Bill Summary – FastDemocracy

HOUSE . . . . . . . No. 4773
           The Commonwealth of Massachusetts
                   ______________________________________
                     HOUSE OF REPRESENTATIVES, June 18, 2024.
   The committee on Ways and Means, to whom was referred the Bill
promoting access to midwifery care and out-of-hospital birth options
(House, No. 4566), reports recommending that the same ought to pass
with an amendment substituting therefor the accompanying bill (House,
No. 4773).
                            For the committee,
                                                   AARON MICHLEWITZ.
                                                   FILED ON: 6/18/2024
      HOUSE . . . . . . . . . . . . . . . No. 4773
                                The Commonwealth of Massachusetts
                                                      _______________
                                    In the One Hundred and Ninety-Third General Court
                                                       (2023-2024)
                                                      _______________
     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:
         SECTION 1. Section 9 of chapter 13 of the General Laws, as appearing in the 2022
 Official Edition, is hereby amended by inserting after the word “counselors”, in line 7, the
 following words:- the board of registration in midwifery.
         SECTION 2. Section 11A of said chapter 13, as so appearing, is hereby amended by
 striking out the first paragraph and inserting in place thereof the following paragraph:-
         There shall be a board of allied health professions, hereinafter called the board, which
 shall consist of 15 members who are residents of the commonwealth to be appointed by the
 governor. Three of such members shall be qualified athletic trainers licensed in accordance with
 section 23B of chapter 112; 2 of such members shall be occupational therapists licensed in
 accordance with said section 23B; 1 such member shall be an occupational therapy assistant
 licensed in accordance with said section 23B; 2 of such members shall be physical therapists
 licensed in accordance with said section 23B; 1 such member shall be a physical therapist
 assistant licensed in accordance with said section 23B; 3 of such members shall be lactation
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 consultants licensed in accordance with said section 23B; 2 of such members shall be a physician
 licensed in accordance with section 2 of chapter 112; and 1 such member shall be selected from
 and shall represent the general public.
        SECTION 3. Said section 11A of said chapter 13, as so appearing, is hereby further
 amended by striking out the words “or physical therapy”, in lines 51 and 52, and inserting in
 place thereof the following words:- physical therapy or lactation consulting.
        SECTION 4. Said chapter 13 is hereby further amended by adding the following section:-
        Section 110. (a) There shall be within the department of public health a board of
 registration in midwifery, hereinafter called the board. The board shall consist of 9 members who
 are residents of the commonwealth to be appointed by the governor: 5 of whom shall be
 midwives licensed under section 293 of chapter 112 with not less than 5 years of experience in
 the practice of midwifery; 1 of whom shall be an obstetrician-gynecologist licensed to practice
 medicine under section 2 of said chapter 112 with experience working with midwives; 1 of
 whom shall be a maternal-fetal medicine specialist licensed to practice medicine under said
 section 2 of said chapter 112 with experience working with midwives; 1 of whom shall be a
 certified nurse-midwife licensed under section 80B of said chapter 112 and authorized to practice
 nurse midwifery under section 80C of said chapter 112; and 1 of whom shall be a member of the
 public. When making the appointments, the governor shall consider members with experience
 working on the issue of racial disparities in maternal health. The appointed members shall serve
 for terms of 3 years. Upon the expiration of a term of office, a member shall continue to serve
 until a successor has been appointed and qualified. A member shall not serve for more than 2
 consecutive full terms; provided, however, that a person who is chosen to fill a vacancy in an
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 unexpired term of a prior board member may serve for 2 consecutive full terms in addition to the
 remainder of such unexpired term. A member may be removed by the governor for neglect of
 duty, misconduct, malfeasance or misfeasance in the office after a written notice of the charges
 against the member and sufficient opportunity to be heard thereon. Upon the death, resignation,
 or removal for cause of a member of the board, the governor shall fill the vacancy for the
 remainder of that member’s term.
        (b) Annually, the board shall elect from its membership a chair and a secretary who shall
 serve until their successors have been elected and qualified. The board shall meet not less than 4
 times annually and may hold additional meetings at the call of the chair or upon the request of
 not less than 5 members. A quorum for the conduct of official business shall be a majority of
 those appointed. Board members shall serve without compensation but shall be reimbursed for
 actual and reasonable expenses incurred in the performance of their duties. The members shall be
 public employees for the purposes of chapter 258 for all acts or omissions within the scope of
 their duties as board members.
