Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H4785 Compare Versions

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1	1	1 of 39
2	2	FILED ON: 6/20/2024
3	3	HOUSE . . . . . . . . . . . . . . . No. 4785
4	4	House bill No. 4773, as changed by the committee on Bills in the Third Reading and as amended
5	5	and passed to be engrossed by the House. June 20, 2024.
6	6	The Commonwealth of Massachusetts
7	7	_______________
8	8	In the One Hundred and Ninety-Third General Court
9	9	(2023-2024)
10	10	_______________
11	11	An Act promoting access to midwifery care and out-of-hospital birth options.
12	12	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
13	13	of the same, as follows:
14	14	1 SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2022
15	15	2Official Edition, is hereby amended by inserting after the word “counselors”, in line 7, the
16	16	3following words:- the board of registration in midwifery.
17	17	4 SECTION 2. Section 11A of said chapter 13, as so appearing, is hereby amended by
18	18	5striking out the first paragraph and inserting in place thereof the following paragraph:-
19	19	6 There shall be a board of allied health professions, hereinafter called the board, which
20	20	7shall consist of 15 members who are residents of the commonwealth to be appointed by the
21	21	8governor. Three of such members shall be qualified athletic trainers licensed in accordance with
22	22	9section 23B of chapter 112; 2 of such members shall be occupational therapists licensed in
23	23	10accordance with said section 23B; 1 such member shall be an occupational therapy assistant
24	24	11licensed in accordance with said section 23B; 2 of such members shall be physical therapists
25	25	12licensed in accordance with said section 23B; 1 such member shall be a physical therapist 2 of 39
26	26	13assistant licensed in accordance with said section 23B; 3 of such members shall be lactation
27	27	14consultants licensed in accordance with said section 23B; 2 of such members shall be a physician
28	28	15licensed in accordance with section 2 of chapter 112; and 1 such member shall be selected from
29	29	16and shall represent the general public.
30	30	17 SECTION 3. Said section 11A of said chapter 13, as so appearing, is hereby further
31	31	18amended by striking out the words “or physical therapy”, in lines 51 and 52, and inserting in
32	32	19place thereof the following words:- physical therapy or lactation consulting.
33	33	20 SECTION 4. Said chapter 13 is hereby further amended by adding the following section:-
34	34	21 Section 110. (a) There shall be within the department of public health a board of
35	35	22registration in midwifery, hereinafter called the board. The board shall consist of 9 members who
36	36	23are residents of the commonwealth to be appointed by the governor: 5 of whom shall be
37	37	24midwives licensed under section 293 of chapter 112 with not less than 5 years of experience in
38	38	25the practice of midwifery; 1 of whom shall be an obstetrician-gynecologist licensed to practice
39	39	26medicine under section 2 of said chapter 112 with experience working with midwives; 1 of
40	40	27whom shall be a maternal-fetal medicine specialist licensed to practice medicine under said
41	41	28section 2 of said chapter 112 with experience working with midwives; 1 of whom shall be a
42	42	29certified nurse-midwife licensed under section 80B of said chapter 112 and authorized to practice
43	43	30nurse midwifery under section 80C of said chapter 112; and 1 of whom shall be a member of the
44	44	31public. When making the appointments, the governor shall consider members with experience
45	45	32working on the issue of racial disparities in maternal health. The appointed members shall serve
46	46	33for terms of 3 years. Upon the expiration of a term of office, a member shall continue to serve
47	47	34until a successor has been appointed and qualified. A member shall not serve for more than 2 3 of 39
48	48	35consecutive full terms; provided, however, that a person who is chosen to fill a vacancy in an
49	49	36unexpired term of a prior board member may serve for 2 consecutive full terms in addition to the
50	50	37remainder of such unexpired term. A member may be removed by the governor for neglect of
51	51	38duty, misconduct, malfeasance or misfeasance in the office after a written notice of the charges
52	52	39against the member and sufficient opportunity to be heard thereon. Upon the death, resignation,
53	53	40or removal for cause of a member of the board, the governor shall fill the vacancy for the
54	54	41remainder of that member’s term.
55	55	42 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
56	56	43serve until their successors have been elected and qualified. The board shall meet not less than 4
57	57	44times annually and may hold additional meetings at the call of the chair or upon the request of
58	58	45not less than 5 members. A quorum for the conduct of official business shall be a majority of
59	59	46those appointed. Board members shall serve without compensation but shall be reimbursed for
60	60	47actual and reasonable expenses incurred in the performance of their duties. The members shall be
61	61	48public employees for the purposes of chapter 258 for all acts or omissions within the scope of
62	62	49their duties as board members.
63	63	50 SECTION 5. Chapter 32A of the General Laws is hereby amended by inserting after
64	64	51section 17S the following 2 sections:-
65	65	52 Section 17T. The commission shall provide to any active or retired employee of the
66	66	53commonwealth who is insured under the group insurance commission coverage for postpartum
67	67	54depression screenings conducted pursuant to section 247 of chapter 111.
68	68	55 Section 17U. (a) The commission shall provide to any active or retired employee of the
69	69	56commonwealth who is insured under the group insurance commission coverage for the 4 of 39
70	70	57provision of medically necessary pasteurized donor human milk and donor human milk-derived
71	71	58products, provided that:
72	72	59 (i) the milk is obtained from a human milk bank that meets quality guidelines established
73	73	60by the department of public health;
74	74	61 (ii) a licensed medical practitioner has issued a written order for the provision of such
75	75	62human breast milk or donor human milk-derived products for the covered infant; and
76	76	63 (iii) the covered infant meets the following conditions:-
77	77	64 (1) is under the age of 6 months;
78	78	65 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
79	79	66that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
80	80	67or acquired condition that may benefit from the use of such human breast milk as determined by
81	81	68the department of public health; and
82	82	69 (3) is medically or physically unable to receive maternal breast milk or participate in
83	83	70breastfeeding or whose mother is medically or physically unable, despite receiving lactation
84	84	71support, to produce maternal breast milk in sufficient quantities or caloric density.
85	85	72 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
86	86	73payment arrangement, the commission shall include the cost of reimbursement provided under
87	87	74subsection (a) of this section for donor human milk and donor human milk-derived products in
88	88	75the development of the reimbursement rate for such diagnosis related group or bundled payment.
89	89	76 SECTION 6. Section 1E of chapter 46 of the General Laws, as appearing in the 2022 5 of 39
90	90	77Official Edition, is hereby amended by inserting after the definition of “Administrator” the
91	91	78following definition:-
92	92	79 “Certified nurse-midwife”, a nurse licensed under section 80B of said chapter 112 and
93	93	80authorized to practice nurse midwifery under section 80C of said chapter 112.
94	94	81 SECTION 7. Said section 1E of said chapter 46, as so appearing, is hereby further
95	95	82amended by inserting after the definition of “Hospital medical officer” the following definition:-
96	96	83 “Licensed midwife”, a midwife licensed to practice by the board of registration in
97	97	84midwifery pursuant to section 293 of chapter 112.
98	98	85 SECTION 8. Section 3B of said chapter 46, as so appearing, is hereby amended by
99	99	86inserting after the word “physician”, in line 1, the following words:- certified nurse-midwife or
100	100	87licensed midwife.
101	101	88 SECTION 9. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
102	102	89amended by inserting after the definition of “Isomer” the following definition:-
103	103	90 “Licensed midwife”, a midwife licensed to practice by the board of registration in
104	104	91midwifery pursuant to section 293 of chapter 112.
