Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S2928 Compare Versions

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1	1	1 of 28
2	2	SENATE . . . . . . . . . . . . . . No. 2928
3	3	Senate, July 30, 2024 -- Text of the Senate amendment to the House Bill relative to increasing
4	4	access to perinatal health care (House, No. 4785) (being the text of Senate document numbered
5	5	2899, printed as amended)
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	1 SECTION 1. Chapter 6A of the General Laws is hereby amended by inserting after
12	12	2section 16FF the following section:-
13	13	3 Section 16GG. (a) As used in this section, the following words shall have the following
14	14	4meanings unless the context clearly requires otherwise:
15	15	5 “Eligible entity”, a non-profit or community-based organization or health center serving
16	16	6perinatal individuals including, but not limited to: (i) a recognized Indian tribe or tribal
17	17	7organization; (ii) an organization serving individuals from medically underserved populations
18	18	8and other underserved populations; and (iii) a public health agency, including a municipal public
19	19	9health department.
20	20	10 “Medically underserved populations”, a historically underserved population or a
21	21	11population within a geographic area with a lack of access to primary care, behavioral health or
22	22	12perinatal healthcare providers or have a high infant mortality, high poverty or high elderly
23	23	13population, as determined by the secretary. 2 of 28
24	24	14 “Perinatal”, relating to the time period from the first day of pregnancy to 1 year following
25	25	15the end of the pregnancy.
26	26	16 “Perinatal individuals”, biological parents, birthing persons, adoptive parents, foster
27	27	17parents and any other individuals involved in the gestation, birth and custodial care of an infant
28	28	18and those who have lost a pregnancy due to a stillbirth, miscarriage or a medical termination.
29	29	19 “Secretary”, the secretary of health and human services.
30	30	20 (b) Subject to appropriation, the secretary shall establish a program to award grants to
31	31	21eligible entities to address mental health conditions and substance use disorders for perinatal
32	32	22individuals.
33	33	23 (c) The secretary shall promulgate regulations and guidelines as necessary to develop and
34	34	24implement the grant application process and eligible uses of grant funds pursuant to this section.
35	35	25 (d) The secretary shall give preference to eligible entities that:
36	36	26 (i) are community-based organizations or entities partnering with community-based
37	37	27organizations to address mental health conditions or substance use disorders in perinatal
38	38	28individuals; and
39	39	29 (ii) operate in areas with high rates of adverse perinatal health outcomes or significant
40	40	30disparities in perinatal health outcomes, as determined by the secretary.
41	41	31 (e) An eligible entity that receives a grant under this section shall use funds for
42	42	32establishing or expanding programs that improve or address mental health, behavioral health or
43	43	33substance use disorders for perinatal individuals with a focus on perinatal individuals from
44	44	34medically underserved populations. 3 of 28
45	45	35 (f) The secretary shall provide, directly or by contract, technical assistance to entities
46	46	36seeking a grant or receiving a grant under this section for the development, use, evaluation and
47	47	37post-grant period sustainability of the program proposed, established or expanded through the
48	48	38grant. The secretary shall advertise or promote such technical assistance to eligible entities to
49	49	39raise awareness about the grants and technical assistance.
50	50	40 (g) The secretary shall promulgate regulations as necessary to implement subsection (f)
51	51	41and for the collection of quantitative and qualitative data, delineated by demographic
52	52	42information, on the activities conducted and individuals served pursuant to such grants.
53	53	43 SECTION 2. Chapter 32A of the General Laws is hereby amended by inserting after
54	54	44section 17S the following 2 sections:-
55	55	45 Section 17T. The commission shall provide to any active or retired employee of the
56	56	46commonwealth who is insured under the group insurance commission coverage for post-
57	57	47pregnancy depression screenings. For the purposes of this section, the term “post-pregnancy
58	58	48depression” shall mean postpartum depression occurring after childbirth or after the end of the
59	59	49pregnancy.
60	60	50 Section 17U. The commission shall provide to any active or retired employee of the
61	61	51commonwealth who is insured under the group insurance commission coverage for the universal
62	62	52postpartum home visiting program administered by the department of public health. Such
63	63	53coverage shall not be subject to cost-sharing, including co-payments and co-insurance, and shall
64	64	54not be subject to any deductible; provided, however, that cost-sharing shall be required if the
65	65	55applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
66	66	56as a result of the prohibition on cost-sharing for this service. 4 of 28
67	67	57 SECTION 3. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
68	68	58Official Edition, is hereby amended by inserting after the definition of “Administrator” the
69	69	59following definition:-
70	70	60 “Certified nurse midwife”, a nurse licensed under section 80B of said chapter 112 and
71	71	61authorized to practice nurse midwifery under section 80C of said chapter 112.
72	72	62 SECTION 4. Said section 1E of said chapter 46, as so appearing, is hereby further
73	73	63amended by inserting after the definition of “Hospital medical officer” the following definition:-
74	74	64 “Licensed certified professional midwife”, an individual who provides midwifery
75	75	65services and is licensed by the department of public health pursuant to chapter 111.
76	76	66 SECTION 5. Section 3B of said chapter 46, as so appearing, is hereby amended by
77	77	67inserting after the word “physician”, in line 1, the following words:- , certified nurse-midwife
78	78	68and licensed certified professional midwife.
79	79	69 SECTION 6. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
80	80	70amended by inserting after the definition of “Isomer” the following definition:-
81	81	71 “Licensed certified professional midwife”, an individual who provides midwifery
82	82	72services and is licensed by the department of public health pursuant to chapter 111.
