WEST virginia legislature
2025 regular session
Committee Substitute
for
Senate Bill 482
By Senators Woodrum and Rucker
[Reported February 26, 2025, from the Committee on Government Organization]
A BILL to amend the Code of West Virginia, 1931, as amended, by adding a new article, designated §30-44-1, §30-44-2, §30-44-3, §30-44-4, §30-44-5, §30-44-6, §30-44-7, §30-44-8, §30-44-9, §30-44-10, §30-44-11, §30-44-12, and §30-44-13, relating to creating the Certified Professional Midwife Licensing and Regulation Act.
Be it enacted by the Legislature of West Virginia:
## Article 44. Certified Professional Midwife Licensing and Regulation.
## §30-44-1. Definitions.
"Board" means the West Virginia Board of Registered Nurses.
"Client" means a person receiving midwife care and shall be considered synonymous with "patient".
"Consultation" means discussing the aspects of an individual client's circumstance with other professionals to assure comprehensive and quality care for the client and for purposes of adjusting the client's treatment plan.
"Collaboration" means the process by which a licensed midwife and an appropriate obstetrical provider jointly manage the care of a client.
"CPM" means the certified professional midwife credential issued by the North American Registry of Midwives (NARM).
"HIPAA" means the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. § 1320d et seq. of the United States Code.
"NARM" means the North American Registry of Midwives.
"NACPM" means the National Association of Certified Professional Midwives.
"Midwife care" means providing primary maternity care that is consistent with NARM standards and NACPM practice guidelines.
"Referral" means the process by which a licensed midwife arranges for an accepting licensed health care provider to assume primary management responsibility for the condition requiring referral, which shall not preclude the licensed midwife from continuing in the provision of care as mutually agreed upon with the accepting provider.
"Transfer" means the act of transporting a client to a licensed health care facility providing a higher level of care.
(1) Is at least 18 years of age;
(2) Has achieved a high school diploma or the equivalent thereof;
(3) Has completed midwife education according to North American Registry of Midwives (NARM) requirements or those of a successor organization;
(6) If the applicant has been licensed in another jurisdiction, has provided information on the status of each license and any disciplinary action taken or pending to the Board.
(b) An applicant who meets the requirements of this section shall be issued a license to practice as a licensed midwife. The license shall be issued for a term of two years from the date of initial licensure and may be renewed pursuant to §30-44-3 of this code.
(b) The board may deny an application for renewal for any reason which would justify the denial of an original application.
(c) The LM shall provide evidence of current certification with NARM at the time of renewal.
(d) Renewal applicants shall provide proof of participation in data submission on perinatal outcomes to a national or state midwife organization.
(e) Upon approval of the renewal application for a licensed midwife, the license shall be renewed for two years.
(f) Reinstatement. — If the LM license has lapsed, an applicant may file the application for licensure as a licensed midwife to request reinstatement and pay the fee established in §30-44-2 of this code. The applicant shall provide evidence of current certification with NARM at the time of application for reinstatement.
(g) An LM whose license has been suspended may apply for reinstatement upon the expiration of the suspension period by:
(1) Submitting a reinstatement application;
(2) Providing proof of compliance with any terms or conditions of the suspension order;
(3) Demonstrating current certification with NARM; and
(4) Paying the reinstatement fee established by the board, not to exceed $150.
(h) An LM whose license has been revoked may apply for reinstatement after a minimum of one year by:
(1) Submitting a reinstatement application to the board;
(2) Demonstrating evidence of rehabilitation, including completion of any required corrective actions specified in the revocation order;
(3) Providing proof of current certification with NARM; and
(4) Paying the reinstatement fee established by the board, not to exceed $250.
(i) The Board may expedite reinstatement applications for suspensions or revocations if the applicant demonstrates urgency in returning to practice due to critical community needs or exceptional circumstances.
(1) A serial number;
(2) The full name of the applicant;
(3) The date of expiration;
(4) The date of issuance;
(5) The seal of the board; and
(6) The signature of the executive secretary of the board.
An individual certified by the board as a licensed midwife pursuant to the provisions of this article shall be known as a West Virginia licensed midwife and may use the initials "LM" after his or her name. No other person may assume a title or use abbreviations or any other words, letters, figures, signs, or devices to indicate that the person using the same is a licensed midwife.
(1) Is or was guilty of fraud or deceit in procuring or attempting to procure a license to provide midwife care, or has been convicted of a felony; or
(2) Is unfit or incompetent by reason of negligence, habits, or other causes; or
(3) Is habitually intemperate, or is addicted to the use of habit-forming drugs or is mentally incompetent; or
(4) Is guilty of conduct derogatory to the morals or standing of the profession; or
(5) Is calling himself or herself a licensed midwife without a current license; or
(6) Has willfully or repeatedly violated any of the provisions of this article; or
(7) Is providing or offering to provide services that are outside of the scope of practice as defined by NARM or NACPM.
