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SENATE . . . . . . . . . . . . . . No. 2928
Senate, July 30, 2024 -- Text of the Senate amendment to the House Bill relative to increasing
access to perinatal health care (House, No. 4785) (being the text of Senate document numbered
2899, printed as amended)
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
_______________
1 SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after
2section 16FF the following section:-
3 Section 16GG. (a) As used in this section, the following words shall have the following
4meanings unless the context clearly requires otherwise:
5 “Eligible entity”, a non-profit or community-based organization or health center serving
6perinatal individuals including, but not limited to: (i) a recognized Indian tribe or tribal
7organization; (ii) an organization serving individuals from medically underserved populations
8and other underserved populations; and (iii) a public health agency, including a municipal public
9health department.
10 “Medically underserved populations”, a historically underserved population or a
11population within a geographic area with a lack of access to primary care, behavioral health or
12perinatal healthcare providers or have a high infant mortality, high poverty or high elderly
13population, as determined by the secretary. 2 of 28
14 “Perinatal”, relating to the time period from the first day of pregnancy to 1 year following
15the end of the pregnancy.
16 “Perinatal individuals”, biological parents, birthing persons, adoptive parents, foster
17parents and any other individuals involved in the gestation, birth and custodial care of an infant
18and those who have lost a pregnancy due to a stillbirth, miscarriage or a medical termination.
19 “Secretary”, the secretary of health and human services.
20 (b) Subject to appropriation, the secretary shall establish a program to award grants to
21eligible entities to address mental health conditions and substance use disorders for perinatal
22individuals.
23 (c) The secretary shall promulgate regulations and guidelines as necessary to develop and
24implement the grant application process and eligible uses of grant funds pursuant to this section.
25 (d) The secretary shall give preference to eligible entities that:
26 (i) are community-based organizations or entities partnering with community-based
27organizations to address mental health conditions or substance use disorders in perinatal
28individuals; and
29 (ii) operate in areas with high rates of adverse perinatal health outcomes or significant
30disparities in perinatal health outcomes, as determined by the secretary.
31 (e) An eligible entity that receives a grant under this section shall use funds for
32establishing or expanding programs that improve or address mental health, behavioral health or
33substance use disorders for perinatal individuals with a focus on perinatal individuals from
34medically underserved populations. 3 of 28
35 (f) The secretary shall provide, directly or by contract, technical assistance to entities
36seeking a grant or receiving a grant under this section for the development, use, evaluation and
37post-grant period sustainability of the program proposed, established or expanded through the
38grant. The secretary shall advertise or promote such technical assistance to eligible entities to
39raise awareness about the grants and technical assistance.
40 (g) The secretary shall promulgate regulations as necessary to implement subsection (f)
41and for the collection of quantitative and qualitative data, delineated by demographic
42information, on the activities conducted and individuals served pursuant to such grants.
43 SECTION 2. Chapter 32A of the General Laws is hereby amended by inserting after
44section 17S the following 2 sections:-
45 Section 17T. The commission shall provide to any active or retired employee of the
46commonwealth who is insured under the group insurance commission coverage for post-
47pregnancy depression screenings. For the purposes of this section, the term “post-pregnancy
48depression” shall mean postpartum depression occurring after childbirth or after the end of the
49pregnancy.
50 Section 17U. The commission shall provide to any active or retired employee of the
51commonwealth who is insured under the group insurance commission coverage for the universal
52postpartum home visiting program administered by the department of public health. Such
53coverage shall not be subject to cost-sharing, including co-payments and co-insurance, and shall
54not be subject to any deductible; provided, however, that cost-sharing shall be required if the
55applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
56as a result of the prohibition on cost-sharing for this service. 4 of 28
57 SECTION 3. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
58Official Edition, is hereby amended by inserting after the definition of “Administrator” the
59following definition:-
60 “Certified nurse midwife”, a nurse licensed under section 80B of said chapter 112 and
61authorized to practice nurse midwifery under section 80C of said chapter 112.
62 SECTION 4. Said section 1E of said chapter 46, as so appearing, is hereby further
63amended by inserting after the definition of “Hospital medical officer” the following definition:-
64 “Licensed certified professional midwife”, an individual who provides midwifery
65services and is licensed by the department of public health pursuant to chapter 111.
66 SECTION 5. Section 3B of said chapter 46, as so appearing, is hereby amended by
67inserting after the word “physician”, in line 1, the following words:- , certified nurse-midwife
68and licensed certified professional midwife.
69 SECTION 6. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
70amended by inserting after the definition of “Isomer” the following definition:-
71 “Licensed certified professional midwife”, an individual who provides midwifery
72services and is licensed by the department of public health pursuant to chapter 111.