83	83	73 SECTION 7. Section 7 of said chapter 94C, as so appearing, is hereby amended by
84	84	74adding the following subsection:-
85	85	75 (j) A licensed certified professional midwife shall not be required to register pursuant to
86	86	76this section to purchase, possess or administer controlled substances approved by the department
87	87	77as necessary to practice as a licensed certified professional midwife. 5 of 28
88	88	78 SECTION 8. Section 9 of said chapter 94C, as so appearing, is hereby amended by
89	89	79inserting after the figure “112”, in line 7, the following words:- , licensed certified professional
90	90	80midwife pursuant to subsection (j) of said section 7 and section 250 of chapter 111.
91	91	81 SECTION 9. Said section 9 of said chapter 94C, as so appearing, is hereby further
92	92	82amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
93	93	83instance, the following words:- , licensed certified professional midwife.
94	94	84 SECTION 10. Said section 9 of said chapter 94C, as so appearing, is hereby further
95	95	85amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
96	96	86midwifery.
97	97	87 SECTION 11. Chapter 111 of the General Laws is hereby amended by inserting after
98	98	88section 51L the following section:-
99	99	89 Section 51M. (a) The department shall promulgate regulations relative to the operation
100	100	90and maintenance of birth centers licensed as clinics pursuant to section 51. For the purposes of
101	101	91this section, “freestanding birth centers” shall mean birth centers licensed as clinics pursuant to
102	102	92section 51.
103	103	93 (b) The regulations shall include, but not be limited to, requirements that a freestanding
104	104	94birth center:
105	105	95 (i) keep a detailed and written plan on the premises for the transfer of a client to a nearby
106	106	96hospital providing obstetrical and newborn services as needed for emergency treatment that is
107	107	97beyond the capabilities of the freestanding birth center; 6 of 28
108	108	98 (ii) maintain policies and procedures to ensure coordination of the ongoing care and
109	109	99transfer of a patient when complications occur that render the patient ineligible for freestanding
110	110	100birth center care during the antepartum, intrapartum or postpartum period;
111	111	101 (iii) employ an administrative director responsible for implementing and overseeing the
112	112	102operational policies of the freestanding birth center;
113	113	103 (iv) employ a director of clinical affairs who shall be a certified nurse-midwife or
114	114	104physician licensed to practice in the commonwealth whose professional scope of practice
115	115	105includes preconception, prenatal, labor, birth and postpartum care and early care of newborns;
116	116	106provided, however, that a director of clinical affairs may be the primary attendant during the
117	117	107perinatal period; and
118	118	108 (v) employ birth attendants that are certified nurse midwives, licensed certified
119	119	109professional midwives, physicians or other providers licensed to practice in the commonwealth
120	120	110whose professional scope of practice includes preconception, prenatal, labor, birth and
121	121	111postpartum care and early care of newborns; provided, however, that birth attendants may be the
122	122	112primary attendants in accordance with their professional scope of practice.
123	123	113 (c) Regulations promulgated pursuant to this section shall not require a licensed
124	124	114freestanding birth center or its directors, providers or staff to practice under the supervision of a
125	125	115hospital or other health care provider or to enter into an agreement, written or otherwise, with
126	126	116another hospital or health care provider or maintain privileges at a hospital.
127	127	117 (d) To be licensed by the department as a freestanding birth center pursuant to subsection
128	128	118(a) and section 51, a freestanding birth center shall provide reimbursable services to individuals
129	129	119with public health insurance on a non-discriminatory basis. 7 of 28
130	130	120 (e) Only freestanding birth centers and hospital-affiliated birth centers licensed pursuant
131	131	121to 105 CMR 140 and 105 CMR 142 shall include the words “birth center” or “birthing center” in
132	132	122such center’s name.
133	133	123 SECTION 12. Said chapter 111 is hereby further amended by inserting after section 70H
134	134	124the following section:-
135	135	125 Section 70I. (a) The department shall establish, promote and maintain a public
136	136	126information program regarding congenital cytomegalovirus, which shall include information on:
137	137	127(i) current, evidence-based information pertaining to congenital cytomegalovirus that has been
138	138	128vetted by medical experts, as determined by the department; (ii) additional resources or referrals
139	139	129for congenital cytomegalovirus and support for families and healthcare providers; and (iii)
140	140	130preventative measures to avoid contracting congenital cytomegalovirus.
141	141	131 (b) Healthcare providers, including, but not limited to, physician assistants, nurses, nurse-
142	142	132midwives and licensed certified professional midwives, that render prenatal or postnatal care
143	143	133shall provide expecting parents with information provided by the department under subsection
144	144	134(a) at said parents’ first prenatal appointment. The department shall also make such information
145	145	135available on the department website and to persons seeking information about congenital
146	146	136cytomegalovirus.
147	147	137 SECTION 13. Section 202 of said chapter 111, as appearing in the 2022 Official Edition,
148	148	138is hereby amended by inserting after the word “physician”, in line 17, the following words:- ,
149	149	139certified nurse-midwife or licensed certified professional midwife.
150	150	140 SECTION 14. Said section 202 of said chapter 111, as so appearing, is hereby further
151	151	141amended by inserting after the word “death”, in line 19, the following words:- ; provided, that a 8 of 28
152	152	142physician shall file such report if a certified nurse-midwife or licensed certified professional
153	153	143midwife was not in attendance.