(1) An appropriate licensed health care provider or other person from providing emergency care, including care of a precipitous delivery; or
(2) Any licensed midwife from delegating to an apprentice or personnel under his or her personal employ and supervised by the licensed midwife activities or functions that are nondiscretionary and that do not require the exercise of professional judgment for their performance, if those activities or functions are authorized by, and performed for, the licensed midwife and responsibility for such activities or functions is assumed by the licensed midwife; or
(3) Any person from performing tasks related to midwife care under the direct and immediate supervision of a licensed doctor of medicine or osteopathy, a certified nurse-midwife, or a licensed midwife during completion of NARM requirements to achieve a CPM credential.
(1) Refer to himself or herself as a licensed midwife while his or her license, issued under the provisions of this article, is suspended or revoked;
(2) Use in connection with his or her name any designation tending to imply that he or she is licensed to provide midwife care unless duly licensed so to practice under the provisions of this article;
(3) Provide midwife care with an active CPM credential without being licensed as a licensed midwife; or
(4) Otherwise violate any provisions of this article.
(b) Upon conviction, such misdemeanor shall be punishable by a fine of not more than $250.
(1) Are consistent with the NARM current job description for the profession and the NACPM standards of practice;
(2) Ensure independent practice; and
(3) Provide for an appropriate license fee.
(b) The rules may not require any agreement, written or otherwise, with another health care professional, or require the assessment of a woman who is seeking midwife care services by another health care professional.
(b) A licensed midwife may not obtain or use any drug in Schedule I through V of the Uniform Controlled Substances Act, 21 U.S.C. § 801.
(c) A licensed midwife may obtain medications and devices to treat conditions from entities including a pharmacy, manufacturer, medical equipment supplier, outsourcing facility, warehouser, or wholesale distributor.
(d) An entity that provides a medication to a licensed midwife in accordance with this section and who relies in good faith upon the license information provided by the licensed midwife is not subject to liability for providing the medication.
(e) All medications prescribed or administered must be documented in the client's medical records.
(2) The licensed midwife shall offer standard tests and screenings for evaluating risks and shall document client response to any recommendations. The licensed midwife shall also continually assess the pregnant woman and baby in order to recognize conditions that may arise during the course of care that require disclosure of risk for birth outside of a hospital.
(3) The licensed midwife shall review the client's pregnancy history, including records of the current or previous pregnancies, if available. If, on initial or subsequent assessment, one of the conditions listed in this section exists, the licensed midwife shall consult with an appropriate obstetrical provider and shall select either collaboration or referral, as appropriate, and shall document that recommendation in the client record:
(A) Complete placenta previa;
(B) Partial placenta previa persisting after 32 weeks;
(C) HIV infection;
(D) Cardiovascular disease, including hypertension;
(E) Severe psychiatric illness;
(F) Pre-eclampsia or eclampsia;
(G) Intrauterine growth restriction;
(H) Known potentially serious anatomic fetal abnormalities;
(I) Any type of diabetes not controlled by diet and exercise;
(J) Labor prior to 37 weeks;
(K) Substance use disorder with current or recent use; or
(L) Any other condition or symptom that may threaten the life of the client or fetus, as assessed by the licensed midwife exercising reasonable skill and knowledge.
(4) If a client with a condition listed in this section declines to accept an indicated consultation, collaboration, or referral, the licensed midwife shall document the refusal in writing and shall refer the client to an appropriate higher level of care.
(5) If a risk factor first develops during labor or delivery, the licensed midwife shall use judgment, taking into account the health and condition of the mother and baby, in determining whether to proceed with an out-of-hospital birth or arrange transportation to a hospital. If the condition puts the client or baby acutely in jeopardy, but the client refuses the transfer to a higher level of care, the licensed midwife shall call 911 and provide care until another appropriate obstetrical provider assumes care.
(b)Transfers. —
(1) Every licensed midwife shall have a written plan for emergency transfer, transport of an infant to a newborn nursery or neonatal intensive care nursery, or transport of an individual to an appropriate obstetrical department or patient care area. Transport via private vehicle is an acceptable method of transport if it is the most expedient and safest method for accessing medical services.
(2) When the maternal or fetal health status requires transfer to a health care facility for a higher level of care, the licensed midwife shall:
(A) Initiate immediate transport according to the licensed midwife's emergency plan;
(B) Provide emergency stabilization until emergency medical services arrive or transfer is completed; and
(C) Notify the receiving provider or hospital, if possible, of:
(i) The incoming transfer;
(ii) The reason for the transfer;
(iii) A brief relevant clinical history;
(iv) The planned mode of transport; and
(v) The expected time of arrival.
(D) The licensed midwife may continue to provide routine or urgent care en route in coordination with any emergency services personnel and may address the psychosocial needs of the client during the change of birth setting.
(c) Medical Records. —
(1) The licensed midwife shall maintain a record for each client. The record shall be complete and accurate. It shall document:
(A) The client's history;
(B) Physical examinations;
(C) Laboratory test results;
(D) Medications prescribed or administered;
(E) Antepartum visits;
(F) Consultations, collaborations, and referrals;
(G) Labor and delivery;
(H) Postpartum visits; and
(I) Neonatal evaluations.
(2) The licensed midwife shall comply with all state and federal laws and regulations regarding the confidentiality of the client's records, including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 42 U.S.C. § 1320d et al.
(d) Newborn care. —
The customary scope of care of a newborn up to six weeks of age by a licensed midwife includes, but is not limited to, clinical assessment, treatment, education, support, and referral.