105	105	92 SECTION 10. Section 7 of said chapter 94C, as so appearing, is hereby amended by
106	106	93adding the following subsection:-
107	107	94 (j) The commissioner shall promulgate regulations that provide for the automatic
108	108	95registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
109	109	96prescriptions in accordance with the provisions of section 295 of chapter 112 and the regulations 6 of 39
110	110	97issued by the board of registration in midwifery under said section 295 of said chapter 112,
111	111	98unless the registration of such licensed midwife has been suspended or revoked pursuant to the
112	112	99provisions of section 13 or section 14 or unless such registration is denied for cause by the
113	113	100commissioner pursuant to chapter 30A. Prior to promulgating such regulations, the
114	114	101commissioner shall consult with the board of registration in midwifery and the department of
115	115	102public health.
116	116	103 SECTION 11. Section 9 of said chapter 94C, as so appearing, is hereby amended by
117	117	104inserting after the figure “112”, in line 7, the following words:- , licensed midwife as limited by
118	118	105subsection (j) of said section 7 and section 295 of said chapter 112.
119	119	106 SECTION 12. Said section 9 of said chapter 94C, as so appearing, is hereby further
120	120	107amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
121	121	108instance, the following words:- , licensed midwife.
122	122	109 SECTION 13. Said section 9 of said chapter 94C, as so appearing, is hereby further
123	123	110amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
124	124	111midwifery.
125	125	112 SECTION 13A. Section 24O of chapter 111 of the General Laws, inserted by section 43
126	126	113of chapter 28 of the acts of 2023, is hereby amended by striking out subsection (d), the second
127	127	114time the subsection appears, and subsection (e), and inserting in place thereof the following 3
128	128	115subsections:-
129	129	116 (e)(1) The committee shall consist of the following members: the commissioner, or their
130	130	117designee, who shall serve as chair; the assistant secretary for MassHealth, or their designee, a 7 of 39
131	131	118representative of the department of public health; the executive director of the health policy
132	132	119commission, or their designee; a representative of the Perinatal-Neonatal Quality Improvement
133	133	120Network of Massachusetts; the chief medical examiner, or their designee; the chair of the
134	134	121Massachusetts chapter of the American College of Obstetrics and Gynecology, or their designee;
135	135	122the chair of the Massachusetts chapter of the American College of Nurse Midwives, or their
136	136	123designee; the chair of the Massachusetts chapter of the Association of Women's Health, Obstetric
137	137	124and Neonatal Nurses, or their designee; and the commissioner shall appoint the following
138	138	125members: a medical professional with obstetric and neonatal nursing training; a medical
139	139	126professional with training in cardiology; a medical professional with training in pathology; a
140	140	127medical professional with expertise in substance use prevention and treatment; a psychology,
141	141	128social work or other mental health professional; a representative from academia in a relevant
142	142	129field; a medical professional with formal anesthesiology training; a medical professional with
143	143	130maternal fetal medicine or perinatology training; a medical professional with psychiatric
144	144	131training; a medical professional with family medicine training; the director of a federally-funded
145	145	132Healthy Start program, or their designee; 2 individuals who practice as doulas; 2 community or
146	146	133family members who have been directly affected by a maternal death; a member of a
147	147	134community-based organization; a representative from the department of children and families;
148	148	135and a law enforcement officer.
149	149	136 (2) Each member, other than the commissioner, shall serve for a term of 3 years and until
150	150	137their successor is appointed. Nothing in this section shall prohibit the commissioner from
151	151	138appointing a committee member to serve additional terms. The committee shall convene as
152	152	139deemed necessary by the department. The commissioner shall, to the extent feasible, appoint
153	153	140members representing the racial, ethnic and geographic diversity of the commonwealth and shall 8 of 39
154	154	141prioritize appointing members from communities and groups most impacted by maternal
155	155	142mortality and maternal morbidity.
156	156	143 (f) Not later than December 31 of each even-numbered year, the committee shall submit
157	157	144to the clerks of the house of representatives and the senate, the house and senate committees on
158	158	145ways and means and the joint committee on public health a report, including, but not limited to:
159	159	146 (i) a description of the incidents of maternal mortality and severe maternal morbidity
160	160	147reviewed during the immediately preceding 24 months, provided in a manner that shall not allow
161	161	148for the identification of any person;
162	162	149 (ii) a summary of the disparities identified and reviewed;
163	163	150 (iii) recommendations to reduce maternal mortality and severe maternal morbidity in the
164	164	151commonwealth; and
165	165	152 (iv) recommendations for any legislation or other changes to policy to reduce maternal
166	166	153mortality and severe maternal morbidity or otherwise improve the delivery of health care in the
167	167	154commonwealth.
168	168	155 (g) Notwithstanding any general or special law to the contrary, upon the determination of
169	169	156a majority of the committee, that the review of any information or record is necessary to carry
170	170	157out the purpose of this section, the committee shall request and the relevant offices and agencies
171	171	158shall provide requested records or information from any agency, department or office of the
172	172	159commonwealth including, but not limited to: (i) the executive office of health and human
173	173	160services and its constituent agencies; (ii) the executive office of public safety and security; (iii)
174	174	161the center for health information and analysis; (iv) the office of patient protection; (v) any health 9 of 39
175	175	162care facility, state comprehensive health planning agency or acute-care hospital as defined in
176	176	163section 25B; and (vi) any health care provider or professional licensed pursuant to chapter 112.
177	177	164The committee may receive and solicit voluntary information, including oral or written
178	178	165statements relating to any case that may come before the committee from any public or private
179	179	166entity and any person including, but not limited to, a patient in a case of maternal morbidity.
180	180	167 SECTION 14. Said chapter 111 is hereby further amended by inserting after section 24O
181	181	168the following section:-
182	182	169 Section 24P. (a) As used in this section the following words shall, unless the context
183	183	170clearly requires otherwise, have the following meanings:
184	184	171 “Fetal death”, as defined in section 202.
185	185	172 “Infant death”, the death of an infant that occurs between the birth of the infant and 1
186	186	173year of age.
187	187	174 (b) The department shall establish a program to conduct an in-depth fetal and infant
188	188	175mortality review of each individual fetal or infant death occurring within the commonwealth in
189	189	176order to identify social, economic and systems factors associated with fetal and infant deaths and
190	190	177inform public health policy programs. For each case of fetal or infant death to be reviewed, the
191	191	178department may collect relevant data from a variety of sources, which may include physician and
192	192	179hospital records in addition to relevant information from local boards of health and community
193	193	180organizations.
194	194	181 (c) The department may promulgate regulations, consistent with this section, regarding
195	195	182the process for conducting fetal infant mortality reviews, which may include guidance from the 10 of 39
196	196	183federal Health Resources and Services Administration’s national fetal, infant and child death
197	197	184review program.
198	198	185 SECTION 15. Said chapter 111 is hereby further amended by inserting after section 51L
199	199	186the following section:-
200	200	187 Section 51M. (a) The department shall promulgate regulations relative to the operation
201	201	188and maintenance of birth centers licensed as clinics pursuant to section 51, hereinafter referred to
202	202	189as “freestanding birth centers.”
