FILED ON: 6/20/2024
HOUSE . . . . . . . . . . . . . . . No. 4785
House bill No. 4773, as changed by the committee on Bills in the Third Reading and as amended
and passed to be engrossed by the House. June 20, 2024.
The Commonwealth of Massachusetts
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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 after the word “counselors”, in line 7, the
3 following words:- the board of registration in midwifery.
4 SECTION 2. Section 11A of said chapter 13, as so appearing, is hereby amended by
5 striking out the first paragraph and inserting in place thereof the following paragraph:-
6 There shall be a board of allied health professions, hereinafter called the board, which
7 shall consist of 15 members who are residents of the commonwealth to be appointed by the
8 governor. Three of such members shall be qualified athletic trainers licensed in accordance with
9 section 23B of chapter 112; 2 of such members shall be occupational therapists licensed in
10 accordance with said section 23B; 1 such member shall be an occupational therapy assistant
11 licensed in accordance with said section 23B; 2 of such members shall be physical therapists
12 licensed in accordance with said section 23B; 1 such member shall be a physical therapist
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13 assistant licensed in accordance with said section 23B; 3 of such members shall be lactation
14 consultants licensed in accordance with said section 23B; 2 of such members shall be a physician
15 licensed in accordance with section 2 of chapter 112; and 1 such member shall be selected from
16 and shall represent the general public.
17 SECTION 3. Said section 11A of said chapter 13, as so appearing, is hereby further
18 amended by striking out the words “or physical therapy”, in lines 51 and 52, and inserting in
19 place thereof the following words:- physical therapy or lactation consulting.
20 SECTION 4. Said chapter 13 is hereby further amended by adding the following section:-
21 Section 110. (a) There shall be within the department of public health a board of
22 registration in midwifery, hereinafter called the board. The board shall consist of 9 members who
23 are residents of the commonwealth to be appointed by the governor: 5 of whom shall be
24 midwives licensed under section 293 of chapter 112 with not less than 5 years of experience in
25 the practice of midwifery; 1 of whom shall be an obstetrician-gynecologist licensed to practice
26 medicine under section 2 of said chapter 112 with experience working with midwives; 1 of
27 whom shall be a maternal-fetal medicine specialist licensed to practice medicine under said
28 section 2 of said chapter 112 with experience working with midwives; 1 of whom shall be a
29 certified nurse-midwife licensed under section 80B of said chapter 112 and authorized to practice
30 nurse midwifery under section 80C of said chapter 112; and 1 of whom shall be a member of the
31 public. When making the appointments, the governor shall consider members with experience
32 working on the issue of racial disparities in maternal health. The appointed members shall serve
33 for terms of 3 years. Upon the expiration of a term of office, a member shall continue to serve
34 until a successor has been appointed and qualified. A member shall not serve for more than 2
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35 consecutive full terms; provided, however, that a person who is chosen to fill a vacancy in an
36 unexpired term of a prior board member may serve for 2 consecutive full terms in addition to the
37 remainder of such unexpired term. A member may be removed by the governor for neglect of
38 duty, misconduct, malfeasance or misfeasance in the office after a written notice of the charges
39 against the member and sufficient opportunity to be heard thereon. Upon the death, resignation,
40 or removal for cause of a member of the board, the governor shall fill the vacancy for the
41 remainder of that member’s term.
42 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
43 serve until their successors have been elected and qualified. The board shall meet not less than 4
44 times annually and may hold additional meetings at the call of the chair or upon the request of
45 not less than 5 members. A quorum for the conduct of official business shall be a majority of
46 those appointed. Board members shall serve without compensation but shall be reimbursed for
47 actual and reasonable expenses incurred in the performance of their duties. The members shall be
48 public employees for the purposes of chapter 258 for all acts or omissions within the scope of
49 their duties as board members.
50 SECTION 5. Chapter 32A of the General Laws is hereby amended by inserting after
51 section 17S the following 2 sections:-
52 Section 17T. The commission shall provide to any active or retired employee of the
53 commonwealth who is insured under the group insurance commission coverage for postpartum
54 depression screenings conducted pursuant to section 247 of chapter 111.
