Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S1457 Compare Versions

Only one version of the bill is available at this time.

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2	2	SENATE DOCKET, NO. 1327 FILED ON: 1/19/2023
3	3	SENATE . . . . . . . . . . . . . . No. 1457
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Rebecca L. Rausch
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act promoting access to midwifery care and out-of-hospital birth options.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Rebecca L. RauschNorfolk, Worcester and MiddlesexJack Patrick Lewis7th Middlesex1/30/2023Hannah Kane11th Worcester1/31/2023Jason M. LewisFifth Middlesex2/1/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/1/2023Lydia EdwardsThird Suffolk2/3/2023Patrick M. O'ConnorFirst Plymouth and Norfolk2/7/2023Thomas M. Stanley9th Middlesex2/8/2023Walter F. TimiltyNorfolk, Plymouth and Bristol2/8/2023Vanna Howard17th Middlesex2/9/2023Anne M. GobiWorcester and Hampshire2/9/2023James B. EldridgeMiddlesex and Worcester2/10/2023John F. KeenanNorfolk and Plymouth2/28/2023 1 of 13
16	16	SENATE DOCKET, NO. 1327 FILED ON: 1/19/2023
17	17	SENATE . . . . . . . . . . . . . . No. 1457
18	18	By Ms. Rausch, a petition (accompanied by bill, Senate, No. 1457) of Rebecca L. Rausch, Jack
19	19	Patrick Lewis, Hannah Kane, Jason M. Lewis and other members of the General Court for
20	20	legislation to promote access to midwifery care and out-of-hospital birth options. Public Health.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Third General Court
24	24	(2023-2024)
25	25	_______________
26	26	An Act promoting access to midwifery care and out-of-hospital birth options.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2020
30	30	2Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the
31	31	3following words:- , the board of registration in midwifery.
32	32	4 SECTION 2. Said chapter 13, as so appearing, is hereby further amended by adding the
33	33	5following section:-
34	34	6 Section 110. (a) There shall be within the department of public health a board of
35	35	7registration in midwifery. The board shall consist of 8 members to be appointed by the governor,
36	36	85 of whom shall be midwives with not less than 5 years of experience in the practice of
37	37	9midwifery and who shall be licensed under sections 276 to 289, inclusive, of chapter 112, 1 of
38	38	10whom shall be a physician licensed to practice medicine under section 2 of said chapter 112 with
39	39	11experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed to
40	40	12practice midwifery under section 80B of said chapter 112 and 1 of whom shall be a member of 2 of 13
41	41	13the public. Four of the members of the board of registration in midwifery shall have experience
42	42	14working on the issue of racial disparities in maternal health or be a member of a population that
43	43	15is underrepresented in the midwifery profession. When making the appointments, the governor
44	44	16shall consider the recommendations of organizations representing certified professional
45	45	17midwives in the commonwealth. The appointed members shall serve for terms of 3 years. Upon
46	46	18the expiration of a term of office, a member shall continue to serve until a successor has been
47	47	19appointed and qualified. A member shall not serve for more than 2 consecutive terms; provided,
48	48	20however, that a person who is chosen to fill a vacancy in an unexpired term of a prior board
49	49	21member may serve for 2 consecutive terms in addition to the remainder of that unexpired term. A
50	50	22member may be removed by the governor for neglect of duty, misconduct, malfeasance or
51	51	23misfeasance in the office after a written notice of the charges against the member and sufficient
52	52	24opportunity to be heard thereon. Upon the death or removal for cause of a member of the board,
53	53	25the governor shall fill the vacancy for the remainder of that member’s term after considering
54	54	26suggestions from a list of nominees provided by organizations representing certified professional
55	55	27midwives in the commonwealth. For the initial appointment of the board, the 5 members
56	56	28required to be licensed midwives shall be persons with at least 5 years of experience in the
57	57	29practice of midwifery who meet the eligibility requirements set forth in subsection (a) of section
58	58	30281 of chapter 112. Members of the board shall be residents of the commonwealth.
59	59	31 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
60	60	32serve until their successors have been elected and qualified. The board shall meet not less than 4
61	61	33times annually and may hold additional meetings at the call of the chair or upon the request of
62	62	34not less than 4 members. A quorum for the conduct of official business shall be a majority of
63	63	35those appointed. Board members shall serve without compensation but shall be reimbursed for 3 of 13
64	64	36actual and reasonable expenses incurred in the performance of their duties. The members shall be
65	65	37public employees for the purposes of chapter 258 for all acts or omissions within the scope of
66	66	38their duties as board members.