154	154	144 SECTION 15. Said chapter 111 is hereby further amended by adding the following 7
155	155	145sections:-
156	156	146 Section 245. (a) The commissioner shall develop and disseminate to the public
157	157	147information regarding pregnancy loss and treatment, which shall include information on: (i) the
158	158	148prevalence of pregnancy loss, including miscarriage and recurrent miscarriages, among pregnant
159	159	149people; and (ii) the accessibility and range of evidence-based treatment options, as medically
160	160	150appropriate, for pregnancy loss, including, but not limited to, comprehensive mental health
161	161	151supports, necessary procedures and medications and culturally responsive supports including, but
162	162	152not limited to, doula care. The commissioner shall ensure that information disseminated pursuant
163	163	153to this section is available in multiple languages, including, but not limited to, Spanish,
164	164	154Portuguese, Mandarin, Cantonese, Haitian Creole and other spoken languages in the
165	165	155commonwealth.
166	166	156 (b) The commissioner may disseminate information pursuant to this section to the public
167	167	157directly through the department’s website or through arrangements with agencies carrying out
168	168	158intra-agency initiatives, nonprofit organizations, consumer groups, community organizations,
169	169	159institutions of higher education or state or local public-private partnerships.
170	170	160 (c) The commissioner shall develop and coordinate programs for conducting and
171	171	161supporting evidence-based research on the causes of pregnancy loss and treatment options.
172	172	162 (d) The commissioner shall, in consultation with relevant professional boards of
173	173	163registration, develop and disseminate to perinatal health care workers information on pregnancy 9 of 28
174	174	164loss to ensure that such perinatal health care workers remain informed about current information
175	175	165regarding pregnancy loss and prioritizing both the physical and mental health care of patients
176	176	166experiencing pregnancy loss. For the purposes of this subsection, the term “perinatal health care
177	177	167worker” shall include, but not be limited to, a licensed certified professional midwife, physician
178	178	168assistant, nurse practitioner, clinical nurse specialist, doula, community health worker, nurse-
179	179	169midwife, physicians, peer supporter, lactation consultant, nutritionist or dietitian, childbirth
180	180	170educator, social worker, trained family support specialist or home visitor and language
181	181	171interpreter or navigator.
182	182	172 (e) The commissioner shall, in a manner that protects personal privacy and complies with
183	183	173federal law, collect and assess data regarding pregnancy loss, including information delineated
184	184	174by race, ethnicity, health insurance status, disability, income level and geography on the
185	185	175prevalence of and knowledge about pregnancy loss.
186	186	176 Section 246. (a) As used in this section, the following words shall have the following
187	187	177meanings unless the context clearly requires otherwise:
188	188	178 “Perinatal individual”, an individual that is either pregnant or is within 12 months from
189	189	179the end of pregnancy.
190	190	180 “Perinatal mood and anxiety disorders”, mental health disorders, including, but not
191	191	181limited to, postpartum depression, experienced by a perinatal individual during the period of time
192	192	182between the beginning of pregnancy and 1 year after the end of pregnancy.
193	193	183 (b) The department shall develop and maintain a comprehensive digital resource center
194	194	184on perinatal mood and anxiety disorders. The digital resource center shall be available to the
195	195	185public at no cost on the department’s website and shall include information and resources for: (i) 10 of 28
196	196	186health care providers and organizations serving perinatal individuals to aid them in treating and
197	197	187making appropriate referrals for individuals experiencing perinatal mood and anxiety disorders;
198	198	188and (ii) perinatal individuals and their families to aid them in understanding and identifying
199	199	189perinatal mood and anxiety disorders and how to navigate available resources and obtain
200	200	190treatment.
201	201	191 (c) In developing the comprehensive digital resource center, the department shall consult
202	202	192with: (i) health care professionals, including, but not limited to, obstetricians, gynecologists,
203	203	193pediatricians, primary care providers, certified nurse-midwives, licensed certified professional
204	204	194midwives, psychiatrists and other mental health clinicians; (ii) organizations serving perinatal
205	205	195individuals; and (iii) health insurance carriers.
206	206	196 (d) The department shall develop and implement a public information campaign to
207	207	197promote awareness of perinatal mood and anxiety disorders, which shall promote the digital
208	208	198resource center developed pursuant to this section.
209	209	199 Section 247. (a) For the purposes of this section, “postnatal individual” shall mean an
210	210	200individual who reached the end of pregnancy within the previous 12 months and “post-
211	211	201pregnancy depression” shall mean postpartum depression occurring after childbirth or after the
212	212	202end of the pregnancy.
213	213	203 (b) Every postnatal individual who receives health care services from a primary care
214	214	204provider, obstetrician, gynecologist, certified nurse-midwife or licensed certified professional
215	215	205midwife shall be offered a screening for post-pregnancy depression and, if the postnatal
216	216	206individual does not object to such screening, such primary care provider, certified nurse-midwife 11 of 28
217	217	207or licensed certified professional midwife shall ensure that the postnatal individual is
218	218	208appropriately screened for post-pregnancy depression in line with evidence-based guidelines.
219	219	209 (c) Every postnatal individual whose infant receives health care services from a
220	220	210pediatrician shall be offered a screening for post pregnancy depression by the infant’s
221	221	211pediatrician and, if the postnatal individual does not object to such screening, such pediatrician
222	222	212shall ensure that the postnatal individual is appropriately screened for post-pregnancy depression
223	223	213in line with evidence-based guidelines.
224	224	214 (d) If a health care professional administering a screening in accordance with this section
225	225	215determines, based on the screening methodology administered, that the postnatal individual is
226	226	216likely to be suffering from post-pregnancy depression, such health care professional shall discuss
227	227	217available treatments for post-pregnancy depression, including pharmacological treatments, and
228	228	218provide an appropriate referral to a mental health clinician.
