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SENATE DOCKET, NO. 1596 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 784
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Joan B. Lovely
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act promoting and enhancing the sustainability of birth centers and the midwifery workforce.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Joan B. LovelySecond EssexSusannah M. Whipps2nd Franklin2/12/2025Bruce E. TarrFirst Essex and Middlesex2/26/2025Hannah Kane11th Worcester3/3/2025Joanne M. ComerfordHampshire, Franklin and Worcester3/3/2025 1 of 12
SENATE DOCKET, NO. 1596 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 784
By Ms. Lovely, a petition (accompanied by bill, Senate, No. 784) of Joan B. Lovely, Susannah
M. Whipps, Bruce E. Tarr, Hannah Kane and others for legislation to promote and enhance the
sustainability of birth centers and the midwifery workforce. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
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An Act promoting and enhancing the sustainability of birth centers and the midwifery workforce.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 10 of the General Laws are hereby amended by inserting after
2section 35TTT the following section:-
3 Section 35UUU. (a) There shall be established and set up on the books of the
4commonwealth a separate fund known as the Midwifery Workforce Development Fund. The
5fund shall be administered by the secretary of the executive office of health and human services
6in consultation with the advisory committee established pursuant to subsection (d); provided, that
7the secretary may delegate administration of part or all of the fund to an organization
8representing certified professional midwives. There shall be credited to the fund: (i) revenue
9from appropriations or other money authorized by the general court and specifically designated
10to be credited to the fund; (ii) federal grants and other federal funds designated for maternal
11health; (iii) interest earned on such revenues; and (iv) all other funds from public and private
12sources credited or transferred into the fund, including gifts, public or private grants, settlements 2 of 12
13and donations. Any unexpended balance in the fund at the end of a fiscal year shall not revert to
14the General Fund and shall remain available for expenditure in subsequent fiscal years. No
15expenditure made from the fund shall cause the fund to become deficient at any point. Any fiscal
16year-end balance in the fund that is subject to appropriation shall not be subject to section 5C of
17chapter 29. The fund shall not be subject to appropriation.
18 (b) Expenditures from the fund shall be used for:
19 (i) providing assistance to students in education and training programs to qualify them to
20become licensed certified professional midwives, including, but not limited to:
21 (A) program costs, tuition, books and fees related to the cost of education and training for
22participants in training and educational programs, including distance learning programs and
23including tuition and other costs related to obtaining a midwifery degree or Midwifery Bridge
24Certificate;
25 (B) costs related to obtaining an applicable license, including, but not limited to,
26examination and licensing fees;
27 (C) stipends for program participants; and
28 (D) stipends for childcare and transportation for program participants;
29 (ii) a student loan forgiveness program for certified professional midwives and certified
30nurse midwives; provided, that the program may require participants to practice in an
31underserved area or serve marginalized populations, as defined by the secretary in consultation
32with the advisory committee; 3 of 12
33 (iii) a grant program to fund local initiatives supporting the development of educational
34programs for certified professional midwives;
35 (iv) retention of practicing midwives, and mental health and psychosocial support for
36certified professional midwives and certified nurse midwives; and
37 (v) with the approval of the advisory committee, other purposes consistent with the goals
38of the fund.
39 (c) Annually, not later than December 1, the secretary of health and human services shall
40report on the activities of the fund to the clerks of the house of representatives and the senate and
41to the house and senate committees on ways and means and the joint committee on children,
42families and persons with disabilities. The report shall include: (i) an accounting of expenditures
43made from the fund with a description of the authorized purpose of each expenditure; (ii) an
44accounting of amounts credited to the fund; and (iii) any unexpended balance remaining in the
45fund. The report may also include analysis and recommendations prepared by the advisory
46committee, which may include recommendations for changes to this section. The report shall be
47published on the public web site of the executive office of health and human services or the
48department of public health.
49 (d) There shall be an advisory committee to make recommendations concerning the
50operation and expenditures of the fund. The advisory committee that shall consist of the
51following members: a representative of the Massachusetts chapter of the National Association of
52Certified Professional Midwives, who shall serve as chair, a representative of the American
53College of Nurse Midwives; a member of the Pregnancy, Infancy and Early Childhood Division
54of the Department of Public Health; a representative of the Massachusetts League of Community 4 of 12
55Health Centers; and the following members chosen by the chair: a representative of a midwifery
56educational program; a representative of a community college; a representative of an
57organization concerned about reproductive justice and health equity; a representative of a safety-
58net hospital; and a representative of a free-standing birth center.