203	203	190 (b) The regulations shall include, but shall not be limited to, a licensed freestanding birth
204	204	191center having:
205	205	192 (i) a detailed and written plan on the premises for transfer of a client to a nearby hospital
206	206	193providing obstetrical and newborn services as needed for emergency treatment beyond that
207	207	194provided by the birth center;
208	208	195 (ii) policies and procedures to ensure coordination of ongoing care and transfer when
209	209	196complications occur that render the patient ineligible for birth center care during the antepartum,
210	210	197intrapartum or postpartum period;
211	211	198 (iii) an administrative director responsible for implementing and overseeing the
212	212	199operational policies of the birth center;
213	213	200 (iv) a director of clinical affairs on staff who shall be a certified nurse-midwife, licensed
214	214	201midwife or physician licensed to practice in the commonwealth whose professional scope of
215	215	202practice includes preconception, prenatal, labor, birth and postpartum care and early care of the
216	216	203newborn and who may be the primary attendants during the perinatal period; and 11 of 39
217	217	204 (v) birth attendants that are certified nurse midwives, licensed midwives, physicians or
218	218	205other providers licensed to practice in the commonwealth whose professional scope of practice
219	219	206includes preconception, prenatal, labor, birth and postpartum care and early care of the newborn
220	220	207and who may be the primary attendants in accordance with their professional scope of practice.
221	221	208 (c) No regulations shall require a licensed freestanding birth center or the directors and
222	222	209providers on staff to practice under the supervision of a hospital or another health care provider
223	223	210or to enter into an agreement, written or otherwise, with another hospital or health care provider,
224	224	211or maintain privileges at a hospital.
225	225	212 (d) In order to be licensed as freestanding birth centers pursuant to subsection (a) and
226	226	213under section 51 by the department, a freestanding birth center shall provide reimbursable
227	227	214services to individuals with public health insurance on a non-discriminatory basis.
228	228	215 SECTION 15A. Section 110A of said chapter 111, as appearing in the 2022 Official
229	229	216Edition, is hereby amended by striking out the first paragraph and inserting in place thereof the
230	230	217following paragraph:-
231	231	218 The physician attending a newborn child shall cause said child to be subjected to tests for
232	232	219phenylketonuria, cretinism, Duchenne muscular dystrophy, and such other specifically treatable
233	233	220genetic or biochemical disorders or treatable infectious diseases which may be determined by
234	234	221testing as specified by the commissioner. The commissioner shall convene an advisory
235	235	222committee on newborn screening to assist the commissioner in determining which tests are
236	236	223necessary; provided, that said advisory committee shall convene not less than twice per year. 12 of 39
237	237	224 SECTION 16. Section 202 of said chapter 111, as appearing in the 2022 Official Edition,
238	238	225is hereby amended by inserting after the word “physician”, in line 17, the following words:- ,
239	239	226certified nurse-midwife or licensed midwife.
240	240	227 SECTION 17. Said section 202 of said chapter 111, as so appearing, is hereby further
241	241	228amended by inserting after the word “attendance”, in line 17, the following words:- , or without
242	242	229the attendance of a certified nurse-midwife or licensed midwife,.
243	243	230 SECTION 18. Said chapter 111 is hereby further amended by adding the following 3
244	244	231sections:-
245	245	232 Section 245. (a) The commissioner shall develop and disseminate to the public,
246	246	233information regarding pregnancy loss, including miscarriage and recurrent miscarriage, which
247	247	234shall include information on: (i) the awareness of pregnancy loss and the incidence and
248	248	235prevalence of pregnancy loss among pregnant people; and (ii) the accessibility of the range of
249	249	236evidence-based treatment options, as medically appropriate, for pregnancy loss, including, but
250	250	237not limited to, comprehensive mental health supports, necessary procedures and medications and
251	251	238culturally responsive supports including as pregnancy-loss doula care. The commissioner shall
252	252	239ensure that information disseminated pursuant to this section is available in multiple languages,
253	253	240including Spanish, Portuguese, Mandarin, Cantonese, Haitian Creole, and other commonly
254	254	241spoken languages in the commonwealth.
255	255	242 (b) The commissioner may disseminate information to the public directly through the
256	256	243department’s website or through arrangements with agencies carrying out intra-agency
257	257	244initiatives, nonprofit organizations, consumer groups, community organizations, institutions of
258	258	245higher education or state or local public-private partnerships. 13 of 39
259	259	246 (c) The commissioner shall develop and coordinate programs for conducting and
260	260	247supporting evidence-based research with respect to the causes of and current and novel treatment
261	261	248options and procedures for pregnancy loss.
262	262	249 (d) The commissioner shall, in consultation with and in accordance with guidelines from
263	263	250relevant professional boards of registration, develop and disseminate to perinatal health care
264	264	251workers information on pregnancy loss to ensure that such perinatal health care workers remain
265	265	252informed about current information regarding pregnancy loss and prioritizing both the physical
266	266	253and mental health care of patients experiencing pregnancy loss. For purposes of this subsection,
267	267	254the term “perinatal health care worker” shall include, but shall not be limited to, a licensed
268	268	255midwife, physician assistant, nurse practitioner, clinical nurse specialist, doula, community
269	269	256health worker, peer supporter, licensed lactation consultant, nutritionist or dietitian, childbirth
270	270	257educator, social worker, trained family support specialist or home visitor, and language
271	271	258interpreter or navigator.
272	272	259 (e) The commissioner shall, in a manner that protects personal privacy and complies with
273	273	260federal law, collect and assess data regarding pregnancy loss, including information
274	274	261disaggregated by race, ethnicity, health insurance status, disability, income level and geography
275	275	262on the prevalence of, the incidence of and knowledge about pregnancy loss.
276	276	263 Section 246. (a) As used in this section, the following words shall, unless the context
277	277	264clearly requires otherwise, have the following meanings:
278	278	265 “Perinatal individual”, an individual that is either pregnant or is within 12 months from
279	279	266the date of giving birth. 14 of 39
280	280	267 “Perinatal mood and anxiety disorders”, any mental health disorder experienced by a
281	281	268perinatal individual during the period of time from the beginning of pregnancy up until 1 year
282	282	269following the birth of a child, including, but not limited to, postpartum depression.
283	283	270 (b) The department shall develop and maintain a comprehensive digital resource center
284	284	271on perinatal mood and anxiety disorders. The digital resource center shall be available to the
285	285	272public at no cost on the department’s website, and shall include information and resources for: (i)
286	286	273health care providers and organizations serving perinatal individuals to aid them in diagnosing,
287	287	274treating or making appropriate referrals for individuals experiencing perinatal mood and anxiety
288	288	275disorders; (ii) perinatal individuals and their families to aid them in understanding and
289	289	276identifying perinatal mood and anxiety disorders and how to navigate available resources and
290	290	277obtain treatment.
291	291	278 (c) Prior to developing the comprehensive digital resource center, the department shall
292	292	279consult with: (i) health care professionals, including, but not limited to, obstetricians,
293	293	280gynecologists, pediatricians, primary care providers, certified nurse-midwives, licensed
294	294	281midwives, psychiatrists, and other mental health clinicians; (ii) organizations serving perinatal
295	295	282individuals; and (iii) health insurance carriers.
296	296	283 (d) The department shall develop and implement a public information campaign to
297	297	284promote awareness of perinatal mood and anxiety disorders, which shall promote the digital
298	298	285resource center developed pursuant to this section.
299	299	286 Section 247. (a) For the purposes of this section, “postnatal individual” shall refer to an
300	300	287individual who is within 12 months of giving birth. 15 of 39
301	301	288 (b) Every postnatal individual who receives health care services from a primary care
302	302	289provider, obstetrician, gynecologist, certified nurse-midwife, or licensed midwife shall be offered
303	303	290a screening for postpartum depression, and, if the postnatal individual does not object to such
304	304	291screening, such primary care provider, certified nurse-midwife, or licensed midwife shall ensure
305	305	292that the postnatal individual is appropriately screened for postpartum depression in line with
306	306	293evidence-based guidelines.