        SECTION 5. Chapter 32A of the General Laws is hereby amended by inserting after
 section 17S the following section:-
        Section 17T. The commission shall provide to any active or retired employee of the
 commonwealth who is insured under the group insurance commission coverage for postpartum
 depression screenings conducted pursuant to section 247 of chapter 111.
        SECTION 6. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
 Official Edition, is hereby amended by inserting after the definition of “Administrator” the
 following definition:-
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        “Certified nurse-midwife”, a nurse licensed under section 80B of said chapter 112 and
 authorized to practice nurse midwifery under section 80C of said chapter 112.
        SECTION 7. Said section 1E of said chapter 46, as so appearing, is hereby further
 amended by inserting after the definition of “Hospital medical officer” the following definition:-
        “Licensed midwife”, a midwife licensed to practice by the board of registration in
 midwifery pursuant to section 293 of chapter 112.
        SECTION 8. Section 3B of said chapter 46, as so appearing, is hereby amended by
 inserting after the word “physician”, in line 1, the following words:- certified nurse-midwife or
 licensed midwife.
        SECTION 9. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
 amended by inserting after the definition of “Isomer” the following definition:-
        “Licensed midwife”, a midwife licensed to practice by the board of registration in
 midwifery pursuant to section 293 of chapter 112.
        SECTION 10. Section 7 of said chapter 94C, as so appearing, is hereby amended by
 adding the following subsection:-
        (j) The commissioner shall promulgate regulations that provide for the automatic
 registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
 prescriptions in accordance with the provisions of section 295 of chapter 112 and the regulations
 issued by the board of registration in midwifery under said section 295 of said chapter 112,
 unless the registration of such licensed midwife has been suspended or revoked pursuant to the
 provisions of section 13 or section 14 or unless such registration is denied for cause by the
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 commissioner pursuant to chapter 30A. Prior to promulgating such regulations, the
 commissioner shall consult with the board of registration in midwifery and the department of
 public health.
        SECTION 11. Section 9 of said chapter 94C, as so appearing, is hereby amended by
 inserting after the figure “112”, in line 7, the following words:- , licensed midwife as limited by
 subsection (j) of said section 7 and section 295 of said chapter 112.
        SECTION 12. Said section 9 of said chapter 94C, as so appearing, is hereby further
 amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
 instance, the following words:- , licensed midwife.
        SECTION 13. Said section 9 of said chapter 94C, as so appearing, is hereby further
 amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
 midwifery.
        SECTION 14. Chapter 111 of the General Laws is hereby amended by inserting after
 section 24O the following section:-
        Section 24P. (a) As used in this section the following words shall, unless the context
 clearly requires otherwise, have the following meanings:
        “Fetal death”, as defined in section 202.
        “Infant death”, the death of an infant that occurs between the birth of the infant and 1
 year of age.
        (b) The department shall establish a program to conduct an in-depth fetal and infant
 mortality review of each individual fetal or infant death occurring within the commonwealth in
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 order to identify social, economic and systems factors associated with fetal and infant deaths and
 inform public health policy programs. For each case of fetal or infant death to be reviewed, the
 department may collect relevant data from a variety of sources, which may include physician and
 hospital records in addition to relevant information from local boards of health and community
 organizations.
        (c) The department may promulgate regulations, consistent with this section, regarding
 the process for conducting fetal infant mortality reviews, which may include guidance from the
 federal Health Resources and Services Administration’s national fetal, infant and child death
 review program.
        SECTION 15. Said chapter 111 is hereby further amended by inserting after section 51L
 the following section:-
        Section 51M. (a) The department shall promulgate regulations relative to the operation
 and maintenance of birth centers licensed as clinics pursuant to section 51, hereinafter referred to
 as “freestanding birth centers.”
        (b) The regulations shall include, but shall not be limited to, a licensed freestanding birth
 center having:
        (i) a detailed and written plan on the premises for transfer of a client to a nearby hospital
 providing obstetrical and newborn services as needed for emergency treatment beyond that
 provided by the birth center;
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        (ii) policies and procedures to ensure coordination of ongoing care and transfer when
 complications occur that render the patient ineligible for birth center care during the antepartum,
 intrapartum or postpartum period;
        (iii) an administrative director responsible for implementing and overseeing the
 operational policies of the birth center;
        (iv) a director of clinical affairs on staff who shall be a certified nurse-midwife or
 physician licensed to practice in the commonwealth whose professional scope of practice
 includes preconception, prenatal, labor, birth and postpartum care and early care of the newborn
 and who may be the primary attendants during the perinatal period; and
        (v) birth attendants that are certified nurse midwives, licensed midwives, physicians or
 other providers licensed to practice in the commonwealth whose professional scope of practice
 includes preconception, prenatal, labor, birth and postpartum care and early care of the newborn
 and who may be the primary attendants in accordance with their professional scope of practice.
