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1 A BILL
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3 23-202
4 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
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6 _____________________
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9 To amend the District of Columbia Health Occupations Revision Act of 1985 to provide for the
10 licensure and regulation of certified professional midwives and certified nurse-midwives,
11 and to provide requirements for maternity centers and Medicaid reimbursement; to
12 amend Part B of the Department of Health Functions Clarification Act of 2001to
13 establish an Advisory Committee on Certified Professional Midwives; and to amend the
14 District of Columbia Health Professional Recruitment Program Act of 2005 to include
15 certified professional midwives in the definition of other health professionals.
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17 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
18 act may be cited as the Certified Professional Midwife Amendment Act of 2019.
19 Sec. 2. The District of Columbia Health Occupations Revision Act of 1985, effective
20 March 25, 1986 (D.C. Law 6-99; D.C. Official Code 3-1201.01 et seq.), is amended as follows:
21 (a) Title I is amended as follows:
22 (1) Section 101 (D.C. Official Code 3-1201.01) is amended as follows:
23 (A) Existing paragraph (1C) is redesignated as paragraph (1F).
24 (B) New paragraphs (1C), (1D), and (1E) are added to read as follows:
25 (1C) Certified professional midwife means a person licensed in the
26 District, pursuant this act, to practice certified professional midwifery, who holds a valid
27 certification from the North American Registry of Midwives.
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28 (1D) Certified nurse-midwife means a qualified registered nurse who
29 holds a valid certification from the American Midwifery Certification Board.
30 (1E) Client means a woman under the care of a midwife and such
31 womans fetus or newborn..
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33 (2) Section 102 (D.C. Official Code 3-1201.02) is amended as follows:
34 (A) Paragraph (7A) is redesignated as paragraph (7A-ii).
35 (B) A new paragraph (7A-i) is added to read as follows:
36 (7A-i)(A) Practice of certified professional midwifery means the
37 provision of primary maternity care and well-women care by a certified professional midwife
38 licensed under this act to a client during the preconception, antepartum, intrapartum and,
39 postpartum periods. The practice of certified professional midwifery includes:
40 (i) Discussing any general or specific risk factors
41 pertaining to the health and circumstances of the client associated with the provision of primary
42 maternity care and well-women care;
43 (ii) Consulting with the client regarding the conditions
44 under which consultation, transfer of care, or transport are necessary.
45 (iii) Obtaining the clients health history;
46 (iv) Performing a physical examination of the client;
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47 (v) Developing a written plan of care specific to the client
48 to ensure continuity of care throughout the antepartum, intrapartum, and postpartum periods,
49 including an emergency birth plan;
50 (vi) Consulting, collaborating, referring, or transferring
51 care to appropriate health care professionals as necessary;
52 (vii) Providing care during the antepartum, intrapartum,
53 postpartum, and newborn periods, including:
54 (I) Monitoring and evaluating the condition of the
55 client;
56 (II) Conducting the delivery of a fetus in an out-of-
57 hospital setting;
58 (III) Suturing episiotomy or first and second-
59 degree lacerations, including the administration of a local anesthetic;
60 (IV) Performing emergency procedures, including:
61 (aa) Administering approved medications;
62 (bb) Administering intravenous fluids for
63 stabilization; and
64 (cc) Performing an emergency episiotomy;
65 (V) Providing routine care for a newborn,
66 including immediate care at birth, the performance of newborn examination, and the
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67 administration of intramuscular vitamin K and eye ointment for prevention of ophthalmia
68 neonatorum; and
69 (VI) Providing limited care in between pregnancies
70 to facilitate the continuity of care, including the provision of:
71 (aa) Breastfeeding support and counseling;
72 (bb) Family planning services but only to
73 the extent that such services shall be limited to natural family planning and the provision of
74 cervical caps and diaphragms, in consultation with an appropriate health care provider as
75 necessary; and
76 (cc) Pap smears, but only to the extent that
77 a client with an abnormal pap smear result shall be referred to an appropriately-licensed health
78 care provider.
79 (B) Subparagraph (A) of this paragraph shall not be construed as
80 preventing or restricting the practices, services, or activities of:
81 (i) A licensed physician, licensed naturopathic physician,
82 certified nurse-midwife, or licensed basic or advanced emergency medical technician;
83 (ii) Members of Native American communities who
84 provide traditional midwife services to their communities;
85 (iii) Any person who, in good faith, engages in the
86 practice of the religious tenets of any church or in any religious act if no fee is contemplated,
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87 charged or received;
88 (iv) Any person rendering aid in an emergency; or
89 (v) Student midwives currently enrolled in an accredited
90 midwifery education program and providing services to clients under the direct, on-site, in-
91 person supervision of a certified professional midwife.