307	307	294 (c) Every postnatal individual whose infant receives health care services from a
308	308	295pediatrician shall be offered a screening for postpartum depression by the infant’s pediatrician,
309	309	296and, if the postnatal individual does not object to such screening, such pediatrician shall ensure
310	310	297that the postnatal individual is appropriately screened for postpartum depression in line with
311	311	298evidence-based guidelines.
312	312	299 (d) If a health care professional, administering a screening in accordance with this section
313	313	300determines, based on the screening methodology administered, that the postnatal individual is
314	314	301likely to be suffering from postpartum depression, such health care professional shall discuss
315	315	302available treatments for postpartum depression, including pharmacological treatments, and
316	316	303provide an appropriate referral to a mental health clinician.
317	317	304 SECTION 19. Section 23A of chapter 112 of the General Laws, as appearing in the 2022
318	318	305Official Edition, is hereby amended by striking out, in lines 1 and 2, the words “twenty-three A
319	319	306to twenty-three P” and inserting in place thereof the following words:- 23A to 23P¾.
320	320	307 SECTION 20. Said section 23A of said chapter 112, as so appearing, is hereby further
321	321	308amended by inserting after the definition of “Board” the following 4 definitions:- 16 of 39
322	322	309 “International board certified lactation consultant”, a person who holds current
323	323	310certification from the International Board of Lactation Consultant Examiners as a lactation
324	324	311consultant after demonstrating the appropriate education, knowledge and experience necessary
325	325	312for independent clinical practice.
326	326	313 “International Board of Lactation Consultant Examiners”, the international certification
327	327	314body that confers the International Board Certified Lactation Consultant credential and which is
328	328	315independently accredited by the National Commission for Certifying Agencies.
329	329	316 “Lactation consulting”, the clinical application of scientific principles and a
330	330	317multidisciplinary body of evidence for evaluation, problem identification, treatment, education
331	331	318and consultation to families regarding the course of lactation and infant feeding; including but
332	332	319not limited to: (i) clinical lactation assessment through the systematic collection of subjective
333	333	320and objective data; (ii) analysis of data and creation of a plan of care; (iii) development and
334	334	321implementation of a lactation care plan with demonstration and instruction to parents and
335	335	322communication to the primary health care provider; (iv) provision of lactation education to
336	336	323parents and health care providers; and (v) recommendation and use of assistive devices.
337	337	324 “Licensed lactation consultant”, a person licensed to practice lactation consulting in
338	338	325accordance with section 23B.
339	339	326 SECTION 21. Section 23B of said chapter 112, as so appearing, is hereby amended by
340	340	327striking out, in line 8, the words “and physical therapist assistants” and inserting in place thereof
341	341	328the following words:- , physical therapist assistants and lactation consultants.
342	342	329 SECTION 22. The first paragraph of said section 23B of said chapter 112, as so
343	343	330appearing, is hereby amended by striking out the fourth sentence and inserting in place thereof 17 of 39
344	344	331the following sentence:- An applicant who furnishes satisfactory proof that they are of good
345	345	332moral character and that they have met the educational and clinical practice requirements set
346	346	333forth in section 23F, 23G, 23H, 23I, 23J or 23J½, shall, upon payment of a fee determined by the
347	347	334secretary of administration and finance, be examined by the board, and if found qualified, and if
348	348	335the applicant passes the examination, shall be licensed to practice.
349	349	336 SECTION 23. Section 23C of said chapter 112, as so appearing, is hereby amended by
350	350	337inserting after the word “assistant”, in line 4, the following words:- or lactation consultant.
351	351	338 SECTION 24. Said section 23C of said chapter 112, as so appearing, is hereby further
352	352	339amended by inserting after the word “chapter”, in line 11, the following words:- ; as a licensed
353	353	340lactation consultant.
354	354	341 SECTION 25. Section 23D of said chapter 112, as so appearing, is hereby amended by
355	355	342inserting after the words “physical therapist assistant”, in line 3, the following words:- , or a
356	356	343licensed lactation consultant.
357	357	344 SECTION 26. Section 23E of said chapter 112, as so appearing, is hereby amended by
358	358	345inserting after the word “assistant”, in line 8, the following words:- or lactation consultant.
359	359	346 SECTION 27. Said section 23E of said chapter 112, as so appearing, is hereby further
360	360	347amended by inserting after the word “therapy”, in line 14, the following words:- or lactation
361	361	348consulting.
362	362	349 SECTION 28. Said section 23E of said chapter 112, as so appearing, is hereby further
363	363	350amended by inserting after the words “physical therapy services”, in line 21, the following
364	364	351words:- or lactation consulting services. 18 of 39
365	365	352 SECTION 29. Said section 23E of said chapter 112, as so appearing, is hereby further
366	366	353amended by inserting after the words “physical therapist”, in line 24, the following words:- or
367	367	354licensed lactation consultant.
368	368	355 SECTION 30. Said chapter 112 is hereby further amended by inserting after section 23J
369	369	356the following section:-
370	370	357 Section 23J½. An applicant for licensure as a lactation consultant shall:
371	371	358 (i) be at least 18 years of age;
372	372	359 (ii) have submitted a completed application upon a form and in such manner as the board
373	373	360prescribes, accompanied by applicable fees;
374	374	361 (iii) have met the education and clinical standards established for international board
375	375	362certified lactation consultants by the International Board of Lactation Consultant Examiners, or
376	376	363its successor organization;
377	377	364 (iv) have passed an examination adopted or administered by the board; provided,
378	378	365however, that the board may adopt a standardized national exam, including the examination
379	379	366required for certification by the International Board of Lactation Consultant Examiners or a
380	380	367successor or equivalent entity; and
381	381	368 (v) have completed such other requirements as may be prescribed by the board.
382	382	369 SECTION 31. Section 23K of said chapter 112, as so appearing, is hereby amended by
383	383	370inserting after the words “physical therapy”, in line 9, the following words:- , or lactation
384	384	371consulting. 19 of 39
385	385	372 SECTION 32. Section 23L of said chapter 112, as so appearing, is hereby amended by
386	386	373striking out, in line 3, the words “or physical therapist assistant” and inserting in place thereof
387	387	374the following words:- physical therapist assistant, or licensed lactation consultant.
388	388	375 SECTION 33. Said chapter 112 is hereby further amended by inserting after section
389	389	37623P½ the following section:-
390	390	377 Section 23P¾. (a) Except as otherwise provided in this section and sections 23C and 23E,
391	391	378no person shall provide lactation consulting services unless they are licensed to practice as a
392	392	379lactation consultant pursuant to section 23B.
393	393	380 (b) Nothing in this section shall be construed to prevent the practice of lactation
394	394	381consulting by members of other licensed health care professions when such practice is consistent
395	395	382with the accepted standards and scope of practice for their respective professions; provided,
396	396	383however, that such persons shall not use the title “licensed lactation consultant” unless licensed
397	397	384pursuant to this chapter.