        (c) No regulations shall require a licensed freestanding birth center or the directors and
 providers on staff to practice under the supervision of a hospital or another health care provider
 or to enter into an agreement, written or otherwise, with another hospital or health care provider,
 or maintain privileges at a hospital.
        (d) In order to be licensed as freestanding birth centers pursuant to subsection (a) and
 under section 51 by the department, a freestanding birth center shall provide reimbursable
 services to individuals with public health insurance on a non-discriminatory basis.
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        SECTION 16. Section 202 of said chapter 111, as appearing in the 2022 Official Edition,
 is hereby amended by inserting after the word “physician”, in line 17, the following words:- ,
 certified nurse-midwife or licensed midwife.
        SECTION 17. Said section 202 of said chapter 111, as so appearing, is hereby further
 amended by inserting after the word “attendance”, in line 17, the following words:- , or without
 the attendance of a certified nurse-midwife or licensed midwife,.
        SECTION 18. Said chapter 111 is hereby further amended by adding the following 3
 sections:-
        Section 245. (a) The commissioner shall develop and disseminate to the public,
 information regarding pregnancy loss, including miscarriage and recurrent miscarriage, which
 shall include information on: (i) the awareness of pregnancy loss and the incidence and
 prevalence of pregnancy loss among pregnant people; and (ii) the accessibility of the range of
 evidence-based treatment options, as medically appropriate, for pregnancy loss, including, but
 not limited to, comprehensive mental health supports, necessary procedures and medications and
 culturally responsive supports including as pregnancy-loss doula care.
        (b) The commissioner may disseminate information to the public directly through the
 department’s website or through arrangements with agencies carrying out intra-agency
 initiatives, nonprofit organizations, consumer groups, community organizations, institutions of
 higher education or state or local public-private partnerships.
        (c) The commissioner shall develop and coordinate programs for conducting and
 supporting evidence-based research with respect to the causes of and current and novel treatment
 options and procedures for pregnancy loss.
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        (d) The commissioner shall, in consultation with and in accordance with guidelines from
 relevant professional boards of registration, develop and disseminate to perinatal health care
 workers information on pregnancy loss to ensure that such perinatal health care workers remain
 informed about current information regarding pregnancy loss and prioritizing both the physical
 and mental health care of patients experiencing pregnancy loss. For purposes of this subsection,
 the term “perinatal health care worker” shall include, but shall not be limited to, a licensed
 midwife, physician assistant, nurse practitioner, clinical nurse specialist, doula, community
 health worker, peer supporter, licensed lactation consultant, nutritionist or dietitian, childbirth
 educator, social worker, trained family support specialist or home visitor, and language
 interpreter or navigator.
        (e) The commissioner shall, in a manner that protects personal privacy and complies with
 federal law, collect and assess data regarding pregnancy loss, including information
 disaggregated by race, ethnicity, health insurance status, disability, income level and geography
 on the prevalence of, the incidence of and knowledge about pregnancy loss.
        Section 246. (a) As used in this section, the following words shall, unless the context
 clearly requires otherwise, have the following meanings:
        “Perinatal individual”, an individual that is either pregnant or is within 12 months from
 the date of giving birth.
        “Perinatal mood and anxiety disorders”, any mental health disorder experienced by a
 perinatal individual during the period of time from the beginning of pregnancy up until 1 year
 following the birth of a child, including, but not limited to, postpartum depression.
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        (b) The department shall develop and maintain a comprehensive digital resource center
 on perinatal mood and anxiety disorders. The digital resource center shall be available to the
 public at no cost on the department’s website, and shall include information and resources for: (i)
 health care providers and organizations serving perinatal individuals to aid them in diagnosing,
 treating or making appropriate referrals for individuals experiencing perinatal mood and anxiety
 disorders; (ii) perinatal individuals and their families to aid them in understanding and
 identifying perinatal mood and anxiety disorders and how to navigate available resources and
 obtain treatment.
        (c) Prior to developing the comprehensive digital resource center, the department shall
 consult with: (i) health care professionals, including, but not limited to, obstetricians,
 gynecologists, pediatricians, primary care providers, certified nurse-midwives, licensed
 midwives, psychiatrists, and o