55 Section 17U. (a) The commission shall provide to any active or retired employee of the
56 commonwealth who is insured under the group insurance commission coverage for the
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57 provision of medically necessary pasteurized donor human milk and donor human milk-derived
58 products, provided that:
59 (i) the milk is obtained from a human milk bank that meets quality guidelines established
60 by the department of public health;
61 (ii) a licensed medical practitioner has issued a written order for the provision of such
62 human breast milk or donor human milk-derived products for the covered infant; and
63 (iii) the covered infant meets the following conditions:-
64 (1) is under the age of 6 months;
65 (2) is undergoing treatment in an inpatient setting for a congenital or acquired condition
66 that places the infant at a high risk for development of necrotizing enterocolitis, or a congenital
67 or acquired condition that may benefit from the use of such human breast milk as determined by
68 the department of public health; and
69 (3) is medically or physically unable to receive maternal breast milk or participate in
70 breastfeeding or whose mother is medically or physically unable, despite receiving lactation
71 support, to produce maternal breast milk in sufficient quantities or caloric density.
72 (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled
73 payment arrangement, the commission shall include the cost of reimbursement provided under
74 subsection (a) of this section for donor human milk and donor human milk-derived products in
75 the development of the reimbursement rate for such diagnosis related group or bundled payment.
76 SECTION 6. Section 1E of chapter 46 of the General Laws, as appearing in the 2022
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77 Official Edition, is hereby amended by inserting after the definition of “Administrator” the
78 following definition:-
79 “Certified nurse-midwife”, a nurse licensed under section 80B of said chapter 112 and
80 authorized to practice nurse midwifery under section 80C of said chapter 112.
81 SECTION 7. Said section 1E of said chapter 46, as so appearing, is hereby further
82 amended by inserting after the definition of “Hospital medical officer” the following definition:-
83 “Licensed midwife”, a midwife licensed to practice by the board of registration in
84 midwifery pursuant to section 293 of chapter 112.
85 SECTION 8. Section 3B of said chapter 46, as so appearing, is hereby amended by
86 inserting after the word “physician”, in line 1, the following words:- certified nurse-midwife or
87 licensed midwife.
88 SECTION 9. Section 1 of chapter 94C of the General Laws, as so appearing, is hereby
89 amended by inserting after the definition of “Isomer” the following definition:-
90 “Licensed midwife”, a midwife licensed to practice by the board of registration in
91 midwifery pursuant to section 293 of chapter 112.
92 SECTION 10. Section 7 of said chapter 94C, as so appearing, is hereby amended by
93 adding the following subsection:-
94 (j) The commissioner shall promulgate regulations that provide for the automatic
95 registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
96 prescriptions in accordance with the provisions of section 295 of chapter 112 and the regulations
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 97 issued by the board of registration in midwifery under said section 295 of said chapter 112,
98 unless the registration of such licensed midwife has been suspended or revoked pursuant to the
99 provisions of section 13 or section 14 or unless such registration is denied for cause by the
100 commissioner pursuant to chapter 30A. Prior to promulgating such regulations, the
101 commissioner shall consult with the board of registration in midwifery and the department of
102 public health.
103 SECTION 11. Section 9 of said chapter 94C, as so appearing, is hereby amended by
104 inserting after the figure “112”, in line 7, the following words:- , licensed midwife as limited by
105 subsection (j) of said section 7 and section 295 of said chapter 112.
106 SECTION 12. Said section 9 of said chapter 94C, as so appearing, is hereby further
107 amended by inserting after the word “midwife”, in lines 24, 33, 38, 69, 75, 78 and 87, in each
108 instance, the following words:- , licensed midwife.
109 SECTION 13. Said section 9 of said chapter 94C, as so appearing, is hereby further
110 amended by inserting after the word “nurse-midwifery”, in line 29, the following word:- ,
111 midwifery.
112 SECTION 13A. Section 24O of chapter 111 of the General Laws, inserted by section 43
113 of chapter 28 of the acts of 2023, is hereby amended by striking out subsection (d), the second
114 time the subsection appears, and subsection (e), and inserting in place thereof the following 3
115 subsections:-
116 (e)(1) The committee shall consist of the following members: the commissioner, or their
117 designee, who shall serve as chair; the assistant secretary for MassHealth, or their designee, a
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118 representative of the department of public health; the executive director of the health policy
119 commission, or their designee; a representative of the Perinatal-Neonatal Quality Improvement
120 Network of Massachusetts; the chief medical examiner, or their designee; the chair of the
121 Massachusetts chapter of the American College of Obstetrics and Gynecology, or their designee;
122 the chair of the Massachusetts chapter of the American College of Nurse Midwives, or their
123 designee; the chair of the Massachusetts chapter of the Association of Women's Health, Obstetric
124 and Neonatal Nurses, or their designee; and the commissioner shall appoint the following
125 members: a medical professional with obstetric and neonatal nursing training; a medical
126 professional with training in cardiology; a medical professional with training in pathology; a
127 medical professional with expertise in substance use prevention and treatment; a psychology,
128 social work or other mental health professional; a representative from academia in a relevant
129 field; a medical professional with formal anesthesiology training; a medical professional with
130 maternal fetal medicine or perinatology training; a medical professional with psychiatric
131 training; a medical professional with family medicine training; the director of a federally-funded
132 Healthy Start program, or their designee; 2 individuals who practice as doulas; 2 community or
133 family members who have been directly affected by a maternal death; a member of a
134 community-based organization; a representative from the department of children and families;
135 and a law enforcement officer.