398	398	385 (c) Nothing in the chapter shall prevent perinatal health workers from performing
399	399	386breastfeeding education functions consistent with the accepted standards of their respective
400	400	387occupations; provided, however, such persons shall not use the title “licensed lactation
401	401	388consultant” unless licensed pursuant to this chapter. For the purposes of this subsection,
402	402	389“perinatal health worker” shall mean any perinatal educator, including, but not limited to, a
403	403	390doula, community health worker, peer counselor, peer counselor, peer supporter, breastfeeding
404	404	391and lactation educator or counselor within the Women Infants and Children Program, childbirth
405	405	392educator or social worker. 20 of 39
406	406	393 SECTION 34. Said chapter 112 is hereby further amended by adding the following 8
407	407	394sections:-
408	408	395 Section 290. As used in sections 290 to 297, inclusive, the following words shall, unless
409	409	396the context clearly requires otherwise, have the following meanings:
410	410	397 “Board”, the board of registration in midwifery, established under section 110 of chapter
411	411	39813.
412	412	399 “Certified nurse-midwife”, a nurse licensed under section 80B and authorized to practice
413	413	400nurse midwifery under section 80C.
414	414	401 “Client”, a person under the care of a licensed midwife.
415	415	402 “Licensed midwife”, a person registered by the board to practice midwifery in the
416	416	403commonwealth under section 293.
417	417	404 “Low-risk pregnancy”, a pregnancy with no maternal or fetal factors that place the
418	418	405pregnancy at significantly increased risk for complications, as determined through regulation by
419	419	406the board in consultation with the department of public health, including, but not limited to,
420	420	407factors related to maternal or fetal health conditions likely to affect the pregnancy and the
421	421	408gestational age and presentation of the fetus at the time of labor and delivery.
422	422	409 “MEAC”, the Midwifery Education Accreditation Council or its successor organization.
423	423	410 “NARM”, the North American Registry of Midwives or its successor organization.
424	424	411 Section 291. (a) The practice of midwifery by a licensed midwife shall include, but shall
425	425	412not be limited to: 21 of 39
426	426	413 (i) the practice of providing maternity care to a client during the preconception period and
427	427	414the antepartum, intrapartum and postpartum periods of a low-risk pregnancy;
428	428	415 (ii) the practice of providing newborn care; and
429	429	416 (iii) prescribing, dispensing or administering pharmaceutical agents consistent with
430	430	417section 295.
431	431	418 (b) A licensed midwife shall accept and provide care to clients only in accordance with
432	432	419the scope and standards of practice under this section and regulations promulgated by the board
433	433	420pursuant to section 292.
434	434	421 (c) The practice of midwifery shall not constitute the practice of medicine, certified
435	435	422nurse-midwifery or emergency medical care.
436	436	423 (d) Nothing in this section shall regulate, restrict or prohibit the practice, service or
437	437	424activities of:
438	438	425 (i) a person licensed in the commonwealth from engaging in activities within the scope of
439	439	426practice of the profession or occupation for which such person is licensed, including, but not
440	440	427limited to: the practice of a licensed physician, certified-nurse midwife or certified emergency
441	441	428medical technician; provided, however, that such person does not represent to the public, directly
442	442	429or indirectly, that such person is licensed under section 293 and that such person does not use
443	443	430any name, title or designation indicating that such person is licensed under said section 293;
444	444	431 (ii) a person employed as a midwife by the federal government or an agency thereof if
445	445	432that person provides midwifery services solely under the direction and control of the
446	446	433organization by which such person is employed; 22 of 39
447	447	434 (iii) a traditional birth attendant who provides midwifery services to a client that has
448	448	435cultural or religious birth traditions that have historically included the attendance of traditional
449	449	436birth attendants; provided, that no fee for the traditional birth attendant’s services is
450	450	437contemplated, charged or received and the birth attendant serves only individuals and families in
451	451	438a distinct cultural or religious group;
452	452	439 (iv) persons who are members of Native American communities and provide traditional
453	453	440midwife services to their communities; or
454	454	441 (v) any person rendering aid in an emergency.
455	455	442 Section 292. (a) The board shall have the following powers and duties:
456	456	443 (i) to adopt rules and promulgate regulations governing licensed midwives and the
457	457	444practice of midwifery to promote the public health, welfare and safety consistent with the
458	458	445essential competencies identified by the NARM;
459	459	446 (ii) to administer the licensing process, including, but not limited to: (A) receiving,
460	460	447reviewing, approving and rejecting applications for licensure; (B) issuing, renewing, suspending,
461	461	448revoking and reinstating licenses; (C) investigating complaints against persons licensed under
462	462	449section 293; and (D) holding hearings and ordering disciplinary sanctions against a person who
463	463	450violates sections 290 to 297, inclusive, or any regulation promulgated by the board;
464	464	451 (iii) to establish administrative procedures for processing applications and renewals;
465	465	452 (iv) to adopt and provide a uniform, proctored examination for applicants to measure the
466	466	453qualifications necessary for licensure; provided, however, that the board may adopt a 23 of 39
467	467	454standardized national exam, including the examination required for certification by the NARM
468	468	455or a successor or equivalent entity;
469	469	456 (v) to develop practice standards for licensed midwives that shall include, but not be
470	470	457limited to: (A) the adoption of ethical standards for licensed midwives; (B) the maintenance of
471	471	458records of care, including client charts; (C) the participation in peer review; (D) the development
472	472	459of standardized informed consent forms; and (E) the development of a standardized written
473	473	460emergency transport plan forms relative to the timely transfer of a newborn or client to a
474	474	461hospital;
475	475	462 (vi) to promulgate regulations requiring licensed midwives to have professional
476	476	463malpractice liability insurance or a suitable bond or other indemnity against liability for
477	477	464professional malpractice in such an amount as may be determined by the board; provided,
478	478	465however, that such amount shall be not less than that required for certified-nurse midwives
479	479	466pursuant to section 80B;
480	480	467 (vii) to establish and maintain records of its actions and proceedings in accordance with
481	481	468public records laws; and
482	482	469 (viii) adopt professional continuing education requirements for licensed midwives
483	483	470seeking renewal consistent with those maintained by the NARM.
484	484	471 (b) Nothing in this section shall be construed to authorize the board to promulgate
485	485	472regulations that require a licensed midwife to practice under the supervision of or in
486	486	473collaboration with another health care provider. 24 of 39
487	487	474 Section 293. (a) A person who desires to be licensed as a midwife under this section shall
488	488	475apply to the board in writing on an application form prescribed and furnished by the board. The
489	489	476application shall include a sworn statement and contain information satisfactory to the board to
490	490	477demonstrate that the applicant possesses the qualifications necessary for licensure under this
491	491	478section.
492	492	479 (b) The initial license and renewal fee shall be established pursuant to section 3B of
493	493	480chapter 7; provided, however, that such fees shall not exceed $200 biennially. The board, in
494	494	481consultation with the secretary of administration and finance, shall institute a process for
495	495	482applicants to apply for a financial hardship waiver, which may reduce or fully exempt an
496	496	483applicant from paying the fee pursuant to this section. Fees collected by the board shall be
497	497	484deposited into the Quality in Health Professions Trust Fund pursuant to section 35X of chapter
498	498	48510 to support board operations and administration and to reimburse board members for
499	499	486reasonable expenses incurred in the performance of their official duties.
500	500	487 (c) An applicant for licensure under this section shall: (i) be of good moral character; (ii)
501	501	488be a graduate of a high school or its equivalent; (iii) have completed a formal midwifery
502	502	489education and training program consistent with subsection (d); (iv) possess a valid certified
503	503	490professional midwife credential from the NARM; and (v) have satisfactorily completed the
504	504	491examination required by the board.