67	67	39 SECTION 3. Section 1E of chapter 46 of the General Laws, as appearing in the 2020
68	68	40Official Edition, is hereby amended by inserting after the definition of “Physician” the following
69	69	41definition:-
70	70	42 “Licensed midwife,” a midwife licensed to practice by the board of registration in
71	71	43midwifery as provided in sections 276 to 289 of chapter 112.
72	72	44 SECTION 4. Section 3B of said chapter 46, as so appearing, is hereby amended by
73	73	45inserting after the word “physician”, in line 1, the following words:- or licensed midwife.
74	74	46 SECTION 5. Section 1 of chapter 94C of the general laws, as appearing in the 2020
75	75	47Official Edition, is hereby amended by inserting after the definition of “Isomer” the following
76	76	48definition:-
77	77	49 “Licensed midwife,” a midwife licensed to practice by the board of registration in
78	78	50midwifery as provided in sections 276 to 289 of chapter 112.
79	79	51 SECTION 6. Section 7 of said chapter 94C, as so appearing, is hereby amended by
80	80	52adding the following new subsection:-
81	81	53 (j) The commissioner shall promulgate regulations which provide for the automatic
82	82	54registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
83	83	55prescriptions in accordance with the provisions of sections 279 of chapter 112 and the
84	84	56regulations issued by the board of registration in midwifery under said section 279 of chapter 4 of 13
85	85	57112, unless the registration of such licensed midwife has been suspended or revoked pursuant to
86	86	58the provisions of section 13 or section 14 or unless such registration is denied for cause by the
87	87	59commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations,
88	88	60the commissioner shall consult with the board of registration in midwifery.
89	89	61 SECTION 7. Section 9 of said chapter 94C, as so appearing, is hereby amended by
90	90	62inserting in paragraph (a), after the words “certified nurse midwife as provided in section 80C of
91	91	63said chapter 112” the following words:- , licensed midwife as limited by subsection (j) of said
92	92	64section 7 and section 279 of said chapter 112.
93	93	65 SECTION 8. Section 9 of said chapter 94C, as so appearing, is hereby further amended in
94	94	66paragraph (b), by inserting after the words “midwife” in each place that they appear, the
95	95	67following words:- , licensed midwife.
96	96	68 SECTION 9. Said section 9 of said chapter 94C, as so appearing, is hereby further
97	97	69amended in paragraph (b), by inserting after the words “nurse-midwifery” in each place that they
98	98	70appear, the following words:- , midwifery.
99	99	71 SECTION 10. Section 9 of said chapter 94C is further amended in paragraph (c), by
100	100	72inserting after the words “certified nurse midwife” in each place that they appear, the following
101	101	73words:- , licensed midwife.
102	102	74 SECTION 11. The definition of “medical peer review committee” in section 1 of chapter
103	103	75111 of the General Laws, as appearing in the 2020 official edition, is hereby amended by adding
104	104	76the following sentence:- “Medical peer review committee” shall include a committee or
105	105	77association that is authorized by a midwifery society or association to evaluate the quality of 5 of 13
106	106	78midwifery services or the competence of midwives and suggest improvements in midwifery
107	107	79practices to improve patient care.
108	108	80 SECTION 12. Section 202 of said chapter 111, as so appearing, is hereby amended by
109	109	81inserting, in the second and third paragraphs, after the word “attendance”, in each instance, the
110	110	82following words:- or midwife in attendance.
111	111	83 SECTION 13. Said section 202, as so appearing, is hereby further amended by inserting,
112	112	84in the fourth paragraph, after the word “attendance” the following words:- or without the
113	113	85attendance of a midwife,.
114	114	86 SECTION 14. Section 204 of said chapter 111, as so appearing, is hereby amended by
115	115	87inserting, in lines 7, 12 and 28, after the word “medicine”, in each instance, the following word:-
116	116	88, midwifery.
117	117	89 SECTION 15. Chapter 112 of the General Laws, as appearing in the 2020 Official
118	118	90Edition, is hereby amended by adding the following new sections:-
119	119	91 Section 276. As used in sections 276 to 288, inclusive, of this chapter, the following
120	120	92words shall have the following meanings unless the context clearly requires otherwise:
121	121	93 “Board”, the board of registration in midwifery, established under section 110 of chapter
122	122	9413.
