MD
Maryland House Bill HB838

Maryland 2025 Regular Session

Maryland House Bill HB838 Compare Versions

OldNewDifferences
11
22
33 EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
44 [Brackets] indicate matter deleted from existing law.
5- Underlining indicates amendments to bill.
6- Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7-amendment.
85 *hb0838*
96
107 HOUSE BILL 838
118 J2 5lr3085
12- CF SB 854
13-By: Delegate Cullison Delegates Cullison, Alston, Bagnall, Bhandari, Guzzone,
14-Hill, Hutchinson, S. Johnson, Kerr, Kipke, Lopez, Martinez, Pena–Melnyk,
15-Rosenberg, Ross, Taveras, White Holland, Woods, and Woorman
9+ CF 5lr3348
10+By: Delegate Cullison
1611 Introduced and read first time: January 29, 2025
1712 Assigned to: Health and Government Operations
18-Committee Report: Favorable with amendments
19-House action: Adopted
20-Read second time: March 6, 2025
2113
22-CHAPTER ______
14+A BILL ENTITLED
2315
2416 AN ACT concerning 1
2517
2618 Health Occupations – Licensed Direct–Entry Midwives – Revisions 2
2719
2820 FOR the purpose of altering the scope of practice of licensed direct–entry midwives; 3
2921 providing that the practice of direct–entry midwifery is independent and does not 4
3022 require oversight by another health care practitioner; repealing the requirement that 5
3123 licensed direct–entry midwives report certain information to the Direct–Entry 6
3224 Midwifery Advisory Committee; altering the disciplinary actions that may be taken 7
3325 against a licensed direct–entry midwife or an applicant for a license; continuing the 8
3426 Maryland Licensure of Direct–Entry Midwives Act in accordance with the provisions 9
3527 of the Maryland Program Evaluation Act (sunset law) by extending to a certain date 10
3628 the termination provisions relating to the Act; and generally relating to licensed 11
3729 direct–entry midwives. 12
3830
3931 BY repealing and reenacting, without amendments, 13
4032 Article – Health Occupations 14
4133 Section 8–6C–01(a), (d), (e), (f), and (p) 15
4234 Annotated Code of Maryland 16
4335 (2021 Replacement Volume and 2024 Supplement) 17
4436
4537 BY repealing and reenacting, with amendments, 18
4638 Article – Health Occupations 19
4739 Section 8–6C–01(n), 8–6C–02, 8–6C–03, 8–6C–04(a) and (b)(2)(x), 8–6C–08, 20
48-8–6C–10, 8–6C–20(a), and 8–6C–26 21 2 HOUSE BILL 838
40+8–6C–10, 8–6C–20(a), and 8–6C–26 21
41+ Annotated Code of Maryland 22
42+ (2021 Replacement Volume and 2024 Supplement) 23
43+
44+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 24
45+That the Laws of Maryland read as follows: 25
46+
47+Article – Health Occupations 26
48+ 2 HOUSE BILL 838
4949
5050
51- Annotated Code of Maryland 1
52- (2021 Replacement Volume and 2024 Supplement) 2
51+8–6C–01. 1
5352
54- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 3
55-That the Laws of Maryland read as follows: 4
53+ (a) In this subtitle the following words have the meanings indicated. 2
5654
57-Article – Health Occupations 5
55+ (d) “Board” means the State Board of Nursing. 3
5856
59-8–6C–01. 6
57+ (e) “Committee” means the Direct–Entry Midwifery Advisory Committee 4
58+established under § 8–6C–11 of this subtitle. 5
6059
61- (a) In this subtitle the following words have the meanings indicated. 7
60+ (f) “Health care practitioner” means: 6
6261
63- (d) “Board” means the State Board of Nursing. 8
62+ (1) An individual certified as a nurse–midwife or a nurse practitioner 7
63+under this title; or 8
6464
65- (e) “Committee” means the Dir ect–Entry Midwifery Advisory Committee 9
66-established under § 8–6C–11 of this subtitle. 10
65+ (2) A physician licensed under Title 14 of this article. 9
6766
68- (f) “Health care practitioner” means: 11
67+ (n) (1) “Patient” means [a woman] AN INDIVIDUAL for whom a licensed 10
68+direct–entry midwife performs services. 11
6969
70- (1) An individual certified as a nurse–midwife or a nurse practitioner 12
71-under this title; or 13
70+ (2) “Patient” includes [a woman’s] AN INDIVIDUAL ’S newborn for the 12
71+purpose of perinatal or postpartum care. 13
7272
73- (2) A physician licensed under Title 14 of this article. 14
73+ (p) (1) “Practice direct–entry midwifery” means: 14
7474
75- (n) (1) “Patient” means [a woman] AN INDIVIDUAL for whom a licensed 15
76-direct–entry midwife performs services. 16
75+ (i) Providing maternity care that is consistent with a midwife’s 15
76+training, education, and experience; and 16
7777
78- (2) “Patient” includes [a woman’s] AN INDIVIDUAL ’S newborn for the 17
79-purpose of perinatal or postpartum care. 18
78+ (ii) Identifying and referring patients who require medical care to an 17
79+appropriate health care provider. 18
8080
81- (p) (1) “Practice direct–entry midwifery” means: 19
81+ (2) “Practice direct–entry midwifery” includes the activities described in § 19
82+8–6C–02 of this subtitle. 20
8283
83- (i) Providing maternity care that is consistent with a midwife’s 20
84-training, education, and experience; and 21
84+8–6C–02. 21
8585
86- (ii) Identifying and referring patients who require medical care to an 22
87-appropriate health care provider. 23
86+ (a) The practice of direct–entry midwifery includes: 22
8887
89- (2) “Practice direct–entry midwifery” includes the activities described in § 24
90-8–6C–02 of this subtitle. 25
88+ (1) Providing the necessary supervision, care, and advice to a patient 23
89+during a low–risk pregnancy, labor, delivery, and postpartum period; and 24
9190
92-8–6C–02. 26
91+ (2) Newborn care authorized under this subtitle that is provided in a 25
92+manner that is: 26
9393
94- (a) The practice of direct–entry midwifery includes: 27
94+ (i) Consistent with national direct–entry midwifery standards; and 27
95+ HOUSE BILL 838 3
9596
96- (1) Providing the necessary supervision, care, and advice to a patient 28
97-during a low–risk pregnancy, labor, delivery, and postpartum period; and 29 HOUSE BILL 838 3
97+
98+ (ii) Based on the acquisition of clinical skills necessary for the care 1
99+of pregnant women and newborns, including antepartum, intrapartum, and postpartum 2
100+care. 3
101+
102+ (b) The practice of direct–entry midwifery also includes: 4
103+
104+ (1) Obtaining informed consent to provide services to the patient; 5
105+
106+ (2) Discussing: 6
107+
108+ (i) Any general risk factors associated with the services to be 7
109+provided; 8
110+
111+ (ii) Any specific risk factors pertaining to the health and 9
112+circumstances of the individual patient; 10
113+
114+ (iii) Conditions that preclude care by a licensed direct–entry midwife; 11
115+and 12
116+
117+ (iv) The conditions under which consultation, transfer of care, or 13
118+transport of the patient must be implemented; 14
119+
120+ (3) Obtaining a health history of the patient and performing a physical 15
121+examination; 16
122+
123+ (4) Developing a written plan of care specific to the patient, to ensure 17
124+continuity of care throughout the antepartum, intrapartum, and postpartum periods, that 18