229	229	219 Section 248. (a) As used in this section, the following words shall have the following
230	230	220meanings unless the context clearly requires otherwise:
231	231	221 “Programs”, entities or providers qualified by the department to provide universal
232	232	222postpartum home visiting services.
233	233	223 “Provider”, an entity or individual that provides universal postpartum home visiting
234	234	224services.
235	235	225 “Universal postpartum home visiting services”, evidence-based, voluntary home or
236	236	226community-based services for birthing people and caregivers with newborns, including, but not
237	237	227limited to: (i) screenings for unmet health needs including reproductive health services; (ii) 12 of 28
238	238	228maternal and infant nutritional needs; and (iii) emotional health supports, including post
239	239	229pregnancy depression supports.
240	240	230 (b) The department shall establish and administer a statewide system of programs
241	241	231providing universal postpartum home visiting services. Services shall be delivered by a qualified
242	242	232health professional with maternal and pediatric health training, as defined by the department;
243	243	233provided, however, that at least 1 visit shall occur at the patient’s home or a mutually agreed
244	244	234upon location within 8 weeks postpartum.
245	245	235 (c) A provider of universal postpartum home visiting services shall determine whether a
246	246	236recipient of its services is covered or may be eligible for coverage through an alternative source.
247	247	237A provider shall request payment for services it provides from third-party payers pursuant to
248	248	238chapters 32A, 118E, 175, 176A, 176B or 176G before payment is requested from the
249	249	239department.
250	250	240 (d) The department shall monitor and assess the effectiveness of universal postpartum
251	251	241home visiting services. Programs which are in receipt of state or federal funding for said services
252	252	242shall report such information as requested by the department for the purpose of monitoring,
253	253	243assessing the effectiveness of such programs, initiating quality improvement and reducing health
254	254	244disparities.
255	255	245 Section 249. (a) As used in this section, the following words shall have the following
256	256	246meanings unless the context requires otherwise:
257	257	247 “Certified nurse-midwife”, a nurse licensed under section 80B of chapter 112 and
258	258	248authorized to practice nurse midwifery under section 80C of said chapter 112. 13 of 28
259	259	249 (b) The department shall establish a program for the licensure of licensed certified
260	260	250professional midwives. The department shall determine qualifications of a licensed certified
261	261	251professional midwife and develop an application process and application for licensure as a
262	262	252licensed certified professional midwife, including the recertification process and continued
263	263	253education requirements; provided, however, that a valid certified professional midwife credential
264	264	254from the North American Registry of Midwives shall serve as a basis for licensure.
265	265	255 (c) The department shall establish minimum standards for licensure of licensed certified
266	266	256professional midwives including, but not limited to, education, training, experience and ethical
267	267	257standards.
268	268	258 (d) A person who seeks licensure as a licensed certified professional midwife shall
269	269	259complete an application, in a manner determined by the department, which shall include proof of
270	270	260completion of the education, training and experience licensure requirements. Said application
271	271	261shall be accompanied by a registration fee to be determined annually by the secretary of
272	272	262administration and finance under the provision of section 3B of chapter 7; provided, however,
273	273	263that the department shall create a hardship waiver to reduce the fee for applicants. If the
274	274	264department deems an applicant satisfactory, the department shall issue a license to such
275	275	265applicant.
276	276	266 (e) Such licenses shall expire on December 31 of each even-numbered year. The fee for
277	277	267renewal of licensure shall be determined annually by the secretary of administration and finance
278	278	268under the provision of section 3B of chapter 7.
279	279	269 (f) The department shall promulgate such rules and regulations as it deems necessary to
280	280	270enable proper licensure and oversight of licensed certified professional midwives. 14 of 28
281	281	271 (g) The department may suspend or revoke any license to practice as a licensed certified
282	282	272professional midwife or discipline any such licensee for any violation of the law or regulation;
283	283	273provided, however, that the department shall provide the holder of such license the opportunity
284	284	274for a hearing pursuant to chapter 30A; provided, however, that the department may suspend the
285	285	275license of a licensee who poses an imminent danger to the public without a hearing; provided
286	286	276further, that the licensee shall be afforded a hearing within 7 business days of receipt of a notice
287	287	277of such denial, refusal to renew, revocation, limitation, suspension or other disciplinary action.
288	288	278 (h) No individual shall practice as a licensed certified professional midwife or assume
289	289	279such title without a license issued by the department. A person shall not hold themselves out as a
290	290	280licensed certified professional midwife after the expiration date of their license and by doing so,
291	291	281may be subject to a fine determined by regulations promulgated by the department.
292	292	282 (i) The department shall investigate complaints against persons licensed as licensed
293	293	283certified professional midwives.
294	294	284 (j) Nothing in this section shall be construed to authorize the department to promulgate
295	295	285regulations that require a licensed certified professional midwife to practice under the
296	296	286supervision of or in collaboration with another health care provider.
297	297	287 (k) When making determinations pursuant to this section, including, but not limited to,
298	298	288promulgating rules and regulations, the department shall directly engage not less than 5 licensed
299	299	289certified professional midwives, each of whom shall have not less than 5 years of experience in
300	300	290the practice of midwifery, in the decision-making process.