73 SECTION 7. Section 7 of said chapter 94C, as so appearing, is hereby amended by
74adding the following subsection:-
75 (j) A licensed certified professional midwife shall not be required to register pursuant to
76this section to purchase, possess or administer controlled substances approved by the department
77as necessary to practice as a licensed certified professional midwife. 5 of 28
78 SECTION 8. Section 9 of said chapter 94C, as so appearing, is hereby amended by
79inserting after the figure “112”, in line 7, the following words:- , licensed certified professional
80midwife pursuant to subsection (j) of said section 7 and section 250 of chapter 111.
81 SECTION 9. Said section 9 of said chapter 94C, as so appearing, is hereby further
82amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
83instance, the following words:- , licensed certified professional midwife.
84 SECTION 10. Said section 9 of said chapter 94C, as so appearing, is hereby further
85amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
86midwifery.
87 SECTION 11. Chapter 111 of the General Laws is hereby amended by inserting after
88section 51L the following section:-
89 Section 51M. (a) The department shall promulgate regulations relative to the operation
90and maintenance of birth centers licensed as clinics pursuant to section 51. For the purposes of
91this section, “freestanding birth centers” shall mean birth centers licensed as clinics pursuant to
92section 51.
93 (b) The regulations shall include, but not be limited to, requirements that a freestanding
94birth center:
95 (i) keep a detailed and written plan on the premises for the transfer of a client to a nearby
96hospital providing obstetrical and newborn services as needed for emergency treatment that is
97beyond the capabilities of the freestanding birth center; 6 of 28
98 (ii) maintain policies and procedures to ensure coordination of the ongoing care and
99transfer of a patient when complications occur that render the patient ineligible for freestanding
100birth center care during the antepartum, intrapartum or postpartum period;
101 (iii) employ an administrative director responsible for implementing and overseeing the
102operational policies of the freestanding birth center;
103 (iv) employ a director of clinical affairs who shall be a certified nurse-midwife or
104physician licensed to practice in the commonwealth whose professional scope of practice
105includes preconception, prenatal, labor, birth and postpartum care and early care of newborns;
106provided, however, that a director of clinical affairs may be the primary attendant during the
107perinatal period; and
108 (v) employ birth attendants that are certified nurse midwives, licensed certified
109professional midwives, physicians or other providers licensed to practice in the commonwealth
110whose professional scope of practice includes preconception, prenatal, labor, birth and
111postpartum care and early care of newborns; provided, however, that birth attendants may be the
112primary attendants in accordance with their professional scope of practice.
113 (c) Regulations promulgated pursuant to this section shall not require a licensed
114freestanding birth center or its directors, providers or staff to practice under the supervision of a
115hospital or other health care provider or to enter into an agreement, written or otherwise, with
116another hospital or health care provider or maintain privileges at a hospital.
117 (d) To be licensed by the department as a freestanding birth center pursuant to subsection
118(a) and section 51, a freestanding birth center shall provide reimbursable services to individuals
119with public health insurance on a non-discriminatory basis. 7 of 28
120 (e) Only freestanding birth centers and hospital-affiliated birth centers licensed pursuant
121to 105 CMR 140 and 105 CMR 142 shall include the words “birth center” or “birthing center” in
122such center’s name.
123 SECTION 12. Said chapter 111 is hereby further amended by inserting after section 70H
124the following section:-
125 Section 70I. (a) The department shall establish, promote and maintain a public
126information program regarding congenital cytomegalovirus, which shall include information on:
127(i) current, evidence-based information pertaining to congenital cytomegalovirus that has been
128vetted by medical experts, as determined by the department; (ii) additional resources or referrals
129for congenital cytomegalovirus and support for families and healthcare providers; and (iii)
130preventative measures to avoid contracting congenital cytomegalovirus.
131 (b) Healthcare providers, including, but not limited to, physician assistants, nurses, nurse-
132midwives and licensed certified professional midwives, that render prenatal or postnatal care
133shall provide expecting parents with information provided by the department under subsection
134(a) at said parents’ first prenatal appointment. The department shall also make such information
135available on the department website and to persons seeking information about congenital
136cytomegalovirus.
137 SECTION 13. Section 202 of said chapter 111, as appearing in the 2022 Official Edition,
138is hereby amended by inserting after the word “physician”, in line 17, the following words:- ,
139certified nurse-midwife or licensed certified professional midwife.
140 SECTION 14. Said section 202 of said chapter 111, as so appearing, is hereby further
141amended by inserting after the word “death”, in line 19, the following words:- ; provided, that a 8 of 28
142physician shall file such report if a certified nurse-midwife or licensed certified professional
143midwife was not in attendance.