125+includes: 19
126+
127+ (i) A plan for the management of any specific risk factors pertaining 20
128+to the individual health and circumstances of the individual patient; and 21
129+
130+ (ii) A plan to be followed in the event of an emergency, including a 22
131+plan for transportation; 23
132+
133+ (5) Evaluating the results of patient care; 24
134+
135+ (6) Consulting and collaborating with a health care practitioner regarding 25
136+the care of a patient, and referring and transferring care to a health care provider, as 26
137+required; 27
138+
139+ (7) Referral of all patients, within 72 hours after delivery, to a pediatric 28
140+health care practitioner for care of the newborn; 29
141+
142+ (8) As approved by the Board: 30
143+
144+ (i) Obtaining and administering medications; and 31 4 HOUSE BILL 838
98145
99146
100147
101- (2) Newborn care authorized under this subtitle that is provided in a 1
102-manner that is: 2
148+ (ii) Obtaining and using equipment and devices; 1
103149
104- (i) Consistent with national direct–entry midwifery standards; and 3
150+ (9) Obtaining appropriate screening and testing, including laboratory 2
151+tests, urinalysis, and ultrasound; 3
105152
106- (ii) Based on the acquisition of clinical skills necessary for the care 4
107-of pregnant women and newborns, including antepartum, intrapartum, and postpartum 5
108-care. 6
153+ (10) Providing [prenatal] care during the antepartum period, with 4
154+consultation or referral as required; 5
109155
110- (b) The practice of direct–entry midwifery also includes: 7
156+ (11) Providing care during the intrapartum period, including: 6
111157
112- (1) Obtaining informed consent to provide services to the patient; 8
158+ (i) Monitoring and evaluating the condition of the patient and fetus; 7
113159
114- (2) Discussing: 9
160+ (ii) [At the onset of active labor notifying the pediatric health care 8
161+practitioner that delivery is imminent; 9
115162
116- (i) Any general risk factors associated with the services to be 10
117-provided; 11
163+ (iii)] Performing emergency procedures, including: 10
118164
119- (ii) Any specific risk factors pertaining to the health and 12
120-circumstances of the individual patient; 13
165+ 1. Administering approved medications; 11
121166
122- (iii) Conditions that preclude care by a licensed direct–entry midwife; 14
123-and 15
167+ 2. Administering intravenous fluids for stabilization; 12
124168
125- (iv) The conditions under which consultation, transfer of care, or 16
126-transport of the patient must be implemented; 17
169+ 3. Performing an emergency episiotomy; and 13
127170
128- (3) Obtaining a health history of the patient and performing a physical 18
129-examination; 19
171+ 4. Providing care while on the way to a hospital under 14
172+circumstances in which emergency medical services have not been activated; 15
130173
131- (4) Developing a written plan of care specific to the patient, to ensure 20
132-continuity of care throughout the antepartum, intrapartum, and postpartum periods, that 21
133-includes: 22
174+ [(iv)] (III) Activating emergency medical services for an emergency; 16
175+and 17
134176
135- (i) A plan for the management of any specific risk factors pertaining 23
136-to the individual health and circumstances of the individual patient; and 24
177+ [(v)] (IV) Delivering in an out–of–hospital setting; 18
137178
138- (ii) A plan to be followed in the event of an emergency, including a 25
139-plan for transportation; 26
179+ (12) Participating in peer review as required under § 8–6C–18(e)(2) of this 19
180+subtitle; 20
140181
141- (5) Evaluating the results of patient care; 27
182+ (13) Providing care during the postpartum period, including: 21
142183
143- (6) Consulting and collaborating with a health care practitioner regarding 28
144-the care of a patient, and referring and transferring care to a health care provider, as 29
145-required; 30
146- 4 HOUSE BILL 838
184+ (i) Suturing of first and second degree perineal or labial lacerations, 22
185+or suturing of an episiotomy with the administration of a local anesthetic; and 23
147186
187+ (ii) Making further contact with the patient within 48 hours, within 24
188+2 weeks, and at 6 weeks after the delivery to assess for hemorrhage, preeclampsia, 25
189+thrombo–embolism, infection, and emotional well–being; 26
148190
149- (7) Referral of all patients, within 72 hours after delivery, to a pediatric 1
150-health care practitioner for care of the newborn; 2
151-
152- (8) As approved by the Board: 3
153-
154- (i) Obtaining and administering medications; and 4
155-
156- (ii) Obtaining and using equipment and devices; 5
157-
158- (9) Obtaining appropriate screening and testing, including laboratory 6
159-tests, urinalysis, and ultrasound; 7
160-
161- (10) Providing [prenatal] care during the antepartum period, with 8
162-consultation or referral as required; 9
163-
164- (11) Providing care during the intrapartum period, including: 10
165-
166- (i) Monitoring and evaluating the condition of the patient and fetus; 11
167-
168- (ii) [At the onset of active labor notifying the pediatric health care 12
169-practitioner that delivery is imminent; 13
170-
171- (iii)] Performing emergency procedures, including: 14
172-
173- 1. Administering approved medications; 15
174-
175- 2. Administering intravenous fluids for stabilization; 16
176-
177- 3. Performing an emergency episiotomy; and 17
178-
179- 4. Providing care while on the way to a hospital under 18
180-circumstances in which emergency medical services have not been activated; 19
181-
182- [(iv)] (III) Activating emergency medical services for an emergency; 20
183-and 21
184-
185- [(v)] (IV) Delivering in an out–of–hospital setting; 22
186-
187- (12) Participating in peer review as required under § 8–6C–18(e)(2) of this 23
188-subtitle; 24
189-
190- (13) Providing care during the postpartum period, including: 25
191-
192- (i) Suturing of first and second degree perineal or labial lacerations, 26
193-or suturing of an episiotomy with the administration of a local anesthetic; and 27
191+ (14) Providing routine care for the newborn for up to 72 hours after delivery, 27
192+exclusive of administering immunizations, including: 28
194193 HOUSE BILL 838 5
195194
196195
197- (ii) Making further contact with the patient within 48 hours, within 1
198-2 weeks, and at 6 weeks after the delivery to assess for hemorrhage, preeclampsia, 2
199-thrombo–embolism, infection, and emotional well–being; 3
196+ (i) Immediate care at birth, including resuscitating as needed, 1
197+performing a newborn examination, and administering intramuscular vitamin K and eye 2
198+ointment for prevention of ophthalmia neonatorum; 3
200199
201- (14) Providing routine care for the newborn for up to 72 hours after delivery, 4
202-exclusive of administering immunizations, including: 5
