HOUSE . . . . . . . . No. 4566
The Commonwealth of Massachusetts
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HOUSE OF REPRESENTATIVES, April 22, 2024.
The committee on Public Health, to whom were referred the petition
(accompanied by bill, Senate, No. 1335) of Joanne M. Comerford, Jack
Patrick Lewis, Jason M. Lewis, Lydia Edwards and other members of the
General Court for legislation to update the regulations governing licensed
birth centers in Massachusetts, the petition (accompanied by bill, Senate,
No. 1375) of Cindy F. Friedman, Rebecca L. Rausch, Patrick M.
O'Connor, Vanna Howard and other members of the General Court for
legislation relative to postpartum depression screening, the petition
(accompanied by bill, Senate, No. 1414) of Liz Miranda, Lydia Edwards
and Jason M. Lewis for legislation relative to conducting fetal and infant
mortality review, the petition (accompanied by bill, Senate, No. 1457) of
Rebecca L. Rausch, Jack Patrick Lewis, Hannah Kane, Jason M. Lewis
and other members of the General Court for legislation to promote access
to midwifery care and out-of-hospital birth options, the petition
(accompanied by bill, House, No. 2163) of Carole A. Fiola and others that
the Division of Medical Assistance be directed to provide coverage for
screenings for postpartum depression, the petition (accompanied by bill,
House, No. 2187) of Patricia A. Haddad and Carole A. Fiola relative to
conducting fetal and infant mortality review, the petition (accompanied by
bill, House, No. 2209) of Kay Khan, Brandy Fluker Oakley and others for
legislation to establish a board of registration in midwifery and further
regulating out-of-hospital birth access and safety, the petition
(accompanied by bill, House, No. 2265) of Lindsay N. Sabadosa and
others for legislation to establish a pregnancy loss awareness program
within the Department of Public Health, and the petition (accompanied by
bill, House, No. 3616) of Manny Cruz, Chynah Tyler and others relative to
the regulations governing licensed birth centers, reports recommending
that the accompanying bill (House, No. 4566) ought to pass.
For the committee,
MARJORIE C. DECKER.
 FILED ON: 4/18/2024
HOUSE . . . . . . . . . . . . . . . No. 4566
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act promoting access to midwifery care and out-of-hospital birth options.
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. Section 9 of chapter 13 of the General Laws, as appearing in the 2022
2 Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the
3 following words:- the board of registration in midwifery.
4 SECTION 2. Section 11A of chapter 13 of the General Laws, as so appearing, is hereby
5 amended by striking out the first paragraph and inserting in place thereof the following
6 paragraph:-
7 There shall be a board of allied health professions, hereinafter called the board,
8 which shall consist of 12 members to be appointed by the governor. Members of the board shall
9 be residents of the commonwealth and citizens of the United States. Three of such members shall
10 be athletic trainers licensed in accordance with section 23B of chapter 112; 2 of such members
11 shall be occupational therapists licensed in accordance with said section 23B; 1 such member
12 shall be an occupational therapy assistant licensed in accordance with said section 23B; 2 of such
13 members shall be physical therapists licensed in accordance with said section 23B; 1 such
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14 member shall be a physical therapist assistant licensed in accordance with said section 23B; 1
15 such member shall be a lactation consultant licensed in accordance with said section 23B; 1 such
16 member shall be a physician licensed in accordance with section 2 of chapter 112; and 1 such
17 member shall be selected from and shall represent the general public.
18 SECTION 3. Said chapter 13, as so appearing, is hereby further amended by adding the
19 following section:-
20 Section 110. (a) There shall be within the department of public health a board of
21 registration in midwifery. The board shall consist of 8 members to be appointed by the governor,
22 5 of whom shall be midwives with not less than 5 years of experience in the practice of
23 midwifery and who shall be licensed under sections 276 to 289, inclusive, of chapter 112, 1 of
24 whom shall be a physician licensed to practice medicine under section 2 of said chapter 112 with
25 experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed to
26 practice midwifery under section 80B of said chapter 112 and 1 of whom shall be a member of
27 the public. Four of the members of the board of registration in midwifery shall have experience
28 working on the issue of racial disparities in maternal health or be a member of a population that
29 is underrepresented in the midwifery profession. When making the appointments, the governor
30 shall consider the recommendations of organizations representing certified professional
31 midwives in the commonwealth. The appointed members shall serve for terms of 3 years. Upon
32 the expiration of a term of office, a member shall continue to serve until a successor has been
33 appointed and qualified. A member shall not serve for more than 2 consecutive terms; provided,
34 however, that a person who is chosen to fill a vacancy in an unexpired term of a prior board
35 member may serve for 2 consecutive terms in addition to the remainder of that unexpired term. A
36 member may be removed by the governor for neglect of duty, misconduct, malfeasance or
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37 misfeasance in the office after a written notice of the charges against the member and sufficient
38 opportunity to be heard thereon. Upon the death or removal for cause of a member of the board,
39 the governor shall fill the vacancy for the remainder of that member’s term after considering
40 suggestions from a list of nominees provided by organizations representing certified professional
41 midwives in the commonwealth. For the initial appointment of the board, the 5 members
42 required to be licensed midwives shall be persons with at least 5 years of experience in the
43 practice of midwifery who meet the eligibility requirements set forth in subsection (a) of section
44 281 of chapter 112. Members of the board shall be residents of the commonwealth.