144 SECTION 15. Said chapter 111 is hereby further amended by adding the following 7
145sections:-
146 Section 245. (a) The commissioner shall develop and disseminate to the public
147information regarding pregnancy loss and treatment, which shall include information on: (i) the
148prevalence of pregnancy loss, including miscarriage and recurrent miscarriages, among pregnant
149people; and (ii) the accessibility and range of evidence-based treatment options, as medically
150appropriate, for pregnancy loss, including, but not limited to, comprehensive mental health
151supports, necessary procedures and medications and culturally responsive supports including, but
152not limited to, doula care. The commissioner shall ensure that information disseminated pursuant
153to this section is available in multiple languages, including, but not limited to, Spanish,
154Portuguese, Mandarin, Cantonese, Haitian Creole and other spoken languages in the
155commonwealth.
156 (b) The commissioner may disseminate information pursuant to this section to the public
157directly through the department’s website or through arrangements with agencies carrying out
158intra-agency initiatives, nonprofit organizations, consumer groups, community organizations,
159institutions of higher education or state or local public-private partnerships.
160 (c) The commissioner shall develop and coordinate programs for conducting and
161supporting evidence-based research on the causes of pregnancy loss and treatment options.
162 (d) The commissioner shall, in consultation with relevant professional boards of
163registration, develop and disseminate to perinatal health care workers information on pregnancy 9 of 28
164loss to ensure that such perinatal health care workers remain informed about current information
165regarding pregnancy loss and prioritizing both the physical and mental health care of patients
166experiencing pregnancy loss. For the purposes of this subsection, the term “perinatal health care
167worker” shall include, but not be limited to, a licensed certified professional midwife, physician
168assistant, nurse practitioner, clinical nurse specialist, doula, community health worker, nurse-
169midwife, physicians, peer supporter, lactation consultant, nutritionist or dietitian, childbirth
170educator, social worker, trained family support specialist or home visitor and language
171interpreter or navigator.
172 (e) The commissioner shall, in a manner that protects personal privacy and complies with
173federal law, collect and assess data regarding pregnancy loss, including information delineated
174by race, ethnicity, health insurance status, disability, income level and geography on the
175prevalence of and knowledge about pregnancy loss.
176 Section 246. (a) As used in this section, the following words shall have the following
177meanings unless the context clearly requires otherwise:
178 “Perinatal individual”, an individual that is either pregnant or is within 12 months from
179the end of pregnancy.
180 “Perinatal mood and anxiety disorders”, mental health disorders, including, but not
181limited to, postpartum depression, experienced by a perinatal individual during the period of time
182between the beginning of pregnancy and 1 year after the end of pregnancy.
183 (b) The department shall develop and maintain a comprehensive digital resource center
184on perinatal mood and anxiety disorders. The digital resource center shall be available to the
185public at no cost on the department’s website and shall include information and resources for: (i) 10 of 28
186health care providers and organizations serving perinatal individuals to aid them in treating and
187making appropriate referrals for individuals experiencing perinatal mood and anxiety disorders;
188and (ii) perinatal individuals and their families to aid them in understanding and identifying
189perinatal mood and anxiety disorders and how to navigate available resources and obtain
190treatment.
191 (c) In developing the comprehensive digital resource center, the department shall consult
192with: (i) health care professionals, including, but not limited to, obstetricians, gynecologists,
193pediatricians, primary care providers, certified nurse-midwives, licensed certified professional
194midwives, psychiatrists and other mental health clinicians; (ii) organizations serving perinatal
195individuals; and (iii) health insurance carriers.
196 (d) The department shall develop and implement a public information campaign to
197promote awareness of perinatal mood and anxiety disorders, which shall promote the digital
198resource center developed pursuant to this section.
199 Section 247. (a) For the purposes of this section, “postnatal individual” shall mean an
200individual who reached the end of pregnancy within the previous 12 months and “post-
201pregnancy depression” shall mean postpartum depression occurring after childbirth or after the
202end of the pregnancy.
203 (b) Every postnatal individual who receives health care services from a primary care
204provider, obstetrician, gynecologist, certified nurse-midwife or licensed certified professional
205midwife shall be offered a screening for post-pregnancy depression and, if the postnatal
206individual does not object to such screening, such primary care provider, certified nurse-midwife 11 of 28
207or licensed certified professional midwife shall ensure that the postnatal individual is
208appropriately screened for post-pregnancy depression in line with evidence-based guidelines.
209 (c) Every postnatal individual whose infant receives health care services from a
210pediatrician shall be offered a screening for post pregnancy depression by the infant’s
211pediatrician and, if the postnatal individual does not object to such screening, such pediatrician
212shall ensure that the postnatal individual is appropriately screened for post-pregnancy depression
213in line with evidence-based guidelines.