200+ (ii) Assessing newborn feeding and hydration; 4
203201
204- (i) Immediate care at birth, including resuscitating as needed, 6
205-performing a newborn examination, and administering intramuscular vitamin K and eye 7
206-ointment for prevention of ophthalmia neonatorum; 8
202+ (iii) Performing metabolic screening and reporting on the screening 5
203+in accordance with the regulations related to newborn screenings that are adopted by the 6
204+Department; 7
207205
208- (ii) Assessing newborn feeding and hydration; 9
206+ (iv) Performing critical congenital heart disease screening and 8
207+reporting on the screening in accordance with the regulations related to newborn 9
208+screenings that are adopted by the Department; 10
209209
210- (iii) Performing metabolic screening and reporting on the screening 10
211-in accordance with the regulations related to newborn screenings that are adopted by the 11
212-Department; 12
210+ (v) If unable to perform the screening required under item (iii) or (iv) 11
211+of this item, referring the newborn to a pediatric health care practitioner to perform the 12
212+screening within 24 to 48 hours after delivery; and 13
213213
214- (iv) Performing critical congenital heart disease screening and 13
215-reporting on the screening in accordance with the regulations related to newborn 14
216-screenings that are adopted by the Department; 15
214+ (vi) Referring the infant to an audiologist for a hearing screening in 14
215+accordance with the regulations related to newborn screenings that are adopted by the 15
216+Department; 16
217217
218- (v) If unable to perform the screening required under item (iii) or (iv) 16
219-of this item, referring the newborn to a pediatric health care practitioner to perform the 17
220-screening within 24 to 48 hours after delivery; and 18
218+ (15) [Within 24 hours after delivery, notifying a pediatric health care 17
219+practitioner of the delivery; 18
221220
222- (vi) Referring the infant to an audiologist for a hearing screening in 19
223-accordance with the regulations related to newborn screenings that are adopted by the 20
224-Department; 21
221+ (16)] Within 72 hours after delivery: 19
225222
226- (15) [Within 24 hours after delivery, notifying a pediatric health care 22
227-practitioner of the delivery; 23
223+ (i) Transferring health records to the pediatric health care 20
224+practitioner, including documentation of the performance of the screenings required under 21
225+item (14)(iii) and (iv) of this subsection; and 22
228226
229- (16)] Within 72 hours after delivery: 24
227+ (ii) Referring the newborn to a pediatric health care practitioner; 23
230228
231- (i) Transferring health records to the pediatric health care 25
232-practitioner, including documentation of the performance of the screenings required under 26
233-item (14)(iii) and (iv) of this subsection; and 27
229+ [(17)] (16) Providing the following care of the newborn beyond the first 72 24
230+hours after delivery: 25
234231
235- (ii) Referring the newborn to a pediatric health care practitioner; 28
232+ (i) Weight checks and general observation of the newborn’s activity, 26
233+with abnormal findings communicated to the newborn’s pediatric health care practitioner; 27
236234
237- [(17)] (16) Providing the following care of the newborn beyond the first 72 29
238-hours after delivery: 30
235+ (ii) Assessment of newborn feeding and hydration; and 28
239236
240- (i) Weight checks and general observation of the newborn’s activity, 31
241-with abnormal findings communicated to the newborn’s pediatric health care practitioner; 32
237+ (iii) [Breastfeeding] LACTATION support and counseling; and 29
242238
243- (ii) Assessment of newborn feeding and hydration; and 33 6 HOUSE BILL 838
239+ [(18)] (17) Providing limited services to the patient after the postpartum 30
240+period, including: 31
241+ 6 HOUSE BILL 838
242+
243+
244+ (i) [Breastfeeding] LACTATION support and counseling; and 1
245+
246+ (ii) Counseling and referral for all family planning methods. 2
247+
248+ (c) The practice of direct–entry midwifery does not include: 3
249+
250+ (1) Pharmacological induction or augmentation of labor or artificial 4
251+rupture of membranes prior to the onset of labor; 5
252+
253+ (2) Surgical delivery or any surgery except an emergency episiotomy; 6
254+
255+ (3) Use of forceps or vacuum extractor; 7
256+
257+ (4) Except for the administration of a local anesthetic, administration of an 8
258+anesthetic; 9
259+
260+ (5) Administration of any kind of narcotic analgesic; or 10
261+
262+ (6) Administration of any prescription medication in a manner that 11
263+violates this subtitle. 12
264+
265+ (D) EXCEPT FOR A TRANSFER REQUIRED UNDER § 8–6C–03 OF THIS 13
266+SUBTITLE OR A CONSULTATION RE QUIRED UNDER § 8–6C–04 OF THIS SUBTITLE , 14
267+THE PRACTICE OF DIREC T–ENTRY MIDWIFERY IS I NDEPENDENT AND DOES NOT 15
268+REQUIRE OVERSIGHT BY ANOTHER HEALTH CARE PRACTITI ONER. 16
269+
270+8–6C–03. 17
271+
272+ A licensed direct–entry midwife may not assume or continue to take responsibility 18
273+for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care 19
274+to a health care practitioner for a patient who is already under the care of the licensed 20
275+direct–entry midwife, if any of the following disorders or situations is found to be present 21
276+at the initial interview or if any of the following disorders or situations occur as prenatal 22
277+care proceeds: 23
278+
279+ (1) Diabetes mellitus, including uncontrolled gestational diabetes; 24
280+
281+ (2) Hyperthyroidism treated with medication; 25
282+
283+ (3) Uncontrolled hypothyroidism; 26
284+
285+ (4) Epilepsy with seizures or antiepileptic drug use during the previous 12 27
286+months; 28
287+
288+ (5) Coagulation disorders; 29
289+
290+ (6) Chronic pulmonary disease; 30 HOUSE BILL 838 7
244291
245292
246293
247- (iii) [Breastfeeding] LACTATION support and counseling; and 1
294+ (7) Heart disease in which there are arrhythmias or murmurs except when, 1
295+after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a 2
296+licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that 3
297+midwifery care may proceed; 4
248298
249- [(18)] (17) Providing limited services to the patient after the postpartum 2
250-period, including: 3
299+ (8) Hypertension, including pregnancy–induced hypertension (PIH); 5
251300
252- (i) [Breastfeeding] LACTATION support and counseling; and 4
301+ (9) Renal disease; 6
253302
254- (ii) Counseling and referral for all family planning methods. 5
303+ (10) Except as otherwise provided in § 8–6C–04(a)(11) of this subtitle, Rh 7
304+sensitization with positive antibody titer; 8
255305
256- (c) The practice of direct–entry midwifery does not include: 6
306+ (11) Previous uterine surgery, including a cesarean section or myomectomy; 9
257307
258- (1) Pharmacological induction or augmentation of labor or artificial 7
259-rupture of membranes prior to the onset of labor; 8