123	123	95 “Certified nurse-midwife”, a nurse with advanced training and who has obtained
124	124	96certification by the American Midwifery Certification Board.
125	125	97 “Certified professional midwife”, a professional independent midwifery practitioner who
126	126	98has obtained certification by the NARM." 6 of 13
127	127	99 “Client”, a person under the care of a licensed midwife, as described by a written
128	128	100statement pursuant to section 284 of this chapter.
129	129	101 “Licensed midwife”, a person registered by the board to practice midwifery in the
130	130	102commonwealth under sections 276 to 288, inclusive, of this chapter.
131	131	103 “MBC”, the midwifery bridge certificate issued by the NARM or its successor credential.
132	132	104 “MEAC”, the Midwifery Education Accreditation Council or its successor organization.
133	133	105 “Midwifery”, the practice of providing primary care to a client and newborn during the
134	134	106preconception, antepartum, intrapartum and postpartum periods.
135	135	107 “NARM”, the North American Registry of Midwives or its successor organization.
136	136	108 Section 277. Nothing in sections 276 to 288, inclusive, of this chapter shall limit or
137	137	109regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or
138	138	110advanced emergency medical technician. The practice of midwifery shall not constitute the
139	139	111practice of medicine, certified nurse-midwifery or emergency medical care.
140	140	112 Section 278. (a) The board shall:
141	141	113 (i) adopt rules and promulgate regulations governing licensed midwives and the practice
142	142	114of midwifery to promote public health, welfare and safety, consistent with the essential
143	143	115competencies identified by the NARM;
144	144	116 (ii) administer the licensing process, including, but not limited to:
145	145	117 (A) receiving, reviewing, approving, rejecting and issuing applications for licensure; 7 of 13
146	146	118 (B) renewing, suspending, revoking and reinstating licenses;
147	147	119 (C) investigating complaints against persons licensed under sections 276 to 288,
148	148	120inclusive, of this chapter;
149	149	121 (D) holding hearings and ordering the disciplinary sanction of a person who violates
150	150	122sections 276 to 288, inclusive, of this chapter or a regulation of the board;
151	151	123 (iii) establish administrative procedures for processing applications and renewals;
152	152	124 (iv) have the authority to adopt and provide a uniform, proctored examination for
153	153	125applicants to measure the qualifications necessary for licensure;
154	154	126 (v) develop practice standards for licensed midwives that shall include, but not be limited
155	155	127to:
156	156	128 (A) adoption of ethical standards for licensed midwives and apprentice midwives;
157	157	129 (B) maintenance of records of care, including client charts;
158	158	130 (C) participation in peer review; and
159	159	131 (D) development of standardized informed consent, reporting and written emergency
160	160	132transport plan forms;
161	161	133 (vi) establish and maintain records of its actions and proceedings in accordance with
162	162	134public records laws; and
163	163	135 (vii) adopt professional continuing education requirements for licensed midwives seeking
164	164	136renewal consistent with those maintained by the NARM. 8 of 13
165	165	137 (b) Nothing in this section shall limit the board’s authority to impose sanctions that are
166	166	138considered reasonable and appropriate by the board. A person subject to any disciplinary action
167	167	139taken by the board under this section or taken due to a violation of any other law, rule or
168	168	140regulation may file a petition for judicial review pursuant to section 64 of this chapter.
169	169	141 (c) A licensed midwife shall accept and provide care to clients only in accordance with
170	170	142the scope and standards of practice identified in the rules adopted pursuant to this section.
171	171	143 (d) Notwithstanding any other provision in this section, the board shall not issue any
172	172	144regulations that require a licensed midwife to practice under the supervision of or in
173	173	145collaboration with another healthcare provider or to enter into an agreement, written or
174	174	146otherwise, with another healthcare provider.
175	175	147 Section 279. A licensed midwife duly registered to issue written prescriptions in
176	176	148accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess,
177	177	149purchase, and administer pharmaceutical agents consistent with the scope of midwifery practice,
178	178	150including without limitation antihemorrhagic agents including but not limited to oxytocin,
179	179	151misoprostol and methergine; intravenous fluids for stabilization; vitamin K; eye prophylaxes;
180	180	152oxygen; antibiotics for Group B Streptococcal antibiotic prophylaxes; Rho (D) immune globulin;
181	181	153local anesthetic; epinephrine; and other pharmaceutical agents identified by the board, however,
182	182	154that nothing in this section shall be construed to permit a licensed midwife’s use of
183	183	155pharmaceutical agents which are (a) controlled substances as described by Title 21 U.S.C.