214 (d) If a health care professional administering a screening in accordance with this section
215determines, based on the screening methodology administered, that the postnatal individual is
216likely to be suffering from post-pregnancy depression, such health care professional shall discuss
217available treatments for post-pregnancy depression, including pharmacological treatments, and
218provide an appropriate referral to a mental health clinician.
219 Section 248. (a) As used in this section, the following words shall have the following
220meanings unless the context clearly requires otherwise:
221 “Programs”, entities or providers qualified by the department to provide universal
222postpartum home visiting services.
223 “Provider”, an entity or individual that provides universal postpartum home visiting
224services.
225 “Universal postpartum home visiting services”, evidence-based, voluntary home or
226community-based services for birthing people and caregivers with newborns, including, but not
227limited to: (i) screenings for unmet health needs including reproductive health services; (ii) 12 of 28
228maternal and infant nutritional needs; and (iii) emotional health supports, including post
229pregnancy depression supports.
230 (b) The department shall establish and administer a statewide system of programs
231providing universal postpartum home visiting services. Services shall be delivered by a qualified
232health professional with maternal and pediatric health training, as defined by the department;
233provided, however, that at least 1 visit shall occur at the patient’s home or a mutually agreed
234upon location within 8 weeks postpartum.
235 (c) A provider of universal postpartum home visiting services shall determine whether a
236recipient of its services is covered or may be eligible for coverage through an alternative source.
237A provider shall request payment for services it provides from third-party payers pursuant to
238chapters 32A, 118E, 175, 176A, 176B or 176G before payment is requested from the
239department.
240 (d) The department shall monitor and assess the effectiveness of universal postpartum
241home visiting services. Programs which are in receipt of state or federal funding for said services
242shall report such information as requested by the department for the purpose of monitoring,
243assessing the effectiveness of such programs, initiating quality improvement and reducing health
244disparities.
245 Section 249. (a) As used in this section, the following words shall have the following
246meanings unless the context requires otherwise:
247 “Certified nurse-midwife”, a nurse licensed under section 80B of chapter 112 and
248authorized to practice nurse midwifery under section 80C of said chapter 112. 13 of 28
249 (b) The department shall establish a program for the licensure of licensed certified
250professional midwives. The department shall determine qualifications of a licensed certified
251professional midwife and develop an application process and application for licensure as a
252licensed certified professional midwife, including the recertification process and continued
253education requirements; provided, however, that a valid certified professional midwife credential
254from the North American Registry of Midwives shall serve as a basis for licensure.
255 (c) The department shall establish minimum standards for licensure of licensed certified
256professional midwives including, but not limited to, education, training, experience and ethical
257standards.
258 (d) A person who seeks licensure as a licensed certified professional midwife shall
259complete an application, in a manner determined by the department, which shall include proof of
260completion of the education, training and experience licensure requirements. Said application
261shall be accompanied by a registration fee to be determined annually by the secretary of
262administration and finance under the provision of section 3B of chapter 7; provided, however,
263that the department shall create a hardship waiver to reduce the fee for applicants. If the
264department deems an applicant satisfactory, the department shall issue a license to such
265applicant.
266 (e) Such licenses shall expire on December 31 of each even-numbered year. The fee for
267renewal of licensure shall be determined annually by the secretary of administration and finance
268under the provision of section 3B of chapter 7.
269 (f) The department shall promulgate such rules and regulations as it deems necessary to
270enable proper licensure and oversight of licensed certified professional midwives. 14 of 28
271 (g) The department may suspend or revoke any license to practice as a licensed certified
272professional midwife or discipline any such licensee for any violation of the law or regulation;
273provided, however, that the department shall provide the holder of such license the opportunity
274for a hearing pursuant to chapter 30A; provided, however, that the department may suspend the
275license of a licensee who poses an imminent danger to the public without a hearing; provided
276further, that the licensee shall be afforded a hearing within 7 business days of receipt of a notice
277of such denial, refusal to renew, revocation, limitation, suspension or other disciplinary action.
278 (h) No individual shall practice as a licensed certified professional midwife or assume
279such title without a license issued by the department. A person shall not hold themselves out as a
280licensed certified professional midwife after the expiration date of their license and by doing so,
281may be subject to a fine determined by regulations promulgated by the department.
282 (i) The department shall investigate complaints against persons licensed as licensed
283certified professional midwives.
284 (j) Nothing in this section shall be construed to authorize the department to promulgate
285regulations that require a licensed certified professional midwife to practice under the
286supervision of or in collaboration with another health care provider.
287 (k) When making determinations pursuant to this section, including, but not limited to,
288promulgating rules and regulations, the department shall directly engage not less than 5 licensed
289certified professional midwives, each of whom shall have not less than 5 years of experience in
290the practice of midwifery, in the decision-making process.