308+ (12) Indications that the fetus has died in utero; 10
260309
261- (2) Surgical delivery or any surgery except an emergency episiotomy; 9
310+ (13) Premature labor (gestation less than 37 weeks); 11
262311
263- (3) Use of forceps or vacuum extractor; 10
312+ (14) Multiple gestation; 12
264313
265- (4) Except for the administration of a local anesthetic, administration of an 11
266-anesthetic; 12
314+ (15) Noncephalic presentation at or after 38 weeks; 13
267315
268- (5) Administration of any kind of narcotic analgesic; or 13
316+ (16) Placenta previa or abruption; 14
269317
270- (6) Administration of any prescription medication in a manner that 14
271-violates this subtitle. 15
318+ (17) Preeclampsia; 15
272319
273- (D) EXCEPT FOR A TRANSFER RE QUIRED UNDER § 8–6C–03 OF THIS 16
274-SUBTITLE OR A CONSUL TATION REQUIRED UNDE R § 8–6C–04 OF THIS SUBTITLE , 17
275-THE THE PRACTICE OF DIRECT –ENTRY MIDWIFERY IS I NDEPENDENT AND DOES NOT 18
276-REQUIRE OVERSIGHT BY ANOTHER HEALTH CARE PRACTITIONER . 19
320+ (18) [Severe anemia, defined as hemoglobin less than 10 g/dL; 16
277321
278-8–6C–03. 20
322+ (19)] Uncommon diseases and disorders, including Addison’s disease, 17
323+Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, 18
324+scleroderma, rheumatoid arthritis, periarteritis nodosa, AND Marfan’s syndrome[, and 19
325+other systemic and rare diseases and disorders]; 20
279326
280- A licensed direct–entry midwife may not assume or continue to take responsibility 21
281-for a patient’s pregnancy and birth care and shall arrange for the orderly transfer of care 22
282-to a health care practitioner for a patient who is already under the care of the licensed 23
283-direct–entry midwife, if any of the following disorders or situations is found to be present 24
284-at the initial interview or if any of the following disorders or situations occur as prenatal 25
285-care proceeds: 26
327+ [(20)] (19) AIDS/HIV; 21
286328
287- (1) Diabetes mellitus, including uncontrolled gestational diabetes; 27
329+ [(21)] (20) Hepatitis [A through G and non–A through G]; 22
288330
289- (2) Hyperthyroidism treated with medication; 28
331+ [(22)] (21) Acute toxoplasmosis infection, if the patient is symptomatic; 23
290332
291- (3) Uncontrolled hypothyroidism; 29 HOUSE BILL 838 7
333+ [(23)] (22) Acute Rubella infection during pregnancy; 24
334+
335+ [(24)] (23) Acute cytomegalovirus infection, if the patient is symptomatic; 25
336+
337+ [(25)] (24) Acute Parvovirus infection, if the patient is symptomatic; 26
338+ 8 HOUSE BILL 838
339+
340+
341+ [(26)] (25) Alcohol abuse, substance abuse, or prescription abuse during 1
342+pregnancy; 2
343+
344+ [(27)] (26) Continued daily tobacco use into the second trimester; 3
345+
346+ [(28)] (27) Thrombosis; 4
347+
348+ [(29)] (28) Inflammatory bowel disease that is not in remission; 5
349+
350+ [(30)] (29) Primary genital herpes simplex virus infection during the third 6
351+trimester or active genital herpes lesions at the time of labor; 7
352+
353+ [(31) Significant fetal congenital anomaly; 8
354+
355+ (32)] (30) Ectopic pregnancy; OR 9
356+
357+ [(33) Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or 10
358+
359+ (34)] (31) Post term maturity (gestational age 42 0/7 weeks and beyond). 11
360+
361+8–6C–04. 12
362+
363+ (a) A licensed direct–entry midwife shall consult with a health care practitioner, 13
364+and document the consultation, the recommendations of the consultation, and the 14
365+discussion of the consultation with the client, if any of the following conditions are present 15
366+during [prenatal] THE COURSE OF care: 16
367+
368+ (1) Significant mental disease, including depression, bipolar disorder, 17
369+schizophrenia, and other conditions that impair the ability of the patient to participate 18
370+effectively in the patient’s care or that require the use of psychotropic drugs to control the 19
371+condition; 20
372+
373+ (2) Second or third trimester bleeding; 21
374+
375+ (3) Intermittent use of alcohol into the second trimester; 22
376+
377+ (4) Asthma; 23
378+
379+ (5) Diet–controlled gestational diabetes; 24
380+
381+ (6) History of genetic problems, intrauterine death after 20 weeks’ 25
382+gestation, or stillbirth; 26
383+
384+ (7) Abnormal pap smear; 27
385+
386+ (8) Possible ectopic pregnancy; 28 HOUSE BILL 838 9
292387
293388
294389
295- (4) Epilepsy with seizures or antiepileptic drug use during the previous 12 1
296-months; 2
390+ (9) Tuberculosis; 1
297391
298- (5) Coagulation disorders; 3
392+ (10) Controlled hypothyroidism, being treated with thyroid replacement and 2
393+euthyroid, and with thyroid test numbers in the normal range; 3
299394
300- (6) Chronic pulmonary disease; 4
395+ (11) Rh sensitization with positive antibody titer; 4
301396
302- (7) Heart disease in which there are arrhythmias or murmurs except when, 5
303-after evaluation, it is the opinion of a physician licensed under Title 14 of this article or a 6
304-licensed nurse certified as a nurse–midwife or a nurse practitioner under this title that 7
305-midwifery care may proceed; 8
397+ (12) Breech presentation between 35 and 38 weeks; 5
306398
307- (8) Hypertension, including pregnancy–induced hypertension (PIH); 9
399+ (13) Transverse lie or other abnormal presentation between 35 and 38 6
400+weeks; 7
308401
309- (9) Renal disease; 10
402+ (14) Premature rupture of membranes at 37 weeks or less; 8
310403
311- (10) Except as otherwise provided in § 8–6C–04(a)(11) of this subtitle, Rh 11
312-sensitization with positive antibody titer; 12
404+ (15) Small for gestational age or large for gestational age fetus; 9
313405
314- (11) (10) Previous uterine surgery, including a cesarean section or 13
315-myomectomy; 14
406+ (16) Polyhydramnios or oligohydramnios; 10
316407
317- (12) (11) Indications that the fetus has died in utero; 15
408+ (17) Previous LEEP procedure or cone biopsy; 11
318409
319- (13) (12) Premature labor (gestation less than 37 weeks); 16
410+ (18) Previous obstetrical problems, including uterine abnormalities, 12
411+placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or 13
412+preterm delivery for any reason; 14
320413
321- (14) (13) Multiple gestation; 17
414+ (19) Postterm maturity (41 0/7 to 6/7 weeks gestational age); 15
322415
323- (15) (14) Noncephalic presentation at or after 38 weeks; 18
416+ (20) Inflammatory bowel disease, in remission; [or] 16
324417
325- (16) (15) Placenta previa or abruption; 19
418+ (21) Active genital herpes lesions during pregnancy; 17
326419
327- (17) (16) Preeclampsia; 20
420+ (22) SEVERE ANEMIA , AS DEFINED AS HEMOGL OBIN LESS THAN 10 18
421+G/DL AND UNRESPONSIVE TO TREATMENT ; 19
328422
329- (18) (17) [Severe anemia, defined as hemoglobin less than 10 g/dL: 21
423+ (23) PREPREGNANCY BODY MAS S INDEX (BMI) OF LESS THAN 18.5 OR 20
424+35 OR MORE; OR 21
330425
331- (I) THAT HAS BEEN MEASURE D AFTER TREATMENT ; OR 22
426+ (24) SIGNIFICANT FETAL CON GENITAL ANOMALY . 22