59 SECTION 2. Chapter 32A of the General Laws is hereby amended by inserting after
60section 17W the following sections:-
61 Section 17X. (a) The commission shall ensure that the rate of payment for services
62provided to an active or retired employee of the commonwealth who is insured under the group
63insurance commission that are rendered by a certified nurse-midwife authorized to engage in the
64practice of nurse-midwifery by the board of registration in nursing pursuant to section 80C of
65chapter 112 that is within the scope of the certified nurse-midwife's authorization to practice
66shall be no less than the payment rate for the same service if performed by a physician,
67regardless of the site of services, or length of stay.
68 (b) The commission shall ensure that the rate of payment for services for services
69provided to an active or retired employee of the commonwealth who is insured under the group
70insurance that are rendered by a licensed certified professional midwife authorized to engage in
71the practice of midwifery by the board of registration in midwifery pursuant to section 110 of
72chapter 13 that is within the scope of the licensed certified professional midwife's authorization
73to practice shall be no less than the payment rate for the same service if performed by a
74physician, regardless of the site of services, or length of stay.
75 Section 17Y. The commission shall ensure that the rate of payment for services provided
76to an active or retired employee of the commonwealth who is insured under the group insurance 5 of 12
77commission that are rendered by or within a licensed freestanding birth center regulated under
78section 51M of chapter 111, including newborn care and care provided prior to an intrapartum
79transfer to another facility, shall be no less than the payment rate for the same services if
80performed at a hospital, regardless of the site of services, or length of stay. Such payment shall
81include a reasonable facility fee to be negotiated between the birth center and the commission;
82provided, that the facility fee shall be no less than a minimum fee amount determined by the
83department of public health in consultation with the center for health information and analysis,
84the health policy commission, and operators and prospective operators of birth centers in the
85commonwealth.
86 SECTION 3. The third paragraph of section 10A of chapter 118E of the General Laws, as
87inserted by section 40 of chapter 186 of the acts of 2024, is hereby amended by adding the
88following sentences:- The payment rate for a service provided by a licensed certified
89professional midwife that is within the scope of the licensed certified professional midwife’s
90authorization to practice shall be no less than the payment rate for the same service if performed
91by a physician, regardless of the site of services. The payment rate for services provided by or
92within a licensed freestanding birth center regulated under section 51M of chapter 111, including
93newborn care and care provided prior to an intrapartum transfer to another facility, shall be no
94less than the payment rate for the same services if performed at a hospital, regardless of site of
95services or length of stay. Such payment shall include a reasonable facility fee to be negotiated
96between the birth center and the division; provided, that the facility fee shall be no less than a
97minimum fee amount determined by the department of public health in consultation with the
98center for health information and analysis, the health policy commission, and operators and
99prospective operators of birth centers in the commonwealth. 6 of 12
100 SECTION 4. Chapter 175 of the General Laws is hereby amended by inserting after
101section 47YY the following sections:-
102 Section 47ZZ. (a) A policy, contract, agreement, plan or certificate of insurance issued,
103delivered or renewed within or without the commonwealth shall provide that the rate of payment
104for services rendered by a certified nurse-midwife authorized to engage in the practice of nurse-
105midwifery by the board of registration in nursing pursuant to section 80C of chapter 112 that is
106within the scope of the certified nurse-midwife's authorization to practice shall be no less than
107the payment rate for the same service if performed by a physician, regardless of the site of
108services, or length of stay.
109
110 (b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or
111renewed within or without the commonwealth shall provide that the rate of payment for services
112rendered by a licensed certified professional midwife authorized to engage in the practice of
113midwifery by the board of registration in midwifery pursuant to section 110 of chapter 13 that is
114within the scope of the licensed certified professional midwife's authorization to practice shall be
115no less than the payment rate for the same service if performed by a physician, regardless of the
116site of services, or length of stay.