291 Section 250. (a) A licensed certified professional midwife may purchase, possess and
292administer to their patients those controlled substances designated by the department as 15 of 28
293necessary to practice as a licensed certified professional midwife; provided, however, that in
294designating controlled substances under this subsection, the department shall directly engage not
295less than 5 licensed certified professional midwives, each of whom shall have not less than 5
296years of experience in the practice of midwifery.
297 (b) The department shall issue a statewide standing order to authorize licensed certified
298professional midwives to administer to their patients those controlled substances designated by
299the department as necessary to practice as a licensed certified professional midwife. Such
300standing order may be issued by the commissioner or by a practitioner designated by the
301commissioner who is registered to distribute or dispense a controlled substance during
302professional practice under section 7 of chapter 94C and shall include, but not be limited to,
303written and standardized procedures and protocols for the administration of the authorized
304controlled substances by licensed certified professional midwives to their patients.
305 (c) Except for an act of gross negligence or willful misconduct, the commissioner or
306practitioner who issues the statewide standing order under this section shall not be subject to any
307criminal or civil liability or any professional disciplinary action.
308 (d) This section shall not apply to certified nurse midwives licensed pursuant to section
30980B of chapter 112.
310 Section 251. (a) The practice of midwifery by a licensed certified professional midwife
311shall include, but not be limited to:
312 (i) the practice of providing maternity care to a client during the preconception period and
313the antepartum, intrapartum and postpartum periods; provided, however, that the department
314may, through regulations or other guidance, establish rules to limit the practice of midwifery by a 16 of 28
315licensed certified professional midwife based on the risk level of the pregnancy deemed
316appropriate by the department;
317 (ii) the practice of providing newborn care; and
318 (iii) prescribing, dispensing or administering pharmaceutical agents consistent with
319section 250.
320 (b) A licensed certified professional midwife shall provide care to clients in accordance
321with the scope and standards of practice under this section and any regulations promulgated by
322the department pursuant to section 249.
323 (c) A licensed certified professional midwife shall prepare, in a format prescribed by the
324department, a written plan for the appropriate delivery of emergency care. The plan shall include,
325but not be limited to: (i) consultation with other health care providers; (ii) emergency transfer to
326a hospital; and (iii) access to neonatal intensive care units and obstetrical units or other patient
327care areas.
328 (d) When accepting a client for care, a licensed certified professional midwife shall
329obtain the client’s informed consent, which shall be evidenced by a written statement in a format
330prescribed by the department that shall be included in the client’s record of care and be signed by
331both the licensed certified professional midwife and the client. The form shall include, but not be
332limited to: (i) an acknowledgement that the licensed certified professional midwife is not
333authorized to practice medicine; (ii) a description of written practice guidelines, services
334provided and the risks and benefits of birth in the client’s chosen environment; and (iii)
335disclosure that the client may be referred for a consultation with or have their care transferred to
336a physician if the client requires care that is outside the midwife’s scope of practice. 17 of 28
337 (e) The department shall develop standards for licensed certified professional midwives
338to maintain client records, including client charts.
339 (f) The practice of midwifery shall not constitute the practice of medicine, certified nurse
340midwifery or emergency medical care.
341 (g) Nothing in this section shall be construed to authorize the department to promulgate
342regulations that require a licensed certified professional midwife to practice under the
343supervision of or in collaboration with another health care provider.
344 (h) Nothing in this section shall regulate:
345 (i) a person licensed in the commonwealth from acting within the scope of practice of the
346profession or occupation for which such person is licensed, including, but not limited to, a
347licensed physician, certified-nurse midwife or certified emergency medical technician; provided,
348however, that such person shall not represent to the public, directly or indirectly, that such person
349is licensed under section 249 and that such person shall not use any name, title or designation
350indicating that such person is licensed under said section 249;
351 (ii) a person employed as a midwife by the federal government or an agency; provided,
352however, that the person shall provide midwifery services solely under the direction and control
353of the organization by which such person is employed;
354 (iii) a traditional birth attendant who provides midwifery services to a client that has
355cultural or religious birth traditions that have historically included the attendance of traditional
356birth attendants; provided, however, that no fee for the traditional birth attendant’s services shall 18 of 28
357be contemplated, charged or received and the birth attendant shall serve only individuals and
358families in a distinct cultural or religious group;
359 (iv) persons who are members of tribal communities and provide traditional midwife
360services to members of their communities; or
361 (v) a person rendering aid in an emergency.
362 (i) A health care provider that consults with or accepts a transport, transfer or referral
363from a licensed certified professional midwife, or that provides care to a client of a licensed
364certified professional midwife or such client’s newborn, shall not be liable in a civil action for
365personal injury or death caused by an act or omission by the licensed certified professional
366midwife.