332427
333- (II) BASED ON BLOOD TESTS PERFORME D AT OR AFTER 36 23
334-WEEKS; 24
428+ (b) Subject to subsection (c) of this section, a licensed direct–entry midwife shall 23
429+arrange immediate emergency transfer to a hospital if: 24
335430
336- (19)] (18) Uncommon diseases and disorders, including Addison’s disease, 25
337-Cushing’s disease, systemic lupus erythematosus, antiphospholipid syndrome, 26
338-scleroderma, rheumatoid arthritis, periarteritis nodosa, AND Marfan’s syndrome[, and 27
339-other systemic and rare diseases and disorders]; 28 8 HOUSE BILL 838
431+ (2) The patient or newborn is determined to have any of the following 25
432+conditions during labor, delivery, or the immediate postpartum period: 26
433+
434+ (x) [Obvious] LIFE–THREATENING congenital anomalies; 27 10 HOUSE BILL 838
340435
341436
342437
343- [(20)] (19) AIDS/HIV; 1
438+8–6C–08. 1
344439
345- [(21)] (20) Hepatitis [A through G and non–A through G]; 2
440+ (a) A licensed direct–entry midwife shall develop a general written plan for their 2
441+practice for: 3
346442
347- [(22)] (21) Acute toxoplasmosis infection, if the patient is symptomatic; 3
443+ (1) Emergency transfer of a patient, newborn, or both; 4
348444
349- [(23)] (22) Acute Rubella infection during pregnancy; 4
445+ (2) Transport of a newborn to a newborn nursery or neonatal intensive care 5
446+nursery; and 6
350447
351- [(24)] (23) Acute cytomegalovirus infection, if the patient is symptomatic; 5
448+ (3) Transport of a patient to an appropriate hospital with a labor and 7
449+delivery unit. 8
352450
353- [(25)] (24) Acute Parvovirus infection, if the patient is symptomatic; 6
451+ (b) The Committee shall review and recommend approval to the Board of the plan 9
452+required under subsection (a) of this section. 10
354453
355- [(26)] (25) Alcohol abuse, substance abuse, or prescription abuse during 7
356-pregnancy; 8
454+ (c) [The plan required under subsection (a) of this section shall be provided to any 11
455+hospital identified in the plan. 12
357456
358- [(27)] (26) Continued daily tobacco use into the second trimester; 9
457+ (d)] (1) In addition to the general written plan required under subsection (a) of 13
458+this section, a licensed direct–entry midwife shall prepare a plan that is specific to each 14
459+patient and share the plan with the patient. 15
359460
360- [(28)] (27) Thrombosis; 10
461+ (2) The plan required under paragraph (1) of this subsection shall: 16
361462
362- [(29)] (28) Inflammatory bowel disease that is not in remission; 11
463+ (i) Include procedures and processes to be undertaken in the event 17
464+of an emergency for the mother, the newborn, or both; 18
363465
364- [(30)] (29) Primary genital herpes simplex virus infection during the third 12
365-trimester or active genital herpes lesions at the time of labor; 13
466+ (ii) Identify the hospital closest to the address of the planned home 19
467+birth that has a labor and delivery unit; 20
366468
367- [(31) (30) Significant fetal congenital anomaly THAT DIRECTLY IMPACT S 14
368-THE BIRTHING PROCESS OR REQUIRES IMMEDIAT E EMERGENCY CARE , AS 15
369-DETERMINED BY THE BOARD IN REGULATIONS ; 16
469+ (iii) Include a care plan for the newborn; and 21
370470
371- (32)] (30) (31) Ectopic pregnancy; OR 17
471+ (iv) Identify the pediatric health care practitioner who will be 22
472+[notified after delivery in accordance with § 8–6C–02(b)(15) of this subtitle to receive the 23
473+transfer of care of the newborn] RECEIVING THE HEALTH RECORDS OF THE NEWBO RN 24
474+IN ACCORDANCE WITH § 8–6C–02(B)(15) OF THIS SUBTITLE . 25
372475
373- [(33) Prepregnancy body mass index (BMI) of less than 18.5 or 35 or more; or 18
476+ [(e)] (D) (1) The Board, in consultation with stakeholders, shall develop a 26
477+standard form for use in all cases in which a transfer occurs during prenatal care, labor, or 27
478+postpartum. 28
374479
375- (34)] (31) (32) Post term maturity (gestational age 42 0/7 weeks and 19
376-beyond). 20
377-
378-8–6C–04. 21
379-
380- (a) A licensed direct–entry midwife shall consult with a health care practitioner, 22
381-and document the consultation, the recommendations of the consultation, and the 23
382-discussion of the consultation with the client, if any of the following conditions are present 24
383-during [prenatal] THE COURSE OF care: 25
384-
385- (1) Significant mental disease, including depression, bipolar disorder, 26
386-schizophrenia, and other conditions that impair the ability of the patient to participate 27 HOUSE BILL 838 9
480+ (2) The form shall include the medical information needed by the health 29
481+care practitioner receiving the patient. 30
482+ HOUSE BILL 838 11
387483
388484
389-effectively in the patient’s care or that require the use of psychotropic drugs to control the 1
390-condition; 2
485+ [(f)] (E) [(1)] After a decision to transport a patient has been made, the 1
486+licensed direct–entry midwife shall: 2
391487
392- (2) Second or third trimester bleeding; 3
488+ [(i)] (1) Call the receiving health care provider; 3
393489
394- (3) Intermittent use of alcohol into the second trimester; 4
490+ [(ii)] (2) Inform the health care provider of the incoming patient; 4
491+and 5
395492
396- (4) Asthma; 5
493+ [(iii) Accompany the patient to the hospital.] 6
397494
398- (5) Diet–controlled gestational diabetes; 6
495+ [(2)] (3) [On arrival at the hospital, the licensed direct–entry midwife 7
496+shall provide] PROVIDE: 8
399497
400- (6) History of genetic problems, intrauterine death after 20 weeks’ 7
401-gestation, or stillbirth; 8
498+ (i) To the staff of the hospital: 9
402499
403- (7) Abnormal pap smear; 9
500+ 1. The standard form developed under subsection (e) of this 10
501+section; and 11
404502
405- (8) Possible ectopic pregnancy; 10
503+ 2. The [complete] medical records of the patient OR 12
504+NEWBORN, AS REQUESTED BY THE RECEIVING HEALTH CAR E PROVIDER; and 13
406505
407- (9) Tuberculosis; 11
506+ (ii) To the accepting health care practitioner, a verbal summary of 14
507+the care provided to the patient by the licensed direct–entry midwife. 15
408508
409- (10) Controlled hypothyroidism, being treated with thyroid replacement and 12
410-euthyroid, and with thyroid test numbers in the normal range; 13
509+8–6C–10. 16
411510
412- (11) Rh sensitization with positive antibody titer; 14
511+ (a) [On or before October 1 each year, a licensed direct–entry midwife shall report 17
512+to the Committee, in a form specified by the Board, the following information regarding 18
513+cases in which the licensed direct–entry midwife assisted during the previous fiscal year 19
514+when the intended place of birth at the onset of care was an out–of–hospital setting: 20
413515
414- (12) Breech presentation between 35 and 38 weeks; 15
516+ (1) The total number of patients served as primary caregiver at the onset 21
517+of care; 22
415518