505	505	492 (d) An applicant for a license to practice midwifery as a licensed midwife shall submit to
506	506	493the board proof of successful completion of a formal midwifery education and training program
507	507	494as follows: 25 of 39
508	508	495 (i) a certificate of completion or equivalent from an educational program or institution
509	509	496accredited by the MEAC; or
510	510	497 (ii) a midwifery bridge certificate issued by the NARM or a successor credential;
511	511	498provided that an applicant is: (A) certified as a certified professional midwife within 5 years after
512	512	499the effective date of this section and completed a midwifery education and training program from
513	513	500an educational program or institution that is not accredited by the MEAC; or (B) licensed as a
514	514	501professional midwife in a state that does not require completion of a midwifery education and
515	515	502training program from an educational program or institution that is accredited by the MEAC.
516	516	503 (e) The board may license in a like manner, without examination, any midwife who has
517	517	504been licensed in another state under laws which, in the opinion of the board, require
518	518	505qualifications and maintain standards substantially the same as those of this commonwealth for
519	519	506licensed midwives; provided, however, that such midwife applies and remits to the board the
520	520	507appropriate application fee under this section.
521	521	508 (f) The board may petition a court of competent jurisdiction for an injunction against any
522	522	509person practicing midwifery without a license granted pursuant to section 293. Proof of damage
523	523	510or harm sustained by any person shall not be required for issuance of such an injunction. Nothing
524	524	511in this section shall relieve a person from criminal prosecution for practicing midwifery without
525	525	512a license.
526	526	513 Section 294. (a) The board may, after a hearing pursuant to chapter 30A, suspend or
527	527	514revoke the license of a licensed midwife, or reprimand, censure or otherwise discipline a licensed
528	528	515midwife for any of the reasons set forth in section 61. 26 of 39
529	529	516 (b) No person filing a complaint or reporting information pursuant to this section or
530	530	517assisting the board at its request in any manner in discharging its duties and functions shall be
531	531	518liable in any cause of action arising out of providing such information or assistance; provided,
532	532	519however, that the person making the complaint or reporting such information or providing such
533	533	520assistance does so in good faith.
534	534	521 (c) A person subject to any disciplinary action taken by the board pursuant to this section
535	535	522may file a petition for judicial review pursuant to section 64.
536	536	523 Section 295. (a) A licensed midwife duly registered to issue written prescriptions in
537	537	524accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess,
538	538	525purchase and administer pharmaceutical agents consistent with the scope of midwifery practice,
539	539	526including: (i) antihemorrhagic agents, including, but not limited to, oxytocin, misoprostol and
540	540	527methergine; (ii) intravenous fluids for stabilization; (iii) vitamin K; (iv) eye prophylaxes; (v)
541	541	528oxygen; (vi) antibiotics for Group B Streptococcal; (vii) antibiotic prophylaxes; (viii) Rho(D)
542	542	529immune globulin; (ix) local anesthetic; (x) epinephrine; and (xi) other pharmaceutical agents
543	543	530identified by the board through rules or regulations in consultation with the department of public
544	544	531health.
545	545	532 (b) Nothing in this section shall be construed to permit a licensed midwife’s use of
546	546	533pharmaceutical agents which are: (i) controlled substances as defined in chapter 94C, except for
547	547	534those listed in schedule VI; or (ii) not identified by the board of registration in midwifery as
548	548	535consistent with the scope of midwifery practice pursuant to subsection (a).
549	549	536 Section 296. When accepting a client for care, a licensed midwife shall obtain the client’s
550	550	537informed consent, which shall be evidenced by a written statement in a form prescribed by the 27 of 39
551	551	538board and signed by both the licensed midwife and the client. The signed form shall be included
552	552	539in the client’s record of care. The form shall include, but not be limited to, the following: (i) an
553	553	540acknowledgement that the licensed midwife is not authorized to practice medicine; (ii) a
554	554	541description of written practice guidelines, services provided and the risks and benefits of birth in
555	555	542the client’s chosen environment; and (iii) disclosure that the client may be referred for a
556	556	543consultation with or have their care transferred to a physician if the client requires care that is
557	557	544outside the midwife’s scope of practice.
558	558	545 Section 297. (a) A licensed midwife shall only provide care to a client in the case of a
559	559	546low-risk pregnancy. If at any point during pregnancy, childbirth or postpartum care a client or
560	560	547the newborn’s condition deviates from normal, it shall be the duty of the licensed midwife to
561	561	548immediately refer or transfer the client or newborn to a physician. If a physician determines that
562	562	549the client’s condition has been resolved such that the risk factors presented by a client’s disease
563	563	550or condition are not likely to significantly affect the course of pregnancy or childbirth, the
564	564	551licensed midwife may resume care of the client and resume assisting the client during their
565	565	552pregnancy, childbirth or postpartum care. A licensed midwife shall not provide or continue to
566	566	553provide midwifery care to a client whose pregnancy is no longer low-risk; provided, however, in
567	567	554such circumstances nothing in this section shall prohibit a licensed midwife from remaining
568	568	555present in a supportive capacity throughout pregnancy and childbirth, in accordance with the
569	569	556client’s wishes. If at any point after delivery, the newborn’s condition deviates from normal, the
570	570	557licensed midwife shall immediately refer or transfer the client to a physician.
571	571	558 (b) A licensed midwife shall prepare, in a form prescribed by the board, a written plan for
572	572	559the appropriate delivery of emergency care. The plan shall include, but not be limited to: (i) 28 of 39
573	573	560consultation with other health care providers; (ii) emergency transfer to a hospital; and (iii)
574	574	561access to neonatal intensive care units and obstetrical units or other patient care areas.
575	575	562 (c) A health care provider that consults with or accepts a transport, transfer or referral
576	576	563from a licensed midwife, or that provides care to a client of a licensed midwife or such client’s
577	577	564newborn, shall not be liable in a civil action for personal injury or death resulting solely from an
578	578	565act or omission by the licensed midwife.
579	579	566 SECTION 35. Section 10A of chapter 118E of the General Laws, as appearing in the
580	580	5672022 Official Edition, is hereby amended by striking out, in lines 17 and 21, the words “or
581	581	568certified nurse midwife”, each time they appear, and inserting in place thereof, in each instance,
582	582	569the following words:- certified nurse midwife or licensed midwife.
583	583	570 SECTION 36. Said section 10A of said chapter 118E, as so appearing, is hereby further
584	584	571amended by inserting after the first paragraph the following 2 paragraphs:-
585	585	572 The division shall provide coverage for services rendered by a certified nurse-midwife
586	586	573designated to engage in the practice of nurse-midwifery by the board of registration in nursing
587	587	574pursuant to section 80C of chapter 112, and the payment rate for a service provided by a certified
588	588	575nurse-midwife that is within the scope of the certified nurse midwife’s authorization to practice
589	589	576shall be equal to the payment rate for the same service if performed by a physician.
590	590	577 The division shall provide coverage for midwifery services, including prenatal care,
591	591	578childbirth and postpartum care, provided by a licensed midwife regardless of the site of services.
592	592	579 SECTION 37. Said chapter 118E is hereby further amended by inserting after section
593	593	58010Q the following 3 sections:- 29 of 39
594	594	581 Section 10R. (a) For the purposes of this section, “noninvasive prenatal screening” shall
595	595	582mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal
596	596	583chromosomal aneuploidy; provided, that such screening shall include, but not be limited to, an
597	597	584analysis of chromosomes 13, 18 and 21.