367 (j) When making determinations pursuant to this section, including, but not limited to,
368establishing rules, prescribing formats and developing standards, the department shall directly
369engage not less than 5 licensed certified professional midwives, each of whom shall have not less
370than 5 years of experience in the practice of midwifery, in the decision-making process.
371 SECTION 16. Chapter 112 of the General Laws is hereby amended by inserting after
372section 2D the following section:-
373 Section 2E. A person shall not provide ultrasound services pertaining to a possible or
374actual pregnancy except under the supervision of a provider or other licensed health care
375professional who, acting within their scope of practice, provides medical care for people who are
376pregnant or may become pregnant. 19 of 28
377 SECTION 17. Section 10A of chapter 118E of the General Laws, as appearing in the
3782022 Official Edition, is hereby amended by striking out, in lines 17 and 21, the words “or
379certified nurse midwife”, and inserting in place thereof, in each instance, the following words:-
380certified nurse midwife or licensed certified professional midwife.
381 SECTION 18. Said section 10A of said chapter 118E, as so appearing, is hereby further
382amended by inserting after the first paragraph the following 2 paragraphs:-
383 The division shall provide coverage for services rendered by a certified nurse midwife
384designated to engage in the practice of nurse-midwifery by the board of registration in nursing
385pursuant to section 80C of chapter 112 and the payment rate for a service provided by a certified
386nurse midwife that is within the scope of the certified nurse midwife’s authorization to practice
387shall be equal to the payment rate for the same service if the service was performed by a
388physician.
389 The division shall provide coverage for midwifery services, including prenatal care,
390childbirth and postpartum care, provided by a licensed certified nurse midwife regardless of the
391site of services.
392 SECTION 19. Said chapter 118E is hereby further amended by inserting after section
39310Q the following 4 sections:-
394 Section 10R. (a) For purposes of this section, the following terms shall have the
395following meanings unless the context clearly requires otherwise: 20 of 28
396 “Maternal and infant health outcomes”, outcomes arising for the gestational parent and
397the gestational parent’s offspring during the pregnancy including pregnancy complications,
398maternal morbidity, infant mortality and preterm births.
399 “Doula services”, physical, emotional and informational support provided by trained
400doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage,
401stillbirth, adoption or pregnancy loss, as determined appropriate by the division; provided,
402however, that “doula services” shall not constitute medical care.
403 (b) The division and its contracted health insurers, health plans, health maintenance
404organizations, behavioral health management firms and third-party administrators under contract
405to a Medicaid managed care organization, accountable care organization or primary care
406clinician plan shall provide coverage of doula services to pregnant individuals and postpartum
407individuals up to 12 months following the end of the pregnancy and adoptive parents of infants
408until the infants reach 1 year of age; provided, however, that the division shall cover not less than
4096 doula visits across the prenatal and 1-year postpartum period or until an adopted infant reaches
4101 year of age.
411 (c) In determining the scope of doula services, the division shall consult with the
412department of public health and bureau of family health and nutrition.
413 Section 10S. (a) For the purposes of this section, “noninvasive prenatal screening” shall
414mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal
415chromosomal aneuploidy; provided, however, that such screening shall include, but not be
416limited to, an analysis of chromosomes 13, 18 and 21. 21 of 28
417 (b) The division and its contracted health insurers, health plans, health maintenance
418organizations, behavioral health management firms and third-party administrators under contract
419to a Medicaid managed care organization, accountable care organization or primary care
420clinician plan shall provide coverage under all benefit plans for noninvasive prenatal screening
421and shall not limit availability and coverage for such screening based on the age of the pregnant
422patient or any other risk factor, unless the limitation is part of the generally accepted standards of
423professional practice as recommended by the American College of Obstetricians and
424Gynecologists.