416- (13) Transverse lie or other abnormal presentation between 35 and 38 16
417-weeks; 17
519+ (2) The number, by county, of live births attended as primary caregiver; 23
418520
419- (14) Premature rupture of membranes at 37 weeks or less; 18
521+ (3) The number, by county, of cases of fetal demise, infant deaths, and 24
522+maternal deaths attended as primary caregiver at the discovery of the demise or death; 25
420523
421- (15) Small for gestational age or large for gestational age fetus; 19
524+ (4) The number of women whose primary care was transferred to another 26
525+health care practitioner during the antepartum period and the reason for transfer; 27
422526
423- (16) Polyhydramnios or oligohydramnios; 20
424-
425- (17) Previous LEEP procedure or cone biopsy; 21
426-
427- (18) Previous obstetrical problems, including uterine abnormalities, 22
428-placental abruption, placenta accreta, obstetric hemorrhage, incompetent cervix, or 23
429-preterm delivery for any reason; 24
430-
431- (19) Postterm maturity (41 0/7 to 6/7 weeks gestational age); 25
432-
433- (20) Inflammatory bowel disease, in remission; [or] 26
434- 10 HOUSE BILL 838
527+ (5) The number, reason for, and outcome of each nonemergency hospital 28
528+transfer during the intrapartum or postpartum period; 29
529+ 12 HOUSE BILL 838
435530
436531
437- (21) Active genital herpes lesions during pregnancy EXCEPT AS REQUIRED 1
438-BY § 8–6C–03(29) OF THIS SUBTITLE; 2
532+ (6) The number, reason for, and outcome of each urgent or emergency 1
533+transport of an expectant mother in the antepartum period; 2
439534
440- (22) SEVERE ANEMIA , AS DEFINED AS HEMOGL OBIN LESS THAN 10 3
441-G/DL AND UNRESPONSIVE TO TREATMENT ; 4
535+ (7) The number, reason for, and outcome of each urgent or emergency 3
536+transport of an infant or mother during the intrapartum or immediate postpartum period; 4
442537
443- (23) (22) PREPREGNANCY BODY MAS S INDEX (BMI) OF LESS THAN 5
444-18.5 OR 35 OR MORE; OR 6
538+ (8) The number of planned out–of–hospital births at the onset of labor and 5
539+the number of births completed in an out–of–hospital setting; 6
445540
446- (24) (23) SIGNIFICANT FETAL CONGENITAL ANO MALY. 7
541+ (9) A brief description of any complications resulting in the morbidity or 7
542+mortality of a mother or a neonate; and 8
447543
448- (b) Subject to subsection (c) of this section, a licensed direct–entry midwife shall 8
449-arrange immediate emergency transfer to a hospital if: 9
544+ (10) Any other information required by the Board in regulations. 9
450545
451- (2) The patient or newborn is determined to have any of the following 10
452-conditions during labor, delivery, or the immediate postpartum period: 11
546+ (b) The Board shall send a written notice of noncompliance to each licensee who 10
547+fails to meet the reporting requirements under subsection (a) of this section. 11
453548
454- (x) [Obvious] LIFE–THREATENING SIGNIFICANT congenital 12
455-anomalies THAT DIRECTLY AFFECT DELIVERY OR IMMEDIAT E POSTPARTUM CARE OR 13
456-REQUIRE IMMEDIATE EM ERGENCY CARE , AS DETERMINED BY THE BOARD IN 14
457-REGULATIONS; 15
549+ (c) A licensed direct–entry midwife who fails to comply with the reporting 12
550+requirements under this section shall be prohibited from license renewal until the 13
551+information required under subsection (a) of this section is reported. 14
458552
459-8–6C–08. 16
553+ (d) The Committee shall maintain the confidentiality of any report submitted 15
554+under subsection (a) of this section. 16
460555
461- (a) A licensed direct–entry midwife shall develop a general written plan for their 17
462-practice for: 18
556+ (e)] Notwithstanding any other provision of law, a licensed direct–entry midwife 17
557+shall be subject to the same reporting requirements as other health care practitioners who 18
558+provide care to individuals in accordance with this title. 19
463559
464- (1) Emergency transfer of a patient, newborn, or both; 19
560+ [(f)] (B) A licensed direct–entry midwife attending an out–of–hospital delivery 20
561+shall: 21
465562
466- (2) Transport of a newborn to a newborn nursery or neonatal intensive care 20
467-nursery; and 21
563+ (1) For any live birth, complete and submit a birth certificate in accordance 22
564+with § 4–208 of the Health – General Article; and 23
468565
469- (3) Transport of a patient to an appropriate hospital with a labor and 22
470-delivery unit. 23
566+ (2) For any death, make all medical records available and communicate 24
567+relevant circumstances of the death to the individual responsible for completing the 25
568+certificate of death under § 4–212 or § 4–213 of the Health – General Article. 26
471569
472- (b) The Committee shall review and recommend approval to the Board of the plan 24
473-required under subsection (a) of this section. 25
570+8–6C–20. 27
474571
475- (c) [The plan required under subsection (a) of this section shall be provided to any 26
476-hospital identified in the plan. 27
572+ (a) Subject to the hearing provisions of § 8–317 of this title, the Board may deny 28
573+a license OR GRANT A LICENSE , INCLUDING A LICENSE SUBJECT TO A REPRIMAND, 29
574+PROBATION, OR SUSPENSION , to an applicant, reprimand a licensee, place a licensee on 30
575+probation, or suspend or revoke [a] THE license OF A LICENSEE if the applicant or licensee: 31
477576
478- (d)] (1) In addition to the general written plan required under subsection (a) of 28
479-this section, a licensed direct–entry midwife shall prepare a plan that is specific to each 29
480-patient and share the plan with the patient. 30
481-
482- (2) The plan required under paragraph (1) of this subsection shall: 31 HOUSE BILL 838 11
577+ (1) Fraudulently or deceptively obtains or attempts to obtain a license for 32
578+the applicant or for another; 33 HOUSE BILL 838 13
483579
484580
485581
486- (i) Include procedures and processes to be undertaken in the event 1
487-of an emergency for the mother, the newborn, or both; 2
582+ (2) Fraudulently or deceptively uses a license; 1
488583
489- (ii) Identify the hospital closest to the address of the planned home 3
490-birth that has a labor and delivery unit; 4
584+ (3) Is disciplined by a licensing, military, or disciplinary authority in the 2
585+State or in any other state or country or is convicted or disciplined by a court in the State 3
586+or in any other state or country for an act that would be grounds for disciplinary action 4
587+under the Board’s disciplinary statutes; 5
491588
492- (iii) Include a care plan for the newborn; and 5
589+ (4) Is convicted of or pleads guilty or nolo contendere to a felony or to a 6
590+crime involving moral turpitude, whether or not any appeal or other proceeding is pending 7
591+to have the conviction or plea set aside; 8
493592
494- (iv) Identify the pediatric health care practitioner who will be 6
495-[notified after delivery in accordance with § 8–6C–02(b)(15) of this subtitle to receive the 7
