in the chapter shall prevent perinatal health workers from performing
298breastfeeding education functions consistent with the accepted standards of their respective
299occupations; provided, however, such persons shall not use the title “licensed lactation
300consultant” unless licensed pursuant to this chapter. For the purposes of this subsection,
301“perinatal health worker” shall mean any perinatal educator, including, but not limited to, a
302doula, community health worker, peer counselor, peer counselor, peer supporter, breastfeeding
303and lactation educator or counselor within the Women Infants and Children Program, childbirth
304educator or social worker.
305 SECTION 34. Said chapter 112 is hereby further amended by adding the following 8
306sections:-
307 Section 290. As used in sections 290 to 297, inclusive, the following words shall, unless
308the context clearly requires otherwise, have the following meanings: 16 of 29
309 “Board”, the board of registration in midwifery, established under section 110 of chapter
31013.
311 “Certified nurse-midwife”, a nurse licensed under section 80B and authorized to practice
312nurse midwifery under section 80C.
313 “Client”, a person under the care of a licensed midwife.
314 “Licensed midwife”, a person registered by the board to practice midwifery in the
315commonwealth under section 293.
316 “Low-risk pregnancy”, a pregnancy with: (i) an absence of any preexisting maternal
317disease or condition likely to affect the pregnancy; (ii) an absence of a significant disease or
318condition arising from the pregnancy; and (iii) other criteria as determined by the board in
319consultation with the department of public health, including, but not limited to, criteria related to
320the gestational age and presentation of the fetus at the time of labor and delivery.
321 “MEAC”, the Midwifery Education Accreditation Council or its successor organization.
322 “NARM”, the North American Registry of Midwives or its successor organization.
323 Section 291. (a) The practice of midwifery by a licensed midwife shall include, but shall
324not be limited to:
325 (i) the practice of providing maternity care to a client during the preconception period and
326the antepartum, intrapartum and postpartum periods of a low-risk pregnancy;
327 (ii) the practice of providing newborn care; and 17 of 29
328 (iii) prescribing, dispensing or administering pharmaceutical agents consistent with
329section 295.
330 (b) A licensed midwife shall accept and provide care to clients only in accordance with
331the scope and standards of practice under this section and regulations promulgated by the board
332pursuant to section 292.
333 (c) The practice of midwifery shall not constitute the practice of medicine, certified
334nurse-midwifery or emergency medical care.
335 (d) Nothing in this section shall regulate, restrict or prohibit the practice, service or
336activities of:
337 (i) a person licensed in the commonwealth from engaging in activities within the scope of
338practice of the profession or occupation for which such person is licensed, including, but not
339limited to: the practice of a licensed physician, certified-nurse midwife or certified emergency
340medical technician; provided, however, that such person does not represent to the public, directly
341or indirectly, that such person is licensed under section 293 and that such person does not use
342any name, title or designation indicating that such person is licensed under said section 293;
343 (ii) a person employed as a midwife by the federal government or an agency thereof if
344that person provides midwifery services solely under the direction and control of the
345organization by which such person is employed;
346 (iii) a traditional birth attendant who provides midwifery services to a client that has
347cultural or religious birth traditions that have historically included the attendance of traditional
348birth attendants; provided, that no fee for the traditional birth attendant’s services is 18 of 29
349contemplated, charged or received and the birth attendant serves only individuals and families in
350a distinct cultural or religious group;
351 (iv) persons who are members of Native American communities and provide traditional
352midwife services to their communities; or
353 (v) any person rendering aid in an emergency.