301	301	291 Section 250. (a) A licensed certified professional midwife may purchase, possess and
302	302	292administer to their patients those controlled substances designated by the department as 15 of 28
303	303	293necessary to practice as a licensed certified professional midwife; provided, however, that in
304	304	294designating controlled substances under this subsection, the department shall directly engage not
305	305	295less than 5 licensed certified professional midwives, each of whom shall have not less than 5
306	306	296years of experience in the practice of midwifery.
307	307	297 (b) The department shall issue a statewide standing order to authorize licensed certified
308	308	298professional midwives to administer to their patients those controlled substances designated by
309	309	299the department as necessary to practice as a licensed certified professional midwife. Such
310	310	300standing order may be issued by the commissioner or by a practitioner designated by the
311	311	301commissioner who is registered to distribute or dispense a controlled substance during
312	312	302professional practice under section 7 of chapter 94C and shall include, but not be limited to,
313	313	303written and standardized procedures and protocols for the administration of the authorized
314	314	304controlled substances by licensed certified professional midwives to their patients.
315	315	305 (c) Except for an act of gross negligence or willful misconduct, the commissioner or
316	316	306practitioner who issues the statewide standing order under this section shall not be subject to any
317	317	307criminal or civil liability or any professional disciplinary action.
318	318	308 (d) This section shall not apply to certified nurse midwives licensed pursuant to section
319	319	30980B of chapter 112.
320	320	310 Section 251. (a) The practice of midwifery by a licensed certified professional midwife
321	321	311shall include, but not be limited to:
322	322	312 (i) the practice of providing maternity care to a client during the preconception period and
323	323	313the antepartum, intrapartum and postpartum periods; provided, however, that the department
324	324	314may, through regulations or other guidance, establish rules to limit the practice of midwifery by a 16 of 28
325	325	315licensed certified professional midwife based on the risk level of the pregnancy deemed
326	326	316appropriate by the department;
327	327	317 (ii) the practice of providing newborn care; and
328	328	318 (iii) prescribing, dispensing or administering pharmaceutical agents consistent with
329	329	319section 250.
330	330	320 (b) A licensed certified professional midwife shall provide care to clients in accordance
331	331	321with the scope and standards of practice under this section and any regulations promulgated by
332	332	322the department pursuant to section 249.
333	333	323 (c) A licensed certified professional midwife shall prepare, in a format prescribed by the
334	334	324department, a written plan for the appropriate delivery of emergency care. The plan shall include,
335	335	325but not be limited to: (i) consultation with other health care providers; (ii) emergency transfer to
336	336	326a hospital; and (iii) access to neonatal intensive care units and obstetrical units or other patient
337	337	327care areas.
338	338	328 (d) When accepting a client for care, a licensed certified professional midwife shall
339	339	329obtain the client’s informed consent, which shall be evidenced by a written statement in a format
340	340	330prescribed by the department that shall be included in the client’s record of care and be signed by
341	341	331both the licensed certified professional midwife and the client. The form shall include, but not be
342	342	332limited to: (i) an acknowledgement that the licensed certified professional midwife is not
343	343	333authorized to practice medicine; (ii) a description of written practice guidelines, services
344	344	334provided and the risks and benefits of birth in the client’s chosen environment; and (iii)
345	345	335disclosure that the client may be referred for a consultation with or have their care transferred to
346	346	336a physician if the client requires care that is outside the midwife’s scope of practice. 17 of 28
347	347	337 (e) The department shall develop standards for licensed certified professional midwives
348	348	338to maintain client records, including client charts.
349	349	339 (f) The practice of midwifery shall not constitute the practice of medicine, certified nurse
350	350	340midwifery or emergency medical care.
351	351	341 (g) Nothing in this section shall be construed to authorize the department to promulgate
352	352	342regulations that require a licensed certified professional midwife to practice under the
353	353	343supervision of or in collaboration with another health care provider.
354	354	344 (h) Nothing in this section shall regulate:
355	355	345 (i) a person licensed in the commonwealth from acting within the scope of practice of the
356	356	346profession or occupation for which such person is licensed, including, but not limited to, a
357	357	347licensed physician, certified-nurse midwife or certified emergency medical technician; provided,
358	358	348however, that such person shall not represent to the public, directly or indirectly, that such person
359	359	349is licensed under section 249 and that such person shall not use any name, title or designation
360	360	350indicating that such person is licensed under said section 249;
361	361	351 (ii) a person employed as a midwife by the federal government or an agency; provided,
362	362	352however, that the person shall provide midwifery services solely under the direction and control
363	363	353of the organization by which such person is employed;
364	364	354 (iii) a traditional birth attendant who provides midwifery services to a client that has
365	365	355cultural or religious birth traditions that have historically included the attendance of traditional
366	366	356birth attendants; provided, however, that no fee for the traditional birth attendant’s services shall 18 of 28
367	367	357be contemplated, charged or received and the birth attendant shall serve only individuals and
368	368	358families in a distinct cultural or religious group;
369	369	359 (iv) persons who are members of tribal communities and provide traditional midwife
370	370	360services to members of their communities; or
371	371	361 (v) a person rendering aid in an emergency.
372	372	362 (i) A health care provider that consults with or accepts a transport, transfer or referral
373	373	363from a licensed certified professional midwife, or that provides care to a client of a licensed
374	374	364certified professional midwife or such client’s newborn, shall not be liable in a civil action for
375	375	365personal injury or death caused by an act or omission by the licensed certified professional
376	376	366midwife.
377	377	367 (j) When making determinations pursuant to this section, including, but not limited to,
378	378	368establishing rules, prescribing formats and developing standards, the department shall directly
379	379	369engage not less than 5 licensed certified professional midwives, each of whom shall have not less
380	380	370than 5 years of experience in the practice of midwifery, in the decision-making process.