496-transfer of care of the newborn] RECEIVING THE HEALTH RECORDS OF THE NEWBO RN 8
497-IN ACCORDANCE WITH § 8–6C–02(B)(15) OF THIS SUBTITLE . 9
593+ (5) Willfully and knowingly: 9
498594
499- [(e)] (D) (1) The Board, in consultation with stakeholders, shall develop a 10
500-standard form for use in all cases in which a transfer occurs during prenatal care, labor, or 11
501-postpartum. 12
595+ (i) Files a false report or record of an individual under the licensee’s 10
596+care; 11
502597
503- (2) The form shall include the medical information needed by the health 13
504-care practitioner receiving the patient. 14
598+ (ii) Gives any false or misleading information about a material 12
599+matter in an employment application; 13
505600
506- [(f)] (E) [(1)] After a decision to transport a patient has been made, the 15
507-licensed direct–entry midwife shall: 16
601+ (iii) Fails to file or record any health record that is required by law; 14
508602
509- [(i)] (1) Call the receiving health care provider; 17
603+ (iv) Obstructs the filing or recording of any health record as required 15
604+by law; or 16
510605
511- [(ii)] (2) Inform the health care provider of the incoming patient; 18
512-and 19
606+ (v) Induces another person to fail to file or record any health record 17
607+as required by law; 18
513608
514- [(iii) (3) Accompany the patient to the hospital. IF DETERMINED 20
515-TO BE APPROPRIATE BY THE LICENSED DIRECT –ENTRY MIDWIFE AND TH E 21
516-RECEIVING HEALTH CAR E PROVIDER; AND] 22
609+ (6) Knowingly does any act that has been determined by the Board, in its 19
610+regulations, to exceed the scope of practice authorized to the individual under this subtitle; 20
517611
518- [(2)] (3) (4) [On arrival at the hospital, the licensed direct–entry midwife 23
519-shall provide] PROVIDE: 24
612+ (7) Provides professional services while: 21
520613
521- (i) To the staff of the hospital: 25
614+ (i) Under the influence of alcohol; or 22
522615
523- 1. The standard form developed under subsection (e) (D) of 26
524-this section; and 27
616+ (ii) Using any narcotic or controlled dangerous substance, as defined 23
617+in § 5–101 of the Criminal Law Article, or other drug that is in excess of therapeutic 24
618+amounts or without valid medical indication; 25
525619
526- 2. The [complete] medical records of the patient OR 28
527-NEWBORN, AS DETERMINED BY THE BOARD IN REGULATIONS AND AS REQUESTED 29
528-BY THE RECEIVING HEALTH CARE PROVIDER; and 30
529- 12 HOUSE BILL 838
620+ (8) Does an act that is inconsistent with generally accepted professional 26
621+standards in the practice of direct–entry midwifery; 27
530622
623+ (9) Is grossly negligent in the practice of direct–entry midwifery; 28
531624
532- (ii) To the accepting health care practitioner, a verbal summary of 1
533-the care provided to the patient by the licensed direct–entry midwife. 2
625+ (10) Has violated any provision of this title; 29
534626
535-8–6C–10. 3
536-
537- (a) [On or before October 1 each year, a licensed direct–entry midwife shall report 4
538-to the Committee, in a form specified by the Board, the following information regarding 5
539-cases in which the licensed direct–entry midwife assisted during the previous fiscal year 6
540-when the intended place of birth at the onset of care was an out–of–hospital setting: 7
541-
542- (1) The total number of patients served as primary caregiver at the onset 8
543-of care; 9
544-
545- (2) The number, by county, of live births attended as primary caregiver; 10
546-
547- (3) The number, by county, of cases of fetal demise, infant deaths, and 11
548-maternal deaths attended as primary caregiver at the discovery of the demise or death; 12
549-
550- (4) The number of women whose primary care was transferred to another 13
551-health care practitioner during the antepartum period and the reason for transfer; 14
552-
553- (5) The number, reason for, and outcome of each nonemergency hospital 15
554-transfer during the intrapartum or postpartum period; 16
555-
556- (6) The number, reason for, and outcome of each urgent or emergency 17
557-transport of an expectant mother in the antepartum period; 18
558-
559- (7) The number, reason for, and outcome of each urgent or emergency 19
560-transport of an infant or mother during the intrapartum or immediate postpartum period; 20
561-
562- (8) The number of planned out–of–hospital births at the onset of labor and 21
563-the number of births completed in an out–of–hospital setting; 22
564-
565- (9) A brief description of any complications resulting in the morbidity or 23
566-mortality of a mother or a neonate; and 24
567-
568- (10) Any other information required by the Board in regulations. 25
569-
570- (b) The Board shall send a written notice of noncompliance to each licensee who 26
571-fails to meet the reporting requirements under subsection (a) of this section. 27
572-
573- (c) A licensed direct–entry midwife who fails to comply with the reporting 28
574-requirements under this section shall be prohibited from license renewal until the 29
575-information required under subsection (a) of this section is reported. 30
576-
577- (d) The Committee shall maintain the confidentiality of any report submitted 31
578-under subsection (a) of this section. 32 HOUSE BILL 838 13
627+ (11) Submits a false statement to collect a fee; 30 14 HOUSE BILL 838
579628
580629
581630
582- (e)] Notwithstanding any other provision of law, a licensed direct–entry midwife 1
583-shall be subject to the same reporting requirements as other health care practitioners who 2
584-provide care to individuals in accordance with this title REPORTING REQUIREMEN TS 3
585-ADOPTED BY THE BOARD IN REGULAT IONS IN CONSULTATION WITH THE 4
586-COMMITTEE AND ANY OTH ER STAKEHOLDERS DETE RMINED APPROPRIATE B Y THE 5
587-BOARD. 6
631+ (12) Is physically or mentally incompetent; 1
588632
589- [(f)] (B) A licensed direct–entry midwife attending an out–of–hospital delivery 7
590-shall: 8
633+ (13) Knowingly fails to report suspected child abuse in violation of § 5–704 2
634+of the Family Law Article; 3
591635
592- (1) For any live birth, complete and submit a birth certificate in accordance 9
593-with § 4–208 of the Health – General Article; and 10
636+ (14) Except in an emergency life–threatening situation where it is not 4
637+feasible or practicable, fails to comply with the Centers for Disease Control and 5
638+Prevention’s guidelines on universal precautions; 6
594639
595- (2) For any death, make all medical records available and communicate 11
596-relevant circumstances of the death to the individual responsible for completing the 12
597-certificate of death under § 4–212 or § 4–213 of the Health – General Article. 13
640+ (15) Is in independent practice and fails to display the notice required under 7
641+§ 8–6C–23 of this subtitle; 8
598642
599-8–6C–20. 14
643+ (16) Is habitually intoxicated; 9
600644