598	598	585 (b) The division and its contracted health insurers, health plans, health maintenance
599	599	586organizations, behavioral health management firms and third-party administrators under contract
600	600	587to a Medicaid managed care organization or primary care clinician shall provide coverage under
601	601	588all benefit plans for noninvasive prenatal screening and shall not limit availability and coverage
602	602	589for such screening based on the age of the pregnant patient or any other risk factor, unless the
603	603	590limitation is part of the generally accepted standards of professional practice as recommended by
604	604	591the American College of Obstetricians and Gynecologists.
605	605	592 Section 10S. The division and its contracted health insurers, health plans, health
606	606	593maintenance organizations, behavioral health management firms and third-party administrators
607	607	594under contract to a Medicaid managed care organization or primary care clinician plan shall
608	608	595provide coverage for postpartum depression screenings conducted pursuant to section 247 of
609	609	596chapter 111.
610	610	597 Section 10T. (a) The division and its contracted health insurers, health plans, health
611	611	598maintenance organizations, behavioral health management firms and third-party administrators
612	612	599under contract to a Medicaid managed care organization or primary care clinician plan shall
613	613	600provide coverage for the provision of medically necessary pasteurized donor human milk and
614	614	601donor human milk-derived products, provided that: 30 of 39
615	615	602 (i) the milk is obtained from a human milk bank that meets quality guidelines established
616	616	603by the department of public health;
617	617	604 (ii) a licensed medical practitioner has issued a written order for the provision of such
618	618	605human breast milk or donor human milk-derived products for the covered infant; and
619	619	606 (iii) the covered infant meets the following conditions:-
620	620	607 (1) is under the age of 6 months;
621	621	608 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
622	622	609that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
623	623	610or acquired condition that may benefit from the use of such human breast milk as determined by
624	624	611the department of public health; and
625	625	612 (3) is medically or physically unable to receive maternal breast milk or participate in
626	626	613breastfeeding or whose mother is medically or physically unable, despite receiving lactation
627	627	614support, to produce maternal breast milk in sufficient quantities or caloric density.
628	628	615 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
629	629	616payment arrangement, the commission shall include the cost of reimbursement provided under
630	630	617subsection (a) of this section for donor human milk and donor human milk-derived products in
631	631	618the development of the reimbursement rate for such diagnosis related group or bundled payment.
632	632	619 SECTION 37A. Subsection (c) of section 148C of chapter 149 of the General Laws, as
633	633	620appearing in the 2022 Official Edition, is hereby amended by striking out, in line 61, the word
634	634	621“section.”, and inserting in place thereof the following words:- section; or. 31 of 39
635	635	622 SECTION 37B. Said subsection (c) of said section 148C of said chapter 149, as so
636	636	623appearing, is hereby further amended by adding the following clause:-
637	637	624 (5) address the employee’s own physical and mental health needs, and those of their
638	638	625spouse, if the employee or the employee’s spouse experiences pregnancy loss or a failed assisted
639	639	626reproduction, adoption or surrogacy.
640	640	627 SECTION 38. Chapter 175 of the General Laws is hereby amended by inserting after
641	641	628section 47UU the following 2 sections:-
642	642	629 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
643	643	630delivered or renewed within the commonwealth, which is considered creditable coverage under
644	644	631section 1 of chapter 111M, shall provide coverage for postpartum depression screenings
645	645	632conducted pursuant to section 247 of chapter 111.
646	646	633 Section 47WW. (a) Any policy, contract, agreement, plan or certificate of insurance
647	647	634issued, delivered or renewed within the commonwealth, which is considered creditable coverage
648	648	635under section 1 of chapter 111M, shall provide coverage for the provision of medically necessary
649	649	636pasteurized donor human milk and donor human milk-derived products, provided that:
650	650	637 (i) the milk is obtained from a human milk bank that meets quality guidelines established
651	651	638by the department of public health;
652	652	639 (ii) a licensed medical practitioner has issued a written order for the provision of such
653	653	640human breast milk or donor human milk-derived products for the covered infant; and
654	654	641 (iii) the covered infant meets the following conditions:- 32 of 39
655	655	642 (1) is under the age of 6 months;
656	656	643 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
657	657	644that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
658	658	645or acquired condition that may benefit from the use of such human breast milk as determined by
659	659	646the department of public health; and
660	660	647 (3) is medically or physically unable to receive maternal breast milk or participate in
661	661	648breastfeeding or whose mother is medically or physically unable, despite receiving lactation
662	662	649support, to produce maternal breast milk in sufficient quantities or caloric density.
663	663	650 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
664	664	651payment arrangement, the commission shall include the cost of reimbursement provided under
665	665	652subsection (a) of this section for donor human milk and donor human milk-derived products in
666	666	653the development of the reimbursement rate for such diagnosis related group or bundled payment.
667	667	654 SECTION 39. Chapter 176A of the General Laws is hereby amended by inserting after
668	668	655section 8VV the following 2 sections:-
669	669	656 Section 8WW. Any contract between a subscriber and the corporation under an
670	670	657individual or group hospital service plan that is delivered, issued or renewed within the
671	671	658commonwealth shall provide coverage for postpartum depression screenings conducted pursuant
672	672	659to section 247 of chapter 111.
673	673	660 Section 8XX. (a) Any contract between a subscriber and the corporation under an
674	674	661individual or group hospital service plan that is delivered, issued or renewed within the 33 of 39
675	675	662commonwealth shall provide coverage for the provision of medically necessary pasteurized
676	676	663donor human milk and donor human milk-derived products, provided that:
677	677	664 (i) the milk is obtained from a human milk bank that meets quality guidelines established
678	678	665by the department of public health;
679	679	666 (ii) a licensed medical practitioner has issued a written order for the provision of such
680	680	667human breast milk or donor human milk-derived products for the covered infant; and
681	681	668 (iii) the covered infant meets the following conditions:-
682	682	669 (1) is under the age of 6 months;
683	683	670 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
684	684	671that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
685	685	672or acquired condition that may benefit from the use of such human breast milk as determined by
686	686	673the department of public health; and
687	687	674 (3) is medically or physically unable to receive maternal breast milk or participate in
688	688	675breastfeeding or whose mother is medically or physically unable, despite receiving lactation
689	689	676support, to produce maternal breast milk in sufficient quantities or caloric density.
690	690	677 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
691	691	678payment arrangement, the commission shall include the cost of reimbursement provided under
692	692	679subsection (a) of this section for donor human milk and donor human milk-derived products in
693	693	680the development of the reimbursement rate for such diagnosis related group or bundled payment. 34 of 39
694	694	681 SECTION 40. Chapter 176B of the General Laws is hereby amended by inserting after
695	695	682section 4VV the following 2 sections:-
696	696	683 Section 4WW. Any subscription certificate under an individual or group medical service
697	697	684agreement delivered, issued or renewed within the commonwealth, which is considered
698	698	685creditable coverage under section 1 of chapter 111M, shall provide coverage for postpartum
699	699	686depression screenings conducted pursuant to section 247 of chapter 111.
700	700	687 Section 4XX. (a) Any subscription certificate under an individual or group medical
701	701	688service agreement delivered, issued or renewed within the commonwealth, which is considered
702	702	689credible coverage under section 1 of chapter 111M, shall provide coverage for the provision of
703	703	690medically necessary pasteurized donor human milk and donor human milk-derived products,
704	704	691provided that:
705	705	692 (i) the milk is obtained from a human milk bank that meets quality guidelines established
706	706	693by the department of public health;
707	707	694 (ii) a licensed medical practitioner has issued a written order for the provision of such
708	708	695human breast milk or donor human milk-derived products for the covered infant; and
709	709	696 (iii) the covered infant meets the following conditions:-
710	710	697 (1) is under the age of 6 months;
711	711	698 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
712	712	699that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
713	713	700or acquired condition that may benefit from the use of such human breast milk as determined by
714	714	701the department of public health; and 35 of 39
715	715	702 (3) is medically or physically unable to receive maternal breast milk or participate in
716	716	703breastfeeding or whose mother is medically or physically unable, despite receiving lactation
717	717	704support, to produce maternal breast milk in sufficient quantities or caloric density.