354 Section 292. (a) The board shall have the following powers and duties:
355 (i) to adopt rules and promulgate regulations governing licensed midwives and the
356practice of midwifery to promote the public health, welfare and safety consistent with the
357essential competencies identified by the NARM;
358 (ii) to administer the licensing process, including, but not limited to: (A) receiving,
359reviewing, approving and rejecting applications for licensure; (B) issuing, renewing, suspending,
360revoking and reinstating licenses; (C) investigating complaints against persons licensed under
361section 293; and (D) holding hearings and ordering disciplinary sanctions against a person who
362violates sections 290 to 297, inclusive, or any regulation promulgated by the board;
363 (iii) to establish administrative procedures for processing applications and renewals;
364 (iv) to adopt and provide a uniform, proctored examination for applicants to measure the
365qualifications necessary for licensure; provided, however, that the board may adopt a
366standardized national exam, including the examination required for certification by the NARM
367or a successor or equivalent entity;
368 (v) to develop practice standards for licensed midwives that shall include, but not be
369limited to: (A) the adoption of ethical standards for licensed midwives; (B) the maintenance of 19 of 29
370records of care, including client charts; (C) the participation in peer review; (D) the development
371of standardized informed consent forms; and (E) the development of a standardized written
372emergency transport plan forms relative to the timely transfer of a newborn or client to a
373hospital;
374 (vi) to promulgate regulations requiring licensed midwives to have professional
375malpractice liability insurance or a suitable bond or other indemnity against liability for
376professional malpractice in such an amount as may be determined by the board; provided,
377however, that such amount shall be not less than that required for certified-nurse midwives
378pursuant to section 80B;
379 (vii) to establish and maintain records of its actions and proceedings in accordance with
380public records laws; and
381 (viii) adopt professional continuing education requirements for licensed midwives
382seeking renewal consistent with those maintained by the NARM.
383 (b) Nothing in this section shall be construed to authorize the board to promulgate
384regulations that require a licensed midwife to practice under the supervision of or in
385collaboration with another health care provider.
386 Section 293. (a) A person who desires to be licensed as a midwife under this section shall
387apply to the board in writing on an application form prescribed and furnished by the board. The
388application shall include a sworn statement and contain information satisfactory to the board to
389demonstrate that the applicant possesses the qualifications necessary for licensure under this
390section. 20 of 29
391 (b) The initial license and renewal fee shall be established pursuant to section 3B of
392chapter 7; provided, however, that such fees shall not exceed $200 biennially. The board, in
393consultation with the secretary of administration and finance, shall institute a process for
394applicants to apply for a financial hardship waiver, which may reduce or fully exempt an
395applicant from paying the fee pursuant to this section. Fees collected by the board shall be
396deposited into the Quality in Health Professions Trust Fund pursuant to section 35X of chapter
39710 to support board operations and administration and to reimburse board members for
398reasonable expenses incurred in the performance of their official duties.
399 (c) An applicant for licensure under this section shall: (i) be of good moral character; (ii)
400be a graduate of a high school or its equivalent; (iii) have completed a formal midwifery
401education and training program consistent with subsection (d); (iv) possess a valid certified
402professional midwife credential from the NARM; and (v) have satisfactorily completed the
403examination required by the board.
404 (d) An applicant for a license to practice midwifery as a licensed midwife shall submit to
405the board proof of successful completion of a formal midwifery education and training program
406as follows:
407 (i) a certificate of completion or equivalent from an educational program or institution
408accredited by the MEAC; or
409 (ii) a midwifery bridge certificate issued by the NARM or a successor credential;
410provided that an applicant is: (A) certified as a certified professional midwife within 5 years after
411the effective date of this section and completed a midwifery education and training program from
412an educational program or institution that is not accredited by the MEAC; or (B) licensed as a 21 of 29
413professional midwife in a state that does not require completion of a midwifery education and
414training program from an educational program or institution that is accredited by the MEAC.
415 (e) The board may license in a like manner, without examination, any midwife who has
416been licensed in another state under laws which, in the opinion of the board, require
417qualifications and maintain standards substantially the same as those of this commonwealth for
418licensed midwives; provided, however, that such midwife applies and remits to the board the
419appropriate application fee under this section.