45 (b) Annually, the board shall elect from its membership a chair and a secretary
46 who shall serve until their successors have been elected and qualified. The board shall meet not
47 less than 4 times annually and may hold additional meetings at the call of the chair or upon the
48 request of not less than 4 members. A quorum for the conduct of official business shall be a
49 majority of those appointed. Board members shall serve without compensation but shall be
50 reimbursed for actual and reasonable expenses incurred in the performance of their duties. The
51 members shall be public employees for the purposes of chapter 258 for all acts or omissions
52 within the scope of their duties as board members.
53 SECTION 4. Chapter 38 of the general laws is hereby amended by inserting after section
54 2A the following section: --
55 Section 2B. As used in this section, the term below shall have the following
56 meaning: -
57 “Authorized local health agency”, shall mean a health board, department, or other
58 governmental entity that is authorized by the department of public health to receive timely data
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59 relative to fetal and infant deaths for assessing, planning, improving and monitoring the service
60 systems and community resources that support child and maternal health.
61 The department of public health shall establish a process for designating
62 authorized local health agencies. This process may include reasonable criteria regarding the
63 level of expertise, workforce capacity, or organizational capacity. Authorized local health
64 agencies shall be authorized to conduct in-depth fetal infant mortality review of each individual
65 infant and fetal death occurring within their jurisdiction, in order to identify local factors
66 associated with fetal and infant deaths and inform public health policy programs.
67 For each case of fetal or infant death to be reviewed, authorized local health
68 agencies are hereby authorized to collect relevant data from a variety of sources, which may
69 include physician and hospital records in addition to relevant community program records.
70 Authorized local health agencies are authorized to collect, and the department is authorized to
71 provide, timely access to vital records and other data reasonably necessary for fetal and infant
72 mortality review.
73 The department may issue additional guidance through policy or regulation,
74 consistent with this section, regarding the process for conducting fetal infant mortality reviews
75 by authorized local health agencies, which may include guidance from the National Fetal and
76 Infant Mortality Review Program.
77 SECTION 5. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
78 Official Edition, is hereby amended by inserting after the definition of “Physician” the following
79 definition:-
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80 “Licensed midwife,” shall mean a midwife licensed to practice by the board of
81 registration in midwifery as provided in sections 276 to 289 of chapter 112.
82 SECTION 6. Section 3B of said chapter 46, as so appearing, is hereby amended by
83 inserting after the word “physician”, in line 1, the following words:- or licensed midwife.
84 SECTION 7. Section 1 of chapter 94C of the general laws, as appearing in the 2022
85 Official Edition, is hereby amended by inserting after the definition of “Isomer” the following
86 definition:-
87 “Licensed midwife,” shall mean a midwife licensed to practice by the board of
88 registration in midwifery as provided in sections 276 to 289 of chapter 112.
89 SECTION 8. Section 7 of said chapter 94C, as so appearing, is hereby amended by
90 adding the following new subsection:-
91 (j) The commissioner shall promulgate regulations which provide for the
92 automatic registration of licensed midwives, upon the receipt of the fee as herein provided, to
93 issue written prescriptions in accordance with the provisions of sections 279 of chapter 112 and
94 the regulations issued by the board of registration in midwifery under said section 279 of chapter
95 112, unless the registration of such licensed midwife has been suspended or revoked pursuant to
96 the provisions of section 13 or section 14 or unless such registration is denied for cause by the
97 commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations,
98 the commissioner shall consult with the board of registration in midwifery.
99 SECTION 9. Section 9 of said chapter 94C, as so appearing, is hereby amended by
100 inserting in paragraph (a), after the words “certified nurse midwife as provided in section 80C of
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101 said chapter 112” the following words:- , licensed midwife as limited by subsection (j) of said
102 section 7 and section 279 of said chapter 112.