718	718	705 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
719	719	706payment arrangement, the commission shall include the cost of reimbursement provided under
720	720	707subsection (a) of this section for donor human milk and donor human milk-derived products in
721	721	708the development of the reimbursement rate for such diagnosis related group or bundled payment.
722	722	709 SECTION 41. Chapter 176G of the General Laws is hereby amended by inserting after
723	723	710section 4NN the following 2 sections:-
724	724	711 Section 4OO. An individual or group health maintenance contract that is issued or
725	725	712renewed within or without the commonwealth shall provide coverage for postpartum depression
726	726	713screenings conducted pursuant to section 247 of chapter 111.
727	727	714 Section 4PP. (a) An individual or group health maintenance contract that is issued or
728	728	715renewed within or without the commonwealth shall provide coverage for the provision of
729	729	716medically necessary pasteurized donor human milk and donor human milk-derived products,
730	730	717provided that:
731	731	718 (i) the milk is obtained from a human milk bank that meets quality guidelines established
732	732	719by the department of public health;
733	733	720 (ii) a licensed medical practitioner has issued a written order for the provision of such
734	734	721human breast milk or donor human milk-derived products for the covered infant; and
735	735	722 (iii) the covered infant meets the following conditions:- 36 of 39
736	736	723 (1) is under the age of 6 months;
737	737	724 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
738	738	725that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
739	739	726or acquired condition that may benefit from the use of such human breast milk as determined by
740	740	727the department of public health; and
741	741	728 (3) is medically or physically unable to receive maternal breast milk or participate in
742	742	729breastfeeding or whose mother is medically or physically unable, despite receiving lactation
743	743	730support, to produce maternal breast milk in sufficient quantities or caloric density.
744	744	731 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
745	745	732payment arrangement, the commission shall include the cost of reimbursement provided under
746	746	733subsection (a) of this section for donor human milk and donor human milk-derived products in
747	747	734the development of the reimbursement rate for such diagnosis related group or bundled payment.
748	748	735 SECTION 42. (a) There shall be a task force on maternal health access and birthing
749	749	736patient safety. The task force shall consist of: the commissioner of public health or a designee,
750	750	737who shall serve as co-chair; the executive director of the health policy commission or a designee,
751	751	738who shall serve as co-chair; the executive director of the center for health information and
752	752	739analysis or a designee; the executive director of the Betsy Lehman center for patient safety and
753	753	740medical error reduction or a designee; and 5 members appointed by the secretary of health and
754	754	741human services, 1 of whom shall be a representative of the Massachusetts Health and Hospital
755	755	742Association, Inc., 1 of whom shall be a representative of the Massachusetts Nurses Association,
756	756	7431 of whom shall be a representative of the Massachusetts Medical Society, 1 of whom shall be 37 of 39
757	757	744representative of the Perinatal-Neonatal Quality Improvement Network of Massachusetts, and 1
758	758	745of whom shall be a representative of the Neighborhood Birth Center, Inc.
759	759	746 (b) The task force shall study and report maternal health access and birthing patient
760	760	747safety. The task force shall: (i) study the current availability of and access to maternal health
761	761	748services and maternal health care across regions of the commonwealth and among birthing
762	762	749patient populations, including the essential service closure process, the adequacy of the maternal
763	763	750health care workforce and other topics identified in subsection (c); (ii) identify methods to
764	764	751increase the financial investment in and patient access to maternal health care across the
765	765	752commonwealth and ensure equitable access for the most vulnerable birthing patient populations;
766	766	753and (iii) issue a report on the task force’s findings and policy recommendations.
767	767	754 (c) The task force shall study: (i) past essential services closures for inpatient maternity
768	768	755units and acute-level birthing centers, and closures of community-based, office-based and
769	769	756preventative maternal health care, including family planning services, obstetrics and gynecology
770	770	757services and midwifery services; (ii) patient quality and safety considerations of essential service
771	771	758closures of maternal care units, including quality, safety and staffing regulatory requirements
772	772	759promulgated by the department of public health that inform acute level maternal care essential
773	773	760service closures; and (iii) demographic information on patient populations whose access has been
774	774	761most affected by past closures of or current limitations on the availability of maternal care
775	775	762services, including, but not limited to, geography, type of insurance coverage, age, race,
776	776	763ethnicity, income status, LGBTQA+ status and immigration status. 38 of 39
777	777	764 (d) Not later than September 1, 2025, the task force shall submit its report to the clerks of
778	778	765the senate and house of representatives, the joint committee on health care financing and the joint
779	779	766committee on public health.
780	780	767 SECTION 43. Notwithstanding any general or special law to the contrary, for the initial
781	781	768appointments by the governor to the board of registration in midwifery pursuant to section 110 of
782	782	769chapter 13 of the General Laws, inserted by section 4, the 5 members required to be licensed
783	783	770midwives shall be persons with at least 5 years of experience in the practice of midwifery who
784	784	771hold a certificate of completion or equivalent from an educational program or institution
785	785	772accredited by the Midwifery Education Accreditation Council.
786	786	773 SECTION 44. The board of registration in midwifery established pursuant to section 110
787	787	774of chapter 13 of the General Laws, inserted by section 4, shall issue temporary licensure for
788	788	775individuals practicing midwifery and shall promulgate regulations for the temporary licensure of
789	789	776individuals practicing midwifery within 180 days of the effective date of this act. Such
790	790	777temporary licenses shall be valid until December 31, 2025.
791	791	778 SECTION 45. The board of registration in midwifery established pursuant to section 110
792	792	779of chapter 13 of the General Laws, inserted by section 4, shall adopt rules and promulgate
793	793	780regulations pursuant to this act within 1 year from the effective date of this act.
794	794	781 SECTION 46. (a) The department of public health shall promulgate regulations pursuant
795	795	782to section 51M of chapter 111 of the General Laws, inserted by section 15, not later than 180
796	796	783days after the effective date of this act.
797	797	784 (b) Prior to promulgating initial regulations pursuant to said section 51M of said chapter
798	798	785111, the department shall consider, when developing regulations, the standards adopted by the 39 of 39
799	799	786American Association of Birth Centers, and consult with Seven Sisters Birth Center LLC,
800	800	787Neighborhood Birth Center, Inc., the Massachusetts Affiliate of ACNM, Inc. and other entities
801	801	788operating or planning to open birth centers in the commonwealth.
802	802	789 SECTION 46A. The department of public health shall implement newborn screening
803	803	790protocols for Duchenne muscular dystrophy pursuant to section 110A of chapter 111 of the
804	804	791General Laws, as amended by section 15A, not later than 18 months after the effective date of
805	805	792this act.
806	806	793 SECTION 47. All individuals practicing lactation consulting required to be licensed
807	807	794pursuant to section 23B of chapter 112 of the General Laws, as amended by section 21, shall be
808	808	795licensed not later than January 1, 2026.
809	809	796 SECTION 48. All individuals practicing midwifery consistent with section 291 of chapter
810	810	797112 of the General Laws, inserted by section 34, shall be licensed not later than January 1, 2026.