420 (f) The board may petition a court of competent jurisdiction for an injunction against any
421person practicing midwifery without a license granted pursuant to section 293. Proof of damage
422or harm sustained by any person shall not be required for issuance of such an injunction. Nothing
423in this section shall relieve a person from criminal prosecution for practicing midwifery without
424a license.
425 Section 294. (a) The board may, after a hearing pursuant to chapter 30A, suspend or
426revoke the license of a licensed midwife, or reprimand, censure or otherwise discipline a licensed
427midwife for any of the reasons set forth in section 61.
428 (b) No person filing a complaint or reporting information pursuant to this section or
429assisting the board at its request in any manner in discharging its duties and functions shall be
430liable in any cause of action arising out of providing such information or assistance; provided,
431however, that the person making the complaint or reporting such information or providing such
432assistance does so in good faith.
433 (c) A person subject to any disciplinary action taken by the board pursuant to this section
434may file a petition for judicial review pursuant to section 64. 22 of 29
435 Section 295. (a) A licensed midwife duly registered to issue written prescriptions in
436accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess,
437purchase and administer pharmaceutical agents consistent with the scope of midwifery practice,
438including: (i) antihemorrhagic agents, including, but not limited to, oxytocin, misoprostol and
439methergine; (ii) intravenous fluids for stabilization; (iii) vitamin K; (iv) eye prophylaxes; (v)
440oxygen; (vi) antibiotics for Group B Streptococcal; (vii) antibiotic prophylaxes; (viii) Rho(D)
441immune globulin; (ix) local anesthetic; (x) epinephrine; and (xi) other pharmaceutical agents
442identified by the board through rules or regulations in consultation with the department of public
443health.
444 (b) Nothing in this section shall be construed to permit a licensed midwife’s use of
445pharmaceutical agents which are: (i) controlled substances as defined in chapter 94C, except for
446those listed in schedule VI; or (ii) not identified by the board of registration in midwifery as
447consistent with the scope of midwifery practice pursuant to subsection (a).
448 Section 296. When accepting a client for care, a licensed midwife shall obtain the client’s
449informed consent, which shall be evidenced by a written statement in a form prescribed by the
450board and signed by both the licensed midwife and the client. The signed form shall be included
451in the client’s record of care. The form shall include, but not be limited to, the following: (i) an
452acknowledgement that the licensed midwife is not authorized to practice medicine; (ii) a
453description of written practice guidelines, services provided and the risks and benefits of birth in
454the client’s chosen environment; and (iii) disclosure that the client may be referred for a
455consultation with or have their care transferred to a physician if the client requires care that is
456outside the midwife’s scope of practice. 23 of 29
457 Section 297. (a) A licensed midwife shall only provide care to a client in the case of a
458low-risk pregnancy. If at any point during pregnancy, childbirth or postpartum care a client or
459the newborn’s condition deviates from normal, it shall be the duty of the licensed midwife to
460immediately refer or transfer the client or newborn to a physician. If a physician determines that
461the client’s condition has been resolved such that the risk factors presented by a client’s disease
462or condition are not likely to significantly affect the course of pregnancy or childbirth, the
463licensed midwife may resume care of the client and resume assisting the client during their
464pregnancy, childbirth or postpartum care. A licensed midwife shall not provide or continue to
465provide midwifery care to a client whose pregnancy is no longer low-risk; provided, however, in
466such circumstances nothing in this section shall prohibit a licensed midwife from remaining
467present in a supportive capacity throughout pregnancy and childbirth, in accordance with the
468client’s wishes. If at any point after delivery, the newborn’s condition deviates from normal, the
469licensed midwife shall immediately refer or transfer the client to a physician.
470 (b) A licensed midwife shall prepare, in a form prescribed by the board, a written plan for
471the appropriate delivery of emergency care. The plan shall include, but not be limited to: (i)
472consultation with other health care providers; (ii) emergency transfer to a hospital; and (iii)
473access to neonatal intensive care units and obstetrical units or other patient care areas.