92 (C) Subparagraph (A) of this paragraph shall not be construed to
93 authorize an individual licensed under this act to practice certified professional midwifery to:
94 (i) Provide pharmacological induction or augmentation of
95 labor;
96 (ii) Conduct surgical delivery or any surgery except an
97 emergency episiotomy;
98 (iii) Utilize forceps or a vacuum extractor; except, that an
99 individual licensed under this act to practice certified professional midwifery shall be authorized
100 to administer a local anesthetic;
101 (iv) Administer any kind of narcotic analgesic; or
102 (v) Administer any prescription medication in a manner
103 that violates the requirements of this act.
104 (c) Section 203 (D.C. Official Code 3-1202.03) is amended as follows:
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105 (1) The section heading is amended by striking the phrase Trauma
106 Technologists, and Athletic Trainers. and inserting the phrase Trauma Technologists, Athletic
107 Trainers, and Certified Professional Midwives. in its place.
108 (2) Subsection (a) is amended as follows:
109 (A) Paragraph (2) is amended by striking the phrase and the practice of
110 trauma technologists with the advice of the Advisory Committee on Trauma Technologists , and
111 the practice of athletic trainers with the advice of the Advisory Committee on Athletic Trainers.
112 and inserting the phrase the practice of trauma technologists with the advice of the Advisory
113 Committee on Trauma Technologists, the practice of athletic trainers with the advice of the
114 Advisory Committee on Athletic Trainers, and the practice of certified professional midwives
115 with the advice of the Advisory Committee on Certified Professional Midwives. in its place.
116 (B) Paragraph (8) is amended as follows:
117 (i) Subparagraph (F) is amended by striking the phrase ; and and
118 inserting a semicolon in its place.
119 (ii) Subparagraph (G) is amended by striking the period and
120 inserting the phrase ; and in its place.
121 (iii) A new subparagraph (H) is added to read as follows:
122 (H) The practice of certified professional midwifery in accordance with
123 guidelines issued by the Advisory Committee on Certified Professional Midwives..
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124 (d) Section 504 (D.C. Official Code 3-1205.04) is amended by adding a new subsection
125 (t) to read as follows:
126 (t)(1) An individual applying for a license to practice midwifery under this act shall
127 establish to the satisfaction of the Board of Medicine that the individual:
128 (A) Holds a current certification as a certified professional midwife
129 issued by the North American Registry of Midwives (NARM); and
130 (B) Has successfully completed a midwifery education and training
131 program, either through an accredited educational program, or non-accredited educational
132 program; except, that individuals who have successfully completed an educational program
133 accredited by the Midwifery Education Accreditation Council (MEAC) or Accreditation
134 Commission for Midwifery Education (ACME) shall be deemed to have completed an
135 accredited educational program.
136 (2) Beginning October 1, 2020, individuals seeking a license to practice
137 midwifery shall:
138 (A) Successfully complete an educational pathway accredited by
139 MEAC or ACME;
140 (B) In the event the individual has successfully completed a non-
141 accredited education pathway, obtain a midwifery bridge certificate from NARM; or
142 (C) In the event an individual licensed to practice midwifery in a
143 state that does not require the successful completion of an accredited educational pathway as a
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144 prerequisite to obtain a license to practice midwifery seeks to practice in the District, obtain a
145 midwifery bridge certificate from NARM.
146 (3) An individual applying for a license to practice midwifery under this act shall
147 additionally show the following:
148 (A) A criminal history background check in accordance with section 522
149 of this act.
150 (B) That the individual holds a current cardiopulmonary resuscitation
151 certification for healthcare providers issued by the American Red Cross or the American Heart
152 Association; and
153 (C) That the individual holds a current neonatal resuscitation program
154 certification issued by the American Academy of Pediatrics..
155 (e) New titles VI-E and VI-F are added to read as follows:
156 TITLE VI-E.
157 MATERNITY CENTERS CERTIFICATIONS; OPERATIONS; ADMINISTRATION.
158 "Sec. 661. Definitions.