381	381	371 SECTION 16. Chapter 112 of the General Laws is hereby amended by inserting after
382	382	372section 2D the following section:-
383	383	373 Section 2E. A person shall not provide ultrasound services pertaining to a possible or
384	384	374actual pregnancy except under the supervision of a provider or other licensed health care
385	385	375professional who, acting within their scope of practice, provides medical care for people who are
386	386	376pregnant or may become pregnant. 19 of 28
387	387	377 SECTION 17. Section 10A of chapter 118E of the General Laws, as appearing in the
388	388	3782022 Official Edition, is hereby amended by striking out, in lines 17 and 21, the words “or
389	389	379certified nurse midwife”, and inserting in place thereof, in each instance, the following words:-
390	390	380certified nurse midwife or licensed certified professional midwife.
391	391	381 SECTION 18. Said section 10A of said chapter 118E, as so appearing, is hereby further
392	392	382amended by inserting after the first paragraph the following 2 paragraphs:-
393	393	383 The division shall provide coverage for services rendered by a certified nurse midwife
394	394	384designated to engage in the practice of nurse-midwifery by the board of registration in nursing
395	395	385pursuant to section 80C of chapter 112 and the payment rate for a service provided by a certified
396	396	386nurse midwife that is within the scope of the certified nurse midwife’s authorization to practice
397	397	387shall be equal to the payment rate for the same service if the service was performed by a
398	398	388physician.
399	399	389 The division shall provide coverage for midwifery services, including prenatal care,
400	400	390childbirth and postpartum care, provided by a licensed certified nurse midwife regardless of the
401	401	391site of services.
402	402	392 SECTION 19. Said chapter 118E is hereby further amended by inserting after section
403	403	39310Q the following 4 sections:-
404	404	394 Section 10R. (a) For purposes of this section, the following terms shall have the
405	405	395following meanings unless the context clearly requires otherwise: 20 of 28
406	406	396 “Maternal and infant health outcomes”, outcomes arising for the gestational parent and
407	407	397the gestational parent’s offspring during the pregnancy including pregnancy complications,
408	408	398maternal morbidity, infant mortality and preterm births.
409	409	399 “Doula services”, physical, emotional and informational support provided by trained
410	410	400doulas to individuals and families during and after pregnancy, labor, childbirth, miscarriage,
411	411	401stillbirth, adoption or pregnancy loss, as determined appropriate by the division; provided,
412	412	402however, that “doula services” shall not constitute medical care.
413	413	403 (b) The division and its contracted health insurers, health plans, health maintenance
414	414	404organizations, behavioral health management firms and third-party administrators under contract
415	415	405to a Medicaid managed care organization, accountable care organization or primary care
416	416	406clinician plan shall provide coverage of doula services to pregnant individuals and postpartum
417	417	407individuals up to 12 months following the end of the pregnancy and adoptive parents of infants
418	418	408until the infants reach 1 year of age; provided, however, that the division shall cover not less than
419	419	4096 doula visits across the prenatal and 1-year postpartum period or until an adopted infant reaches
420	420	4101 year of age.
421	421	411 (c) In determining the scope of doula services, the division shall consult with the
422	422	412department of public health and bureau of family health and nutrition.
423	423	413 Section 10S. (a) For the purposes of this section, “noninvasive prenatal screening” shall
424	424	414mean a cell-free DNA prenatal screening to ascertain if a pregnancy has a risk of fetal
425	425	415chromosomal aneuploidy; provided, however, that such screening shall include, but not be
426	426	416limited to, an analysis of chromosomes 13, 18 and 21. 21 of 28
427	427	417 (b) The division and its contracted health insurers, health plans, health maintenance
428	428	418organizations, behavioral health management firms and third-party administrators under contract
429	429	419to a Medicaid managed care organization, accountable care organization or primary care
430	430	420clinician plan shall provide coverage under all benefit plans for noninvasive prenatal screening
431	431	421and shall not limit availability and coverage for such screening based on the age of the pregnant
432	432	422patient or any other risk factor, unless the limitation is part of the generally accepted standards of
433	433	423professional practice as recommended by the American College of Obstetricians and
434	434	424Gynecologists.
435	435	425 Section 10T. The division and its contracted health insurers, health plans, health
436	436	426maintenance organizations, behavioral health management firms and third-party administrators
437	437	427under contract to a Medicaid managed care organization, accountable care organization or
438	438	428primary care clinician plan shall provide coverage for post-pregnancy depression screenings. For
439	439	429the purposes of this section, the term “post-pregnancy depression” shall include postpartum
440	440	430depression occurring after childbirth or after the end of the pregnancy. Section 10U. The
441	441	431division and its and its contracted health insurers, health plans, health maintenance organizations,
442	442	432behavioral health management firms and third-party administrators under contract to a Medicaid
443	443	433managed care organization, accountable care organization or primary care clinician plan or other
444	444	434entities contracting with the division to administer benefits shall provide coverage for universal
445	445	435postpartum home visiting services, in accordance with operational standards set by the
446	446	436department of public health pursuant to section 248 of chapter 111. Such coverage shall not be
447	447	437subject to any cost-sharing; provided, however, that cost-sharing shall be required if the
448	448	438applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
449	449	439as a result of the prohibition on cost-sharing for this service. 22 of 28
450	450	440 SECTION 20. Subsection (c) of section 148C of chapter 149 of the General Laws, as
451	451	441appearing in the 2022 Official Edition, is hereby amended by striking out clauses (3) and (4) and
452	452	442inserting in place thereof the following 3 clauses:-
453	453	443 (3) attend the employee’s routine medical appointment or a routine medical appointment
454	454	444for the employee’s child, spouse, parent, or parent of spouse;
455	455	445 (4) address the psychological, physical or legal effects of domestic violence as defined in
456	456	446subsection (g1⁄2) of section 1 of chapter 151A, except that the definition of employee in
457	457	447subsection (a) will govern for purposes of this section; or
458	458	448 (5) address the employee’s own physical and mental health needs, and those of the
459	459	449employee’s spouse, if the employee or the employee’s spouse experiences pregnancy loss or a
460	460	450failed assisted reproduction, adoption or surrogacy.