474 (c) A health care provider that consults with or accepts a transport, transfer or referral
475from a licensed midwife, or that provides care to a client of a licensed midwife or such client’s
476newborn, shall not be liable in a civil action for personal injury or death resulting solely from an
477act or omission by the licensed midwife. 24 of 29
478 SECTION 35. Section 10A of chapter 118E of the General Laws, as appearing in the
4792022 Official Edition, is hereby amended by striking out, in lines 17 and 21, the words “or
480certified nurse midwife”, each time they appear, and inserting in place thereof, in each instance,
481the following words:- certified nurse midwife or licensed midwife.
482 SECTION 36. The first paragraph of said section 10A of said chapter 118E, as so
483appearing, is hereby further amended by adding the following sentence:- The division shall
484provide coverage for midwifery services including prenatal care, childbirth and postpartum care
485provided by a licensed midwife regardless of the site of services.
486 SECTION 37. Said chapter 118E is hereby further amended by inserting after section
48710Q the following 2 sections:-
488 Section 10R. (a) For the purposes of this section, “noninvasive prenatal screening” shall
489mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal
490chromosomal aneuploidy; provided, that such screening shall include, but not be limited to, an
491analysis of chromosomes 13, 18 and 21.
492 (b) The division and its contracted health insurers, health plans, health maintenance
493organizations, behavioral health management firms and third-party administrators under contract
494to a Medicaid managed care organization or primary care clinician shall provide coverage under
495all benefit plans for noninvasive prenatal screening and shall not limit availability and coverage
496for such screening based on the age of the pregnant patient or any other risk factor, unless the
497limitation is part of the generally accepted standards of professional practice as recommended by
498the American College of Obstetricians and Gynecologists. 25 of 29
499 Section 10S. The division and its contracted health insurers, health plans, health
500maintenance organizations, behavioral health management firms and third-party administrators
501under contract to a Medicaid managed care organization or primary care clinician plan shall
502provide coverage for postpartum depression screenings conducted pursuant to section 247 of
503chapter 111.
504 SECTION 38. Chapter 175 of the General Laws is hereby amended by inserting after
505section 47UU the following section:-
506 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
507delivered or renewed within the commonwealth, which is considered creditable coverage under
508section 1 of chapter 111M, shall provide coverage for postpartum depression screenings
509conducted pursuant to section 247 of chapter 111.
510 SECTION 39. Chapter 176A of the General Laws is hereby amended by inserting after
511section 8VV the following section:-
512 Section 8WW. Any contract between a subscriber and the corporation under an
513individual or group hospital service plan that is delivered, issued or renewed within the
514commonwealth shall provide coverage for postpartum depression screenings conducted pursuant
515to section 247 of chapter 111.
516 SECTION 40. Chapter 176B of the General Laws is hereby amended by inserting after
517section 4VV the following section:-
518 Section 4WW. Any subscription certificate under an individual or group medical service
519agreement delivered, issued or renewed within the commonwealth, which is considered 26 of 29
520creditable coverage under section 1 of chapter 111M, shall provide coverage for postpartum
521depression screenings conducted pursuant to section 247 of chapter 111.
522 SECTION 41. Chapter 176G of the General Laws is hereby amended by inserting after
523section 4NN the following section:-
524 Section 4OO. An individual or group health maintenance contract that is issued or
525renewed within or without the commonwealth shall provide coverage for postpartum depression
526screenings conducted pursuant to section 247 of chapter 111.