425 Section 10T. The division and its contracted health insurers, health plans, health
426maintenance organizations, behavioral health management firms and third-party administrators
427under contract to a Medicaid managed care organization, accountable care organization or
428primary care clinician plan shall provide coverage for post-pregnancy depression screenings. For
429the purposes of this section, the term “post-pregnancy depression” shall include postpartum
430depression occurring after childbirth or after the end of the pregnancy. Section 10U. The
431division and its and its contracted health insurers, health plans, health maintenance organizations,
432behavioral health management firms and third-party administrators under contract to a Medicaid
433managed care organization, accountable care organization or primary care clinician plan or other
434entities contracting with the division to administer benefits shall provide coverage for universal
435postpartum home visiting services, in accordance with operational standards set by the
436department of public health pursuant to section 248 of chapter 111. Such coverage shall not be
437subject to any cost-sharing; provided, however, that cost-sharing shall be required if the
438applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
439as a result of the prohibition on cost-sharing for this service. 22 of 28
440 SECTION 20. Subsection (c) of section 148C of chapter 149 of the General Laws, as
441appearing in the 2022 Official Edition, is hereby amended by striking out clauses (3) and (4) and
442inserting in place thereof the following 3 clauses:-
443 (3) attend the employee’s routine medical appointment or a routine medical appointment
444for the employee’s child, spouse, parent, or parent of spouse;
445 (4) address the psychological, physical or legal effects of domestic violence as defined in
446subsection (g1⁄2) of section 1 of chapter 151A, except that the definition of employee in
447subsection (a) will govern for purposes of this section; or
448 (5) address the employee’s own physical and mental health needs, and those of the
449employee’s spouse, if the employee or the employee’s spouse experiences pregnancy loss or a
450failed assisted reproduction, adoption or surrogacy.
451 SECTION 21. Section 47C of chapter 175 of the General Laws, as so appearing, is
452hereby amended by striking out, in line 62, the word “annually” and inserting in place thereof the
453following words:- once per calendar year.
454 SECTION 22. Section 47E of said chapter 175, as so appearing, is hereby amended by
455adding the following 2 sentences:- The reimbursement for the services provided pursuant to this
456section shall be in the same amount as the reimbursement paid under the policy to a licensed
457physician performing the service in the area served. An insurer may not reduce the
458reimbursement paid to a licensed physician in order to comply with this section.
459 SECTION 23. Said chapter 175 is hereby further amended by inserting after section
46047UU the following 2 sections:- 23 of 28
461 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
462delivered or renewed within the commonwealth, which is considered creditable coverage under
463section 1 of chapter 111M, shall provide coverage for post pregnancy depression screenings.
464 Section 47WW. An individual policy of accident and sickness insurance issued pursuant
465to section 108 that provides hospital expense and surgical expense insurance or a group blanket
466or general policy of accident and sickness insurance issued pursuant to section 110 that provides
467hospital expense and surgical expense insurance that is issued or renewed within the
468commonwealth shall provide coverage for universal postpartum home visiting services, in
469accordance with operational standards set by the department of public health pursuant to section
470248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-
471payments and co-insurance, and shall not be subject to any deductible; provided, however, that
472co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by
473the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-
474payments, coinsurance or deductibles for these services.
475 SECTION 24. Chapter 176A of the General Laws is hereby amended by inserting after
476section 8VV the following 2 sections:-
477 Section 8WW. Any contract between a subscriber and the corporation under an
478individual or group hospital service plan that is delivered, issued or renewed within the
479commonwealth shall provide coverage for post-pregnancy depression screenings. For the
480purposes of this section, the term “post-pregnancy depression” shall mean postpartum depression
481occurring after childbirth or after the end of the pregnancy. 24 of 28
482 Section 8XX. Any contract between a subscriber and the corporation under an individual
483or group hospital service plan which is delivered, issued or renewed within the commonwealth
484shall provide coverage for universal postpartum home visiting services, in accordance with
485operational standards set by the department of public health pursuant to section 248 of chapter
486111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-
487insurance, and shall not be subject to any deductible; provided, however, that co-payments,
488coinsurance or deductibles shall be required if the applicable plan is governed by the Internal
489Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments,
490coinsurance or deductibles for these services.
491 SECTION 25. Said chapter 176A is hereby further amended by inserting after section
4928XX the following section:-
493 Section 8YY. Any contract between a subscriber and the corporation under an individual
494or group hospital service plan, which is delivered, issued or renewed in the commonwealth, shall
495provide as a benefit to all individual subscribers and members within the commonwealth and to
496all group members having a principal place of employment within the commonwealth for
497services rendered by a certified nurse midwife designated to engage in the practice of nurse
498midwifery by the board of registration in nursing pursuant to section 80C of chapter 112;
499provided, however, that the: (i) service rendered is within the scope of the certified nurse
500midwife’s authorization to practice by the board of registration in nursing; (ii) policy or contract
501currently provides benefits for identical services rendered by a health care provider licensed by
502the commonwealth; and (iii) reimbursement for the services provided shall be in the same
503amount as the reimbursement paid under the policy to a licensed physician performing the 25 of 28
504service in the area served. An insurer may not reduce the reimbursement paid to a licensed
505physician in order to comply with this section.
506 SECTION 26. Section 4G of chapter 176B of the General Laws, as appearing in the 2018
507Official Edition, is hereby amended by adding the following 2 sentences:- The reimbursement
508for the services provided pursuant to this section shall be in the same amount as the
509reimbursement paid under the policy to a licensed physician performing the service in the area
510served. An insurer may not reduce the reimbursement paid to a licensed physician in order to
511comply with this section.