103 SECTION 10. Section 9 of said chapter 94C, as so appearing, is hereby further amended
104 in paragraph (b), by inserting after the words “midwife” in each place that they appear, the
105 following words:- , licensed midwife.
106 SECTION 11. Said section 9 of said chapter 94C, as so appearing, is hereby further
107 amended in paragraph (b), by inserting after the words “nurse-midwifery” in each place that they
108 appear, the following words:- , midwifery.
109 SECTION 12. Section 9 of said chapter 94C is further amended in paragraph (c), by
110 inserting after the words “certified nurse midwife” in each place that they appear, the following
111 words:- , licensed midwife.
112 SECTION 13. The definition of “medical peer review committee” in section 1 of chapter
113 111 of the General Laws, as appearing in the 2022 official edition, is hereby amended by adding
114 the following sentence:- “Medical peer review committee” shall include a committee or
115 association that is authorized by a midwifery society or association to evaluate the quality of
116 midwifery services or the competence of midwives and suggest improvements in midwifery
117 practices to improve patient care.
118 SECTION 14. Section 51 of chapter 111 of the General Laws, as appearing in the
119 2022 Official Edition, is hereby amended by adding after the word “Gynecologists,” in line 106,
120 the following words:- , American College of Nurse Midwives, American Association of Birth
121 Centers.
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122 SECTION 15. Section 202 of said chapter 111, as so appearing, is hereby amended by
123 inserting, in the second and third paragraphs, after the word “attendance”, in each instance, the
124 following words:- or midwife in attendance.
125 SECTION 16. Said section 202, as so appearing, is hereby further amended by inserting,
126 in the fourth paragraph, after the word “attendance” the following words:- or without the
127 attendance of a midwife,.
128 SECTION 17. Section 204 of said chapter 111, as so appearing, is hereby amended by
129 inserting, in lines 7, 12 and 28, after the word “medicine”, in each instance, the following word:-
130 , midwifery.
131 SECTION 18. Chapter 111 of the General Laws is hereby amended by adding the
132 following section:-
133 Section 244. (a) The commissioner shall develop and disseminate to the public
134 information regarding pregnancy loss, including information on: (i) awareness of pregnancy loss
135 and the incidence and prevalence of pregnancy loss among pregnant people; and (ii) the
136 accessibility of the range of evidence-based treatment options, as medically appropriate, for
137 pregnancy loss, including miscarriage and recurrent miscarriage, including but not limited to
138 comprehensive mental health supports, necessary procedures and medications and culturally
139 responsive supports such as pregnancy-loss doula care.
140 The commissioner may disseminate information to the public directly or through
141 arrangements with agencies carrying out intra-agency initiatives, nonprofit organizations,
142 consumer groups, community organizations, institutions of higher education or state or local
143 public-private partnerships.
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144 (b) The commissioner shall expand and coordinate programs for conducting and
145 supporting evidence-based research with respect to causes of and current and novel treatment
146 options and procedures for pregnancy loss.
147 (c) The commissioner shall, in consultation with and in accordance with
148 guidelines from relevant medical societies, develop and disseminate to perinatal health care
149 workers, including midwives, physician assistants, nurse practitioners, clinical nurse specialists
150 and non-clinical perinatal health care workers, information on pregnancy loss for the purpose of
151 ensuring that such perinatal health care workers remain informed about current information
152 regarding pregnancy loss, including miscarriage and recurrent miscarriage, and prioritizing both
153 the physical and mental health care of the patient. For purposes of this subsection, the term
154 “perinatal health care worker” shall include any doula, community health worker, peer supporter,
155 breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator,
156 social worker, home visitor, language interpreter or navigator.
157 (d) The commissioner shall, in a manner that protects personal privacy and
158 complies with federal law, collect and assess data regarding pregnancy loss, including
159 information disaggregated by race, ethnicity, health insurance status, disability, income level and
160 geography on the prevalence of, the incidence of and knowledge about pregnancy loss.
161 SECTION 19. Section 23A of chapter 112 of the General Laws, as appearing in the 2022
162 Official Edition, is hereby amended by inserting after the definition of “Board” the following
163 definitions:-
164 “International Board Certified Lactation Consultant (IBCLC)” means a person
165 who holds current certification from the International Board of Lactation Consultant Examiners
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166 (IBLCE) as a lactation consultant after demonstrating the appropriate education, knowledge, and
167 experience necessary for independent clinical practice.
168 “International Board of Lactation Consultant Examiners (IBLCE)” means the
169 international certification body that confers the International Board Certified Lactation
170 Consultant credential. and which is independently accredited by the National Commission of
171 Certifying Agencies.
172 “Lactation consulting” means the clinical application of scientific principles and a
173 multidisciplinar