184	184	156Section 812 or in chapter 94C, except for those listed in schedule VI; or (b) not identified by
185	185	157rules and regulations promulgated by the board of registration in midwifery as consistent with
186	186	158the scope of midwifery practice. 9 of 13
187	187	159 Section 280. A person who desires to be licensed and registered as a licensed midwife
188	188	160shall apply to the board in writing on an application form prescribed and furnished by the board.
189	189	161The applicant shall include in the application statements under oath satisfactory to the board
190	190	162showing that the applicant possesses the qualifications described under section 281 prior to any
191	191	163examination which may be required under section 278. The secretary of administration and
192	192	164finance, pursuant to section 3B of chapter 7, shall establish a license application fee, a license
193	193	165renewal fee and any other fee applicable under sections 276 to 288, inclusive, of this chapter;
194	194	166provided, however, that such license applicant and license renewal fees shall not exceed $200
195	195	167biennially. The board, in consultation with the secretary of administration and finance, shall
196	196	168institute a process for applicants to apply for a financial hardship waiver, which may reduce or
197	197	169fully exempt an applicant from paying the fee pursuant to this section. Fees collected by the
198	198	170board shall be deposited into the Quality in Health Professions Trust Fund pursuant to section
199	199	17135X of chapter 10 to support board operations and administration and to reimburse board
200	200	172members for actual and necessary expenses incurred in the performance of their official duties.
201	201	173 Section 281. (a) To be eligible for registration and licensure by the board as a licensed
202	202	174midwife, an applicant shall: (i) be of good moral character; (ii) be a graduate of a high school or
203	203	175its equivalent; and (iii) possess a valid certified professional midwife credential from the NARM.
204	204	176 (b) An applicant for a license to practice midwifery as a certified professional midwife
205	205	177shall submit to the board proof of successful completion of a formal midwifery education and
206	206	178training program as follows:
207	207	179 (i) a certificate of completion or equivalent from an educational program or institution
208	208	180accredited by the MEAC; or 10 of 13
209	209	181 (ii) an MBC, provided that an applicant: (1) is certified as a certified professional
210	210	182midwife within 5 years after the effective date of this section and completed a midwifery
211	211	183education and training program from an educational program or institution that is not accredited
212	212	184by the MEAC; or (2) is licensed as a professional midwife in a state that does not require
213	213	185completion of a midwifery education and training program from an educational program or
214	214	186institution that is accredited by the MEAC.
215	215	187 Section 282. The board may license in a like manner, without examination, any
216	216	188midwife who has been licensed in another state under laws which, in the opinion of the board,
217	217	189require qualifications and maintain standards substantially the same as those of this
218	218	190commonwealth for licensed midwives, provided, however, that such midwife applies and remits
219	219	191fees as provided for in section 279.
220	220	192 Section 283. (a) The board may, after a hearing pursuant to chapter 30A, revoke, suspend
221	221	193or cancel the license of a licensed midwife, or reprimand or censure a licensed midwife, for any
222	222	194of the reasons set forth in section 61.
223	223	195 (b) No person filing a complaint or reporting information pursuant to this section or
224	224	196assisting the board at its request in any manner in discharging its duties and functions shall be
225	225	197liable in any cause of action arising out of providing such information or assistance; provided,
226	226	198however, that the person making the complaint or reporting or providing such information or
227	227	199assistance does so in good faith and without malice. Section 284. When accepting a client for
228	228	200care, a licensed midwife shall obtain the client’s informed consent, which shall be evidenced by
229	229	201a written statement in a form prescribed by the board and signed by both the licensed midwife
230	230	202and the client. 11 of 13
231	231	203 Section 285. A licensed midwife shall prepare, in a form prescribed by the board, a
232	232	204written plan for the appropriate delivery of emergency care. The plan shall include, but not be
233	233	205limited to: (i) consultation with other health care providers; (ii) emergency transfer; and (iii)
234	234	206access to neonatal intensive care units and obstetrical units or other patient care areas.