461	461	451 SECTION 21. Section 47C of chapter 175 of the General Laws, as so appearing, is
462	462	452hereby amended by striking out, in line 62, the word “annually” and inserting in place thereof the
463	463	453following words:- once per calendar year.
464	464	454 SECTION 22. Section 47E of said chapter 175, as so appearing, is hereby amended by
465	465	455adding the following 2 sentences:- The reimbursement for the services provided pursuant to this
466	466	456section shall be in the same amount as the reimbursement paid under the policy to a licensed
467	467	457physician performing the service in the area served. An insurer may not reduce the
468	468	458reimbursement paid to a licensed physician in order to comply with this section.
469	469	459 SECTION 23. Said chapter 175 is hereby further amended by inserting after section
470	470	46047UU the following 2 sections:- 23 of 28
471	471	461 Section 47VV. Any policy, contract, agreement, plan or certificate of insurance issued,
472	472	462delivered or renewed within the commonwealth, which is considered creditable coverage under
473	473	463section 1 of chapter 111M, shall provide coverage for post pregnancy depression screenings.
474	474	464 Section 47WW. An individual policy of accident and sickness insurance issued pursuant
475	475	465to section 108 that provides hospital expense and surgical expense insurance or a group blanket
476	476	466or general policy of accident and sickness insurance issued pursuant to section 110 that provides
477	477	467hospital expense and surgical expense insurance that is issued or renewed within the
478	478	468commonwealth shall provide coverage for universal postpartum home visiting services, in
479	479	469accordance with operational standards set by the department of public health pursuant to section
480	480	470248 of chapter 111. Such coverage shall not be subject to any cost-sharing, including co-
481	481	471payments and co-insurance, and shall not be subject to any deductible; provided, however, that
482	482	472co-payments, coinsurance or deductibles shall be required if the applicable plan is governed by
483	483	473the Internal Revenue Code and would lose its tax-exempt status due to the prohibition on co-
484	484	474payments, coinsurance or deductibles for these services.
485	485	475 SECTION 24. Chapter 176A of the General Laws is hereby amended by inserting after
486	486	476section 8VV the following 2 sections:-
487	487	477 Section 8WW. Any contract between a subscriber and the corporation under an
488	488	478individual or group hospital service plan that is delivered, issued or renewed within the
489	489	479commonwealth shall provide coverage for post-pregnancy depression screenings. For the
490	490	480purposes of this section, the term “post-pregnancy depression” shall mean postpartum depression
491	491	481occurring after childbirth or after the end of the pregnancy. 24 of 28
492	492	482 Section 8XX. Any contract between a subscriber and the corporation under an individual
493	493	483or group hospital service plan which is delivered, issued or renewed within the commonwealth
494	494	484shall provide coverage for universal postpartum home visiting services, in accordance with
495	495	485operational standards set by the department of public health pursuant to section 248 of chapter
496	496	486111. Such coverage shall not be subject to any cost-sharing, including co-payments and co-
497	497	487insurance, and shall not be subject to any deductible; provided, however, that co-payments,
498	498	488coinsurance or deductibles shall be required if the applicable plan is governed by the Internal
499	499	489Revenue Code and would lose its tax-exempt status due to the prohibition on co-payments,
500	500	490coinsurance or deductibles for these services.
501	501	491 SECTION 25. Said chapter 176A is hereby further amended by inserting after section
502	502	4928XX the following section:-
503	503	493 Section 8YY. Any contract between a subscriber and the corporation under an individual
504	504	494or group hospital service plan, which is delivered, issued or renewed in the commonwealth, shall
505	505	495provide as a benefit to all individual subscribers and members within the commonwealth and to
506	506	496all group members having a principal place of employment within the commonwealth for
507	507	497services rendered by a certified nurse midwife designated to engage in the practice of nurse
508	508	498midwifery by the board of registration in nursing pursuant to section 80C of chapter 112;
509	509	499provided, however, that the: (i) service rendered is within the scope of the certified nurse
510	510	500midwife’s authorization to practice by the board of registration in nursing; (ii) policy or contract
511	511	501currently provides benefits for identical services rendered by a health care provider licensed by
512	512	502the commonwealth; and (iii) reimbursement for the services provided shall be in the same
513	513	503amount as the reimbursement paid under the policy to a licensed physician performing the 25 of 28
514	514	504service in the area served. An insurer may not reduce the reimbursement paid to a licensed
515	515	505physician in order to comply with this section.
516	516	506 SECTION 26. Section 4G of chapter 176B of the General Laws, as appearing in the 2018
517	517	507Official Edition, is hereby amended by adding the following 2 sentences:- The reimbursement
518	518	508for the services provided pursuant to this section shall be in the same amount as the
519	519	509reimbursement paid under the policy to a licensed physician performing the service in the area
520	520	510served. An insurer may not reduce the reimbursement paid to a licensed physician in order to
521	521	511comply with this section.