159 For the purposes of this title, the term
160 (1) Applicant means an organization petitioning the Director to become a
161 certified maternity center
162 (2) Director means the Director of the Department of Health
163 (3) Maternity center means a facility or other place, other than a hospital or the
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164 mother's home, that provides antepartal, intrapartal, and postpartal care for both mother and
165 newborn infant during and after normal, uncomplicated pregnancy.
166 Sec. 662. Certification of maternity centers.
167 (a) Upon receipt of satisfactory proof from the applicant, the Mayor shall certify that the
168 following services shall be provided at the maternity center by or under the supervision of a
169 certified nurse-midwife or a certified professional midwife; provided, that a licensed physician is
170 available at all times:
171 (1) Diagnostic services for screening at-risk maternity patients and newborn
172 infants;
173 (2) Referral for care of at-risk maternity patients and newborn infants; and
174 (3) Midwifery services for the care of at-risk maternity patients and newborn
175 infants.
176 (b)(1) An individual or entity shall be appointed by the maternity center to develop and
177 maintain a written organizational plan and be responsible for the appointment of a certified
178 nurse-midwife or a certified professional midwife as director of the maternity center and a
179 qualified physician as Director of Medical Affairs.
180 (2) A maternity center shall not be required to employ a director of medical
181 affairs provided that the maternity center is able to produce demonstrated evidence that the
182 maternity center has access to appropriate consultation and transfer of care with an obstetrician
183 within an appropriate distance from the birthing center.
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184 (c) If midwifery services are provided by the maternity center, a certified nurse midwife
185 or a certified professional midwife shall be appointed director of midwifery services. The
186 director of the maternity center may serve in this capacity.
187 Sec. 662. Maternity Center Operating Procedures.
188 (a)(1) Every maternity center, regardless of size, shall have written practice guidelines
189 establishing procedures for both normal and emergency care. These guidelines shall be
190 consistent with the Practice Guidelines of the American College of Nurse-Midwives, Standards
191 of Practice of the National Association of Certified Professional Midwives and District of
192 Columbia laws and regulations relating to midwifery practices, and shall indicate the areas of
193 responsibility of medical, nurse- and certified professional midwifery and nursing personnel and
194 the extent to which the responsibility of physicians can be delegated. These practice guidelines
195 shall be available to all members of the center and shall be reviewed annually.
196 (2) Delivery practice guidelines shall be consistent with the current professional
197 standards of the National Association of Childbearing Centers, the Commission for the
198 Accreditation of Birth Centers, the National Association of Certified Professional Midwives and
199 the American College of Nurse Midwives.
200 (b) A certified nurse-midwife, a certified professional midwife or a physician with
201 special training in obstetrics, shall attend each patient in labor from the time of admission, during
202 labor, during birth and through the immediate postpartum period. Such attendance may be
203 delegated only to another certified nurse-midwife, a certified professional midwife or physician.
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204 At least 2 attendants must be present at every birth, one of whom is a physician, a certified nurse-
205 midwife or a certified professional midwife. Both attendants shall be currently certified in adult
206 cardiopulmonary resuscitation (CPR), equivalent to the American Heart Association Class C
207 basic life support, and neonatal CPR equivalent to the American Academy of
208 Pediatrics/American Heart Association. Qualified personnel, to include a licensed nurse-
209 midwife, a certified professional midwife or a Board-certified physician on the premises or on
210 call, shall always be on duty when patients are admitted.
211 Sec. 663. Administration of Medications.
212 (a) The practice guidelines governing drugs and medications shall provide for legal
213 authorization, storage, administration and record keeping including:
214 (1) Medications shall be ordered by a certified-nurse midwife, certified
215 professional midwife or physician or other member of the staff who is licensed to write such
216 orders;
217 (2) Medication orders shall be recorded in the patient's chart and signed by the
218 ordering person with his or her whole signature;
219 (3) Medications shall be administered by a physician, nurse midwife, certified
220 professional midwife registered nurse or licensed practical nurse, and in accordance with the
221 approved practice guidelines.
222 TITLE VI-F. MEDICAID REIMBURSEMENT.
223 Sec. 671. Reimbursement for Certified Professional Midwives.
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224 (a) A health benefit plan, and health insurance provided through Medicaid shall provide
225 coverage for services rendered by a certified professional midwife, as that term is defined in
226 section 101(1C) of the District of Columbia Health Occupations Revision Act of 1985, effective
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