117 Section 47AAA. A policy, contract, agreement, plan or certificate of insurance issued,
118delivered or renewed within or without the commonwealth shall provide that the rate of payment
119for services rendered by or within a licensed freestanding birth center regulated under section
12051M of chapter 111, including newborn care and care provided prior to an intrapartum transfer to
121another facility, shall be no less than the payment rate for the same services if performed at a 7 of 12
122hospital, regardless of the site of services, or length of stay. Such payment shall include a
123reasonable facility fee to be negotiated between the birth center and the payer; provided, that the
124facility fee shall be no less than a minimum fee amount determined by the department of public
125health in consultation with the center for health information and analysis, the health policy
126commission, and operators and prospective operators of birth centers in the commonwealth.
127 SECTION 5. Chapter 176A of the General Laws is hereby amended by inserting after
128section 8ZZ the following sections:-
129 Section 8AAA. (a) A contract between a subscriber and the corporation under an
130individual or group hospital service plan that is delivered, issued or renewed within or without
131the commonwealth shall provide that the rate of payment for services rendered by a certified
132nurse-midwife authorized to engage in the practice of nurse-midwifery by the board of
133registration in nursing pursuant to section 80C of chapter 112 that is within the scope of the
134certified nurse-midwife's authorization to practice shall be no less than the payment rate for the
135same service if performed by a physician, regardless of the site of services.
136
137 (b) A contract between a subscriber and the corporation under an individual or group
138hospital service plan that is delivered, issued or renewed within or without the commonwealth
139shall provide that the rate of payment for services rendered by a licensed certified professional
140midwife authorized to engage in the practice of midwifery by the board of registration in
141midwifery pursuant to section 110 of chapter 13 that is within the scope of the licensed certified
142professional midwife's authorization to practice shall be no less than the payment rate for the
143same service if performed by a physician, regardless of the site of services, or length of stay. 8 of 12
144 Section 8BBB. A contract between a subscriber and the corporation under an individual
145or group hospital service plan that is issued, delivered or renewed within or without the
146commonwealth shall provide that the rate of payment for services rendered by or within a
147licensed freestanding birth center regulated under section 51M of chapter 111, including
148newborn care and care provided prior to an intrapartum transfer to another facility, shall be no
149less than the payment rate for the same services if performed at a hospital, regardless of the site
150of services, or length of stay. Such payment shall include a reasonable facility fee to be
151negotiated between the birth center and the payer; provided, that the facility fee shall be no less
152than a minimum fee amount determined by the department of public health in consultation with
153the center for health information and analysis, the health policy commission, and operators and
154prospective operators of birth centers in the commonwealth.
155 SECTION 6. Chapter 176B of the General Laws is hereby amended by inserting after
156section 4ZZ the following sections:-
157 Section 4AAA. (a) Any subscription certificate under an individual or group medical
158service agreement that is delivered, issued or renewed within the commonwealth shall provide
159that the rate of payment for services rendered by a certified nurse-midwife authorized to engage
160in the practice of nurse-midwifery by the board of registration in nursing pursuant to section 80C
161of chapter 112 that is within the scope of the certified nurse-midwife's authorization to practice
162shall be no less than the payment rate for the same service if performed by a physician,
163regardless of the site of services.
164 9 of 12
165 (b) Any subscription certificate under an individual or group medical service agreement
166that is delivered, issued or renewed within the commonwealth shall provide that the rate of
167payment for services rendered by a licensed certified professional midwife authorized to engage
168in the practice of midwifery by the board of registration in midwifery pursuant to section 110 of
169chapter 13 that is within the scope of the licensed certified professional midwife's authorization
170to practice shall be no less than the payment rate for the same service if performed by a
171physician, regardless of the site of services, or length of stay.
172 Section 4BBB. Any subscription certificate under an individual or group medical service
173agreement that is issued, delivered or renewed within or without the commonwealth shall
174provide that the rate of payment for services rendered by or within a licensed freestanding birth
175center regulated under section 51M of chapter 111, including newborn care and care provided
176prior to an intrapartum transfer to another facility, shall be no less than the payment rate for the
177same services if performed at a hospital, regardless of the site of services, or length of stay. Such
178payment shall include a reasonable facility fee to be negotiated between the birth center and the
179payer; provided, that the facility fee shall be no less than a minimum fee amount determined by
180the department of public health in consultation with the center for health information and
181analysis, the health policy commission, and operators and prospective operators of birth centers
182in the commonwealth.