136 (2) Each member, other than the commissioner, shall serve for a term of 3 years and until
137 their successor is appointed. Nothing in this section shall prohibit the commissioner from
138 appointing a committee member to serve additional terms. The committee shall convene as
139 deemed necessary by the department. The commissioner shall, to the extent feasible, appoint
140 members representing the racial, ethnic and geographic diversity of the commonwealth and shall
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141 prioritize appointing members from communities and groups most impacted by maternal
142 mortality and maternal morbidity.
143 (f) Not later than December 31 of each even-numbered year, the committee shall submit
144 to the clerks of the house of representatives and the senate, the house and senate committees on
145 ways and means and the joint committee on public health a report, including, but not limited to:
146 (i) a description of the incidents of maternal mortality and severe maternal morbidity
147 reviewed during the immediately preceding 24 months, provided in a manner that shall not allow
148 for the identification of any person;
149 (ii) a summary of the disparities identified and reviewed;
150 (iii) recommendations to reduce maternal mortality and severe maternal morbidity in the
151 commonwealth; and
152 (iv) recommendations for any legislation or other changes to policy to reduce maternal
153 mortality and severe maternal morbidity or otherwise improve the delivery of health care in the
154 commonwealth.
155 (g) Notwithstanding any general or special law to the contrary, upon the determination of
156 a majority of the committee, that the review of any information or record is necessary to carry
157 out the purpose of this section, the committee shall request and the relevant offices and agencies
158 shall provide requested records or information from any agency, department or office of the
159 commonwealth including, but not limited to: (i) the executive office of health and human
160 services and its constituent agencies; (ii) the executive office of public safety and security; (iii)
161 the center for health information and analysis; (iv) the office of patient protection; (v) any health
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162 care facility, state comprehensive health planning agency or acute-care hospital as defined in
163 section 25B; and (vi) any health care provider or professional licensed pursuant to chapter 112.
164 The committee may receive and solicit voluntary information, including oral or written
165 statements relating to any case that may come before the committee from any public or private
166 entity and any person including, but not limited to, a patient in a case of maternal morbidity.
167 SECTION 14. Said chapter 111 is hereby further amended by inserting after section 24O
168 the following section:-
169 Section 24P. (a) As used in this section the following words shall, unless the context
170 clearly requires otherwise, have the following meanings:
171 “Fetal death”, as defined in section 202.
172 “Infant death”, the death of an infant that occurs between the birth of the infant and 1
173 year of age.
174 (b) The department shall establish a program to conduct an in-depth fetal and infant
175 mortality review of each individual fetal or infant death occurring within the commonwealth in
176 order to identify social, economic and systems factors associated with fetal and infant deaths and
177 inform public health policy programs. For each case of fetal or infant death to be reviewed, the
178 department may collect relevant data from a variety of sources, which may include physician and
179 hospital records in addition to relevant information from local boards of health and community
180 organizations.
181 (c) The department may promulgate regulations, consistent with this section, regarding
182 the process for conducting fetal infant mortality reviews, which may include guidance from the
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183 federal Health Resources and Services Administration’s national fetal, infant and child death
184 review program.
185 SECTION 15. Said chapter 111 is hereby further amended by inserting after section 51L
186 the following section:-
187 Section 51M. (a) The department shall promulgate regulations relative to the operation
188 and maintenance of birth centers licensed as clinics pursuant to section 51, hereinafter referred to
189 as “freestanding birth centers.”
190 (b) The regulations shall include, but shall not be limited to, a licensed freestanding birth
191 center having:
192 (i) a detailed and written plan on the premises for transfer of a client to a nearby hospital
193 providing obstetrical and newborn services as needed for emergency treatment beyond that
194 provided by the birth center;
195 (ii) policies and procedures to ensure coordination of ongoing care and transfer when
196 complications occur that render the patient ineligible for birth center care during the antepartum,
197 intrapartum or postpartum period;
198 (iii) an administrative