522	522	512 SECTION 27. Section 4G of chapter 176B of the General Laws, as appearing in the 2018
523	523	513Official Edition, is hereby amended by adding the following 2 sentences:- The reimbursement
524	524	514for the services provided pursuant to this section shall be in the same amount as the
525	525	515reimbursement paid under the policy to a licensed physician performing the service in the area
526	526	516served. An insurer may not reduce the reimbursement paid to a licensed physician in order to
527	527	517comply with this section.
528	528	518 SECTION 28. Chapter 176B of the General Laws is hereby amended by inserting after
529	529	519section 4VV the following 2 sections:-
530	530	520 Section 4WW. Any subscription certificate under an individual or group medical service
531	531	521agreement delivered, issued or renewed within the commonwealth shall provide coverage for
532	532	522post-pregnancy depression screenings. For the purposes of this section, the term “post-pregnancy
533	533	523depression” shall mean postpartum depression occurring after childbirth or after the end of the
534	534	524pregnancy. 26 of 28
535	535	525 Section 4XX. Any subscription certificate under an individual or group medical service
536	536	526agreement delivered, issued or renewed within the commonwealth shall provide coverage for
537	537	527universal postpartum home visiting services, in accordance with operational standards set by the
538	538	528department of public health pursuant to section 248 of chapter 111 . Such coverage shall not be
539	539	529subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to
540	540	530any deductible; provided, however, that co-payments, coinsurance or deductibles shall be
541	541	531required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-
542	542	532exempt status due to the prohibition on co-payments, coinsurance or deductibles for these
543	543	533services.
544	544	534 SECTION 29. The first paragraph of section 4 of chapter 176G is of the General Laws, as
545	545	535so appearing, is hereby amended by adding the following clause:-
546	546	536 (g) services rendered by a certified nurse midwife designated to engage in the practice of
547	547	537nurse midwifery by the board of registration in nursing pursuant to section 80C of chapter 112,
548	548	538subject to the terms of a negotiated agreement between the health maintenance organization and
549	549	539the provider of health care services; provided, however, that the reimbursement for the services
550	550	540provided shall be in the same amount as the reimbursement paid under the policy to a licensed
551	551	541physician performing the service in the area served; and provided further, that An insurer may
552	552	542not reduce the reimbursement paid to a licensed physician in order to comply with this section.
553	553	543 SECTION 30. Chapter 176G of the General Laws is hereby amended by inserting after
554	554	544section 4NN the following 2 sections:-
555	555	545 Section 4OO. An individual or group health maintenance contract that is issued or
556	556	546renewed within or without the commonwealth shall provide coverage for post-pregnancy 27 of 28
557	557	547depression screenings. For the purposes of this section, the term “post-pregnancy depression”
558	558	548shall mean postpartum depression occurring after childbirth or after the end of the pregnancy.
559	559	549 Section 4PP. Any individual or group health maintenance contract that is issued or
560	560	550renewed within or without the commonwealth shall provide coverage for universal postpartum
561	561	551home visiting services, in accordance with operational standards set by the department of public
562	562	552health pursuant to section 248 of chapter 111. Such coverage shall not be subject to any cost-
563	563	553sharing, including co-payments and co-insurance, and shall not be subject to any deductible;
564	564	554provided, however, that co-payments, coinsurance or deductibles shall be required if the
565	565	555applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status
566	566	556due to the prohibition on co-payments, coinsurance or deductibles for these services.
567	567	557 SECTION 31. (a) The department of public health shall study and report on the
568	568	558feasibility and costs of requiring malpractice liability insurance for licensed certified professional
569	569	559midwives in the commonwealth, which shall include, but not be limited to: (i) cost of
570	570	560malpractice insurance; (ii) impacts on midwifery care accessibility; and (iii) best practices in the
571	571	561area of malpractice insurance for midwives.
572	572	562 (b) Not later than August 1, 2025, the department shall submit its report and
573	573	563recommendations to the clerks of the senate and house of representatives, the joint committee on
574	574	564health care financing, the joint committee on public health and senate and house committees on
575	575	565ways and means.
576	576	566 SECTION 32. Notwithstanding any general or special law to the contrary, the initial
577	577	567midwifery engagements pursuant to sections 249, 250 and 251 of chapter 111 of the General
578	578	568Laws, inserted by section 15, shall be certified professional midwives, each of whom shall: (i) 28 of 28
579	579	569have not less than 5 years of experience in the practice of midwifery; and (ii) hold a certificate of
580	580	570completion or equivalent from an educational program or institution accredited by the Midwifery
581	581	571Education Accreditation Council.
582	582	572 SECTION 33. (a) The department of public health shall promulgate regulations pursuant
583	583	573to section 51M of chapter 111 of the General Laws not later than 180 days after the effective date
584	584	574of this act.
585	585	575 (b) Prior to promulgating initial regulations pursuant to said section 51M of said chapter
586	586	576111, the department shall consider the standards adopted by the American Association of Birth
587	587	577Centers and consult with Seven Sisters Birth Center LLC, Neighborhood Birth Center, Inc. and
588	588	578the Massachusetts Affiliate of ACNM, Inc.
589	589	579 SECTION 34. The department of public health shall adopt rules and promulgate
590	590	580regulations pursuant to sections 249 and 250 of chapter 111 within 1 year from the effective date
591	591	581of this act.