183 SECTION 7. Chapter 176G of the General Laws is hereby amended by inserting after
184section 4RR the following sections:-
185 Section 4SS. (a) Any individual or group health maintenance contract that is issued or
186renewed within or without the commonwealth shall provide that the rate of payment for services 10 of 12
187rendered by a certified nurse-midwife authorized to engage in the practice of nurse-midwifery by
188the board of registration in nursing pursuant to section 80C of chapter 112 that is within the
189scope of the certified nurse-midwife's authorization to practice shall be no less than the payment
190rate for the same service if performed by a physician, regardless of the site of services, or length
191of stay.
192 (b) Any subscription certificate under an individual or group medical service agreement
193that is delivered, issued or renewed within the commonwealth shall provide that the rate of
194payment for services rendered by a licensed certified professional midwife authorized to engage
195in the practice of midwifery by the board of registration in midwifery pursuant to section 110 of
196chapter 13 that is within the scope of the licensed certified professional midwife's authorization
197to practice shall be no less than the payment rate for the same service if performed by a
198physician, regardless of the site of services, or length of stay.
199 Section 4TT. Any individual or group health maintenance contract that is issued,
200delivered or renewed within or without the commonwealth shall provide that the rate of payment
201for services rendered by or within a licensed freestanding birth center regulated under section
20251M of chapter 111, including newborn care and care provided prior to an intrapartum transfer to
203another facility, shall be no less than the payment rate for the same services if performed at a
204hospital, or length of stay. Such payment shall include a reasonable facility fee to be negotiated
205between the birth center and the payer; provided, that the facility fee shall be no less than a
206minimum fee amount determined by the department of public health in consultation with the
207center for health information and analysis, the health policy commission, and operators and
208prospective operators of birth centers in the commonwealth. 11 of 12
209 SECTION 8. (a) No later than 12 months after the effective date of this act, the
210department of public health shall establish licensing requirements, plan review checklists and
211facility guidelines specific for birth centers that reflect the particular needs of birth centers and
212low-risk childbearing people. The requirements and guidelines shall be developed in consultation
213with operators of birth centers in the commonwealth, people involved with the development of
214prospective birth centers in the commonwealth, and groups concerned with improving birth
215outcomes, midwifery and birth centers, including, but not limited to, the American College of
216Nurse-Midwives, the National Association of Certified Professional Midwives, the American
217Association of Birth Centers, and the Commission for the Accreditation of Birth Centers.
218 (b) No later than 90 days after the effective date of this act, the department of public
219health shall waive plan review fees for birth centers which demonstrate substantial financial
220hardship. The department shall issue guidelines and an application process for birth centers
221seeking a waiver of plan review fees under this subsection; provided, that the guidelines and
222application process shall be developed in consultation with operators of birth centers in the
223commonwealth, people involved with the development of prospective birth centers in the
224commonwealth, and groups concerned with improving birth outcomes, midwifery and birth
225centers, including, but not limited to, the American College of Nurse-Midwives and the National
226Association of Certified Professional Midwives.
227 SECTION 9. No later than 18 months after the effective date of this act, the department
228of public health, or a third party designated by the department, shall participate in the
229Community Birth Data Registry organized by the Foundation for Health Care Quality, or an
230equivalent validated national data collection registry, for the purposes of quality improvement 12 of 12
231and research, and direct all midwives in the commonwealth to record data on community births
232with the registry.
233 Aggregate data as defined by the Board of Registration in Midwifery and as collected by
234the registry shall be made available to the Department of Public Health Vital Records Division,
235and shall be included in reports on births and birth outcomes reported by the department.
236Researchers who meet reasonable standards and who have passed an appropriate ethics review
237established by the department may have access to data collected by the registry. Confidential
238birth data involving identifiable individuals shall under no circumstances be used to determine
239whether a person is eligible for a license, privilege, right, grant, or benefit, or whether such
240should be revoked. No individual or entity may query the dataset for purposes of investigation or
241discipline.
242 No later than 6 months after the effective date of this act, the department of public health
243shall issue a report on progress towards establishing a community birth data registry in
244Massachusetts. The report shall identify any barriers identified by the department, how the
245department intends to overcome the barriers, and the cost to the Commonwealth and midwives
246and birth centers of participation. The report shall be filed with the house and senate committees
247on ways and means and the joint committees on public health and children, families and persons
248with disabilities, and published on the web site of the department.
249 For the purposes of this section, the term “community births” shall mean a birth that is
250planned to occur in a home, birth center, or other location other than a hospital, and including
251those that involve or include transfer to a hospital.