527 SECTION 42. (a) There shall be a task force on maternal health access and birthing
528patient safety. The task force shall consist of: the commissioner of public health or a designee,
529who shall serve as co-chair; the executive director of the health policy commission or a designee,
530who shall serve as co-chair; the executive director of the center for health information and
531analysis or a designee; the executive director of the Betsy Lehman center for patient safety and
532medical error reduction or a designee; and 5 members appointed by the secretary of health and
533human services, 1 of whom shall be a representative of the Massachusetts Health and Hospital
534Association, Inc., 1 of whom shall be a representative of the Massachusetts Nurses Association,
5351 of whom shall be a representative of the Massachusetts Medical Society, 1 of whom shall be
536representative of the Perinatal-Neonatal Quality Improvement Network of Massachusetts, and 1
537of whom shall be a representative of the Neighborhood Birth Center, Inc.
538 (b) The task force shall study and report maternal health access and birthing patient
539safety. The task force shall: (i) study the current availability of and access to maternal health
540services and maternal health care across regions of the commonwealth and among birthing
541patient populations, including the essential service closure process, the adequacy of the maternal 27 of 29
542health care workforce and other topics identified in subsection (c); (ii) identify methods to
543increase the financial investment in and patient access to maternal health care across the
544commonwealth and ensure equitable access for the most vulnerable birthing patient populations;
545and (iii) issue a report on the task force’s findings and policy recommendations.
546 (c) The task force shall study: (i) past essential services closures for inpatient maternity
547units and acute-level birthing centers, and closures of community-based, office-based and
548preventative maternal health care, including family planning services, obstetrics and gynecology
549services and midwifery services; (ii) patient quality and safety considerations of essential service
550closures of maternal care units, including quality, safety and staffing regulatory requirements
551promulgated by the department of public health that inform acute level maternal care essential
552service closures; and (iii) demographic information on patient populations whose access has been
553most affected by past closures of or current limitations on the availability of maternal care
554services, including, but not limited to, geography, type of insurance coverage, age, race,
555ethnicity, income status, LGBTQA+ status and immigration status.
556 (d) Not later than September 1, 2025, the task force shall submit its report to the clerks of
557the senate and house of representatives, the joint committee on health care financing and the joint
558committee on public health.
559 SECTION 43. Notwithstanding any general or special law to the contrary, for the initial
560appointments by the governor to the board of registration in midwifery pursuant to section 110 of
561chapter 13 of the General Laws, inserted by section 4, the 5 members required to be licensed
562midwives shall be persons with at least 5 years of experience in the practice of midwifery who 28 of 29
563hold a certificate of completion or equivalent from an educational program or institution
564accredited by the Midwifery Education Accreditation Council.
565 SECTION 44. The board of registration in midwifery established pursuant to section 110
566of chapter 13 of the General Laws, inserted by section 4, shall issue temporary licensure for
567individuals practicing midwifery and shall promulgate regulations for the temporary licensure of
568individuals practicing midwifery within 180 days of the effective date of this act. Such
569temporary licenses shall be valid until December 31, 2025.
570 SECTION 45. The board of registration in midwifery established pursuant to section 110
571of chapter 13 of the General Laws, inserted by section 4, shall adopt rules and promulgate
572regulations pursuant to this act within 1 year from the effective date of this act.
573 SECTION 46. (a) The department of public health shall promulgate regulations pursuant
574to section 51M of chapter 111 of the General Laws, inserted by section 15, not later than 180
575days after the effective date of this act.
576 (b) Prior to promulgating initial regulations pursuant to said section 51M of said chapter
577111, the department shall consider, when developing regulations, the standards adopted by the
578American Association of Birth Centers, and consult with Seven Sisters Birth Center LLC,
579Neighborhood Birth Center, Inc., the Massachusetts Affiliate of ACNM, Inc. and other entities
580operating or planning to open birth centers in the commonwealth.
581 SECTION 47. All individuals practicing lactation consulting required to be licensed
582pursuant to section 23B of chapter 112, inserted by section 21, shall be licensed not later than
583January 1, 2026. 29 of 29
584 SECTION 48. All individuals practicing midwifery consistent with section 291 of chapter
585112 of the General Laws, inserted by section 34, shall be licensed not later than January 1, 2026.