512 SECTION 27. Section 4G of chapter 176B of the General Laws, as appearing in the 2018
513Official Edition, is hereby amended by adding the following 2 sentences:- The reimbursement
514for the services provided pursuant to this section shall be in the same amount as the
515reimbursement paid under the policy to a licensed physician performing the service in the area
516served. An insurer may not reduce the reimbursement paid to a licensed physician in order to
517comply with this section.
518 SECTION 28. Chapter 176B of the General Laws is hereby amended by inserting after
519section 4VV the following 2 sections:-
520 Section 4WW. Any subscription certificate under an individual or group medical service
521agreement delivered, issued or renewed within the commonwealth shall provide coverage for
522post-pregnancy depression screenings. For the purposes of this section, the term “post-pregnancy
523depression” shall mean postpartum depression occurring after childbirth or after the end of the
524pregnancy. 26 of 28
525 Section 4XX. Any subscription certificate under an individual or group medical service
526agreement delivered, issued or renewed within the commonwealth shall provide coverage for
527universal postpartum home visiting services, in accordance with operational standards set by the
528department of public health pursuant to section 248 of chapter 111 . Such coverage shall not be
529subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to
530any deductible; provided, however, that co-payments, coinsurance or deductibles shall be
531required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-
532exempt status due to the prohibition on co-payments, coinsurance or deductibles for these
533services.
534 SECTION 29. The first paragraph of section 4 of chapter 176G is of the General Laws, as
535so appearing, is hereby amended by adding the following clause:-
536 (g) services rendered by a certified nurse midwife designated to engage in the practice of
537nurse midwifery by the board of registration in nursing pursuant to section 80C of chapter 112,
538subject to the terms of a negotiated agreement between the health maintenance organization and
539the provider of health care services; provided, however, that the reimbursement for the services
540provided shall be in the same amount as the reimbursement paid under the policy to a licensed
541physician performing the service in the area served; and provided further, that An insurer may
542not reduce the reimbursement paid to a licensed physician in order to comply with this section.
543 SECTION 30. Chapter 176G of the General Laws is hereby amended by inserting after
544section 4NN the following 2 sections:-
545 Section 4OO. An individual or group health maintenance contract that is issued or
546renewed within or without the commonwealth shall provide coverage for post-pregnancy 27 of 28
547depression screenings. For the purposes of this section, the term “post-pregnancy depression”
548shall mean postpartum depression occurring after childbirth or after the end of the pregnancy.
549 Section 4PP. Any individual or group health maintenance contract that is issued or
550renewed within or without the commonwealth shall provide coverage for universal postpartum
551home visiting services, in accordance with operational standards set by the department of public
552health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-
553sharing, including co-payments and co-insurance, and shall not be subject to any deductible;
554provided, however, that co-payments, coinsurance or deductibles shall be required if the
555applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
556due to the prohibition on co-payments, coinsurance or deductibles for these services.
557 SECTION 31. (a) The department of public health shall study and report on the
558feasibility and costs of requiring malpractice liability insurance for licensed certified professional
559midwives in the commonwealth, which shall include, but not be limited to: (i) cost of
560malpractice insurance; (ii) impacts on midwifery care accessibility; and (iii) best practices in the
561area of malpractice insurance for midwives.
562 (b) Not later than August 1, 2025, the department shall submit its report and
563recommendations to the clerks of the senate and house of representatives, the joint committee on
564health care financing, the joint committee on public health and senate and house committees on
565ways and means.
566 SECTION 32. Notwithstanding any general or special law to the contrary, the initial
567midwifery engagements pursuant to sections 249, 250 and 251 of chapter 111 of the General
568Laws, inserted by section 15, shall be certified professional midwives, each of whom shall: (i) 28 of 28
569have not less than 5 years of experience in the practice of midwifery; and (ii) hold a certificate of
570completion or equivalent from an educational program or institution accredited by the Midwifery
571Education Accreditation Council.
572 SECTION 33. (a) The department of public health shall promulgate regulations pursuant
573to section 51M of chapter 111 of the General Laws not later than 180 days after the effective date
574of this act.
575 (b) Prior to promulgating initial regulations pursuant to said section 51M of said chapter
576111, the department shall consider the standards adopted by the American Association of Birth
577Centers and consult with Seven Sisters Birth Center LLC, Neighborhood Birth Center, Inc. and
578the Massachusetts Affiliate of ACNM, Inc.
579 SECTION 34. The department of public health shall adopt rules and promulgate
580regulations pursuant to sections 249 and 250 of chapter 111 within 1 year from the effective date
581of this act.