601- (a) Subject to the hearing provisions of § 8–317 of this title, the Board may deny 15
602-a license OR GRANT A LICENSE , INCLUDING A LICENSE SUBJECT TO A REPRIMA ND, 16
603-PROBATION, OR SUSPENSION , to an applicant, reprimand a licensee, place a licensee on 17
604-probation, or suspend or revoke [a] THE license OF A LICENSEE if the applicant or licensee: 18
645+ (17) Is addicted to, or habitually abuses, any narcotic or controlled 10
646+dangerous substance as defined in § 5–101 of the Criminal Law Article; 11
605647
606- (1) Fraudulently or deceptively obtains or attempts to obtain a license for 19
607-the applicant or for another; 20
648+ (18) Fails to cooperate with a lawful investigation conducted by the Board; 12
608649
609- (2) Fraudulently or deceptively uses a license; 21
650+ (19) Is expelled from the rehabilitation program established pursuant to § 13
651+8–208 of this title for failure to comply with the conditions of the program; 14
610652
611- (3) Is disciplined by a licensing, military, or disciplinary authority in the 22
612-State or in any other state or country or is convicted or disciplined by a court in the State 23
613-or in any other state or country for an act that would be grounds for disciplinary action 24
614-under the Board’s disciplinary statutes; 25
653+ (20) Engages in conduct that violates the professional code of ethics; 15
615654
616- (4) Is convicted of or pleads guilty or nolo contendere to a felony or to a 26
617-crime involving moral turpitude, whether or not any appeal or other proceeding is pending 27
618-to have the conviction or plea set aside; 28
655+ (21) Is professionally incompetent; 16
619656
620- (5) Willfully and knowingly: 29
657+ (22) Practices direct–entry midwifery without a license, before obtaining or 17
658+renewing a license, including any period when the license has lapsed; 18
621659
622- (i) Files a false report or record of an individual under the licensee’s 30
623-care; 31
660+ (23) After failing to renew a license or after a license has lapsed, commits 19
661+any act that would be grounds for disciplinary action under this section; 20
624662
625- (ii) Gives any false or misleading information about a material 32
626-matter in an employment application; 33 14 HOUSE BILL 838
663+ (24) Violates regulations adopted by the Board or an order from the Board; 21
664+
665+ (25) Performs an act that is beyond the licensee’s knowledge and skills; 22
666+
667+ (26) Fails to submit to a criminal history records check in accordance with § 23
668+8–303 of this title; 24
669+
670+ (27) When acting in a supervisory position, directs another licensed 25
671+direct–entry midwife to perform an act that is beyond the licensed direct–entry midwife’s 26
672+knowledge and skills; or 27
673+
674+ (28) Fails to file a report required under this subtitle. 28
675+
676+8–6C–26. 29 HOUSE BILL 838 15
627677
628678
629679
630- (iii) Fails to file or record any health record that is required by law; 1
680+ Subject to the evaluation and reestablishment provisions of the Maryland Program 1
681+Evaluation Act, and subject to the termination of this subtitle under § 8–802 of this title, 2
682+this subtitle and all regulations adopted under this subtitle shall terminate and be of no 3
683+effect after July 1, [2025] 2030. 4
631684
632- (iv) Obstructs the filing or recording of any health record as required 2
633-by law; or 3
634-
635- (v) Induces another person to fail to file or record any health record 4
636-as required by law; 5
637-
638- (6) Knowingly does any act that has been determined by the Board, in its 6
639-regulations, to exceed the scope of practice authorized to the individual under this subtitle; 7
640-
641- (7) Provides professional services while: 8
642-
643- (i) Under the influence of alcohol; or 9
644-
645- (ii) Using any narcotic or controlled dangerous substance, as defined 10
646-in § 5–101 of the Criminal Law Article, or other drug that is in excess of therapeutic 11
647-amounts or without valid medical indication; 12
648-
649- (8) Does an act that is inconsistent with generally accepted professional 13
650-standards in the practice of direct–entry midwifery; 14
651-
652- (9) Is grossly negligent in the practice of direct–entry midwifery; 15
653-
654- (10) Has violated any provision of this title; 16
655-
656- (11) Submits a false statement to collect a fee; 17
657-
658- (12) Is physically or mentally incompetent; 18
659-
660- (13) Knowingly fails to report suspected child abuse in violation of § 5–704 19
661-of the Family Law Article; 20
662-
663- (14) Except in an emergency life–threatening situation where it is not 21
664-feasible or practicable, fails to comply with the Centers for Disease Control and 22
665-Prevention’s guidelines on universal precautions; 23
666-
667- (15) Is in independent practice and fails to display the notice required under 24
668-§ 8–6C–23 of this subtitle; 25
669-
670- (16) Is habitually intoxicated; 26
671-
672- (17) Is addicted to, or habitually abuses, any narcotic or controlled 27
673-dangerous substance as defined in § 5–101 of the Criminal Law Article; 28
674-
675- (18) Fails to cooperate with a lawful investigation conducted by the Board; 29 HOUSE BILL 838 15
676-
677-
678-
679- (19) Is expelled from the rehabilitation program established pursuant to § 1
680-8–208 of this title for failure to comply with the conditions of the program; 2
681-
682- (20) Engages in conduct that violates the professional code of ethics; 3
683-
684- (21) Is professionally incompetent; 4
685-
686- (22) Practices direct–entry midwifery without a license, before obtaining or 5
687-renewing a license, including any period when the license has lapsed; 6
688-
689- (23) After failing to renew a license or after a license has lapsed, commits 7
690-any act that would be grounds for disciplinary action under this section; 8
691-
692- (24) Violates regulations adopted by the Board or an order from the Board; 9
693-
694- (25) Performs an act that is beyond the licensee’s knowledge and skills; 10
695-
696- (26) Fails to submit to a criminal history records check in accordance with § 11
697-8–303 of this title; 12
698-
699- (27) When acting in a supervisory position, directs another licensed 13
700-direct–entry midwife to perform an act that is beyond the licensed direct–entry midwife’s 14
701-knowledge and skills; or 15
702-
703- (28) Fails to file a report required under this subtitle. 16
704-
705-8–6C–26. 17
706-
707- Subject to the evaluation and reestablishment provisions of the Maryland Program 18
708-Evaluation Act, and subject to the termination of this subtitle under § 8–802 of this title, 19
709-this subtitle and all regulations adopted under this subtitle shall terminate and be of no 20
710-effect after July 1, [2025] 2030. 21
711-
712- SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 22
713-1, 2025. 23
714-
685+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect June 5
686+1, 2025. 6