235	235	207 Section 286. A health care provider that consults with or accepts a transport, transfer or
236	236	208referral from a licensed midwife, or that provides care to a client of a licensed midwife or such
237	237	209client’s newborn, shall not be liable in a civil action for personal injury or death resulting from
238	238	210an act or omission by the licensed midwife, unless the professional negligence or malpractice of
239	239	211the health care provider was a proximate cause of the injury or death.
240	240	212 Section 287. (a) The board may petition any court of competent jurisdiction for an
241	241	213injunction against any person practicing midwifery or any branch thereof without a license
242	242	214granted pursuant to sections 276 to 288, inclusive, of this chapter. Proof of damage or harm
243	243	215sustained by any person shall not be required for issuance of such injunction. Nothing in this
244	244	216section shall relieve a person from criminal prosecution for practicing without a license.
245	245	217 (b) Nothing in this section shall prevent or restrict the practice, service or activities of:
246	246	218 (i) a person licensed in the commonwealth from engaging in activities within the scope of
247	247	219practice of the profession or occupation for which such person is licensed; provided, however,
248	248	220that such person does not represent to the public, directly or indirectly, that such person is
249	249	221licensed under sections 276 to 289, inclusive, and that such person does not use any name, title
250	250	222or designation indicating that such person is licensed under said sections 276 to 289, inclusive; or 12 of 13
251	251	223 (ii) a person employed as a midwife by the federal government or an agency thereof if
252	252	224that person provides midwifery services solely under the direction and control of the
253	253	225organization by which such person is employed;
254	254	226 (iii) a traditional birth attendant who provides midwifery services if no fee is
255	255	227contemplated, charged or received, and such person has cultural or religious traditions that have
256	256	228historically included the attendance of traditional birth attendants at birth, and the birth attendant
257	257	229serves only individuals and families in that distinct cultural or religious group;
258	258	230 (iv) persons who are members of Native American communities and provide traditional
259	259	231midwife services to their communities; or
260	260	232 (v) any person rendering aid in an emergency.
261	261	233 Section 288. A licensed midwife, registered by the board of registration in midwifery
262	262	234pursuant to sections 276 to 288, inclusive, of this chapter, who provides services to any person or
263	263	235beneficiary covered by Title XIX of the Social Security Act or MassHealth pursuant to section
264	264	2369A of chapter 118E, may accept the Medicaid or MassHealth approved rate as payment in full
265	265	237for such services; provided, that a licensed midwife who accepts the Medicaid or MassHealth
266	266	238approved rate pursuant to this section shall be reimbursed at said rate for such services
267	267	239 SECTION 16. Chapter 118E of the General Laws, as appearing in the 2020 Official
268	268	240Edition, is hereby amended in section 10A by adding the words “licensed midwife,” after the
269	269	241word “physician,” in line 15 and after the word “pediatrician,” in line 20, and by inserting at the
270	270	242end of the section the following sentence:- The division shall provide coverage for midwifery
271	271	243services including prenatal care, childbirth and postpartum care provided by a licensed midwife
272	272	244regardless of the site of services. 13 of 13
273	273	245 SECTION 17. The board established pursuant to section 110 of chapter 13 of the General
274	274	246Laws shall adopt rules and promulgate regulations pursuant to this act within 1 year from the
275	275	247effective date of this act.
276	276	248 SECTION 18. The board established pursuant to section 110 of chapter 13 of the General
277	277	249Laws shall promulgate regulations for the licensure of individuals practicing midwifery prior to
278	278	250the date on which the board commences issuing licenses; provided, however, that individuals
279	279	251practicing midwifery in the commonwealth as of the date on which the board commences issuing
280	280	252licenses shall have 2 years from that date to complete the requirements necessary for licensure.
281	281	253 SECTION 19. Nothing in this act shall preclude a person who was practicing midwifery
282	282	254before the effective date of this act from practicing midwifery in the commonwealth until the
283	283	255board establishes procedures for the licensure of midwives pursuant to this act.
284	284	256 SECTION 20. The department of public health shall promulgate regulations within 1 year
285	285	257from the effective date of this act governing birth centers, consistent with standards set forth by
286	286	258the American Association of Birth Centers, including without limitation authorizing licensed
287	287	259professional midwives to practice in birth centers as primary birth attendants, director of birth
288	288	260centers, and director of clinical affairs. Licensed professional midwives practicing in licensed
289	289	261birth centers shall not be required to enter into any agreement for supervision or collaboration
290	290	262with any other healthcare provider or hospital.