Legislative Analysis
Phone: (517) 373-8080
FREESTANDING BIRTH CENTERS
http://www.house.mi.gov/hfa
House Bill 5636 (proposed substitute H-2)
Analysis available at
Sponsor: Rep. Laurie Pohutsky http://www.legislature.mi.gov
Committee: Health Policy
Complete to 11-15-24
SUMMARY:
House Bill 5636 would amend the Public Health Code to define and provide for the licensure
of freestanding birth centers, which would provide midwifery care, reproductive and sexual
health care, and newborn and postpartum care as described below. The bill would provide
parameters for these facilities, prescribe licensing fees, and require the Department of
Licensing and Regulatory Affairs (LARA) to develop and issue rules addressing them. None
of these provisions would be enforceable until two years after the bill takes effect. The bill also
would add new requirements to the code for determining the place of birth to be listed on a
birth certificate under certain circumstances. Those provisions would take effect with the bill.
Freestanding birth centers
The bill would add Part 207 (Freestanding Birth Centers) to Article 17 (Facilities and Agencies)
of the Public Health Code. The new part would require freestanding birth centers to be
licensed under Article 17 and would prohibit use of the term “freestanding birth center” (or a
similar term or abbreviation) to refer to any health facility or agency that is not licensed under
Article 17. However, the bill would prohibit LARA from enforcing the new Part 207 or any
rules issued under it (including the requirement that a freestanding birth center be licensed
under the bill) until two years after the bill takes effect.
Freestanding birth center would, for purposes of Article 17, be defined to mean a
facility that provides (within the scope of practice of the applicable health care
provider) midwifery care for normal deliveries, well-person reproductive and sexual
health care, extended postpartum care, and newborn care. A hospital or freestanding
surgical outpatient facility would not be considered a freestanding birth center.
Health facility or agency means any of the following: 1
• An ambulance operation, aircraft transport operation, nontransport prehospital
life support operation, or medical first response service.
• A county medical care facility.
• A freestanding surgical outpatient facility.
• A health maintenance organization.
• A home for the aged.
• A hospital.
• A nursing home.
• A facility or agency listed above that is located in a university, college, or other
educational institution.
• A hospice or hospice residence.
1
This is the current definition of health facility or agency for Article 17. The bill would add freestanding birth centers.
Section 20115 has additional provisions: https://www.legislature.mi.gov/Laws/MCL?objectName=MCL-333-20115
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 Midwifery care would mean either of the following:
• Maternity care provided to women and neonates during the periods before,
during, and after birth by a midwife licensed under Part 171 of the code that is
consistent with the midwife’s training, education, and experience. 2
• The practice of nursing by a certified nurse midwife (someone licensed as a
registered professional nurse under Part 172 of the code who has been granted
a specialty certification in the health profession specialty field of nurse
midwifery by the Michigan Board of Nursing under section 17210). 3
Health care provider would mean any of the following as licensed under the code:
• A physician.
• A physician’s assistant.
• A certified nurse midwife.
• A midwife.
Freestanding birth centers would be subject to a $2,000 initial licensure application fee for each
initial license and an annual $500 fee for each facility license.
A freestanding birth center would not have to get a certificate of need under the code.
The bill would not require new or additional third-party reimbursement or mandated worker’s
compensation benefits for services rendered at a freestanding birth center.
Duties, responsibilities, requirements
A freestanding birth center would have to provide quality perinatal care 4 that promotes
physiologic birth (commonly called natural birth), including at least all of the following:
• Respectful, supportive care during labor, for which the patient has provided consent.
• Minimization of stress-inducing stimuli.
• Freedom of movement.
• Oral intake, as appropriate.
• Availability of nonpharmacologic pain relief methods.
• Regular and appropriate assessment of the patient and fetus throughout labor.
A freestanding birth center would have to ensure all of the following:
• That the following information is provided to a patient at the start of care:
o A written description of the training, philosophy of practice, qualifications, and
license or specialty certification of a health care provider employed by or under
contract with the facility.
o A written description of the facility’s patient practice policies.
o The complaint process for state and national credentialing organizations for a
health care provider employed by or under contract with the facility.
• That a patient is notified of each health care provider in the facility who maintains a
malpractice liability insurance policy and of each one who does not.
2
Part 171: https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-368-1978-15-171.
3
Part 172: https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-368-1978-15-172
4
Care addressing the time immediately before and after birth.
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 • That a health care provider is present or available to a patient at all times when the
patient is admitted to facility and until the patient and the newborn are determined to
be clinically stable, based on criteria established by the facility.
• That a health care provider monitors the progress of a patient's labor and the condition
of the patient and fetus or newborn at intervals established in the facility’s policies and
procedures.
• That at least two individuals are on the premises and immediately available during a
delivery who meet both of the following:
o They are certified in basic life support from the American Heart Association
(AHA) or an equivalent organization as determined by LARA.
o They are certified in neonatal resuscitation from the AHA, the American
Academy of Pediatrics, or an equivalent organization as determined by LARA.
• That services are provided in a community setting with adequate space for furnishings,
equipment, supplies, and accommodations for patients and the families of patients.
• That both of the following are always available to a patient at any time of day or night:
o Consultation by telephone with a health care provider.
o Intrapartum care provided by an on-call health care provider or other personnel.
• That a program for follow-up care and postpartum evaluation is planned for each
patient.
• That a patient is not discharged until they are clinically stable and have met discharge
criteria established by the facility.
A freestanding birth center would have to do all of the following:
• Have the personnel and equipment necessary to do all of the following:
o Ensure patient safety.
o Meet the demands for services that are routinely provided in the facility.
o Provide coverage during an emergency or periods of high demand.
o Respond to potential patient health emergencies, including at least basic life
support, neonatal resuscitation, and the initial management of postpartum
complications.
• Identify a hospital that is in close proximity to the freestanding birth center and to
which a patient may be transferred from the freestanding birth center.
The owner, operator, and governing body of a freestanding birth center would be responsible
for the operation of the facility, the selection of health care providers, and the quality of care
provided, including requiring that health care providers and other facility employees are
appropriately licensed or registered. As appropriate given the facility’s size and caseload, they
would have to ensure that there are enough health care providers to maintain safety and quality
of care and that those providers have the qualifications, training, and skills necessary to meet
both patient needs and the operational needs of the facility.
Limitations
A freestanding birth center could not do any of the following:
• Use general or regional anesthesia (including epidural anesthesia). However, local
anesthesia, nitrous oxide, and other forms of pain relief could be administered at the
facility as long as all of the following are met:
o A health care provider determines it to be clinically necessary.
o A health care provider administers it within their scope of practice.
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 o It is used in accordance with the facility’s policies and procedures and the
professionally recognized standards of practice described in section 20727 of
the code.
• Use pharmacologic agents to induce, stimulate, or augment labor, or bring about
cervical ripening, before labor or during the first or second stages of labor. However,
a freestanding birth center could use pharmacologic agents during the delivery of a
placenta and in the postpartum period.
• Perform surgical procedures, other than episiotomies, repairs of perineal lacerations,
circumcisions, newborn frenulum revisions, or any other surgical procedure authorized
by LARA by rule.
• Use vacuum extractors or vaginal forceps.
• Allow a patient to deliver at the facility if any of the following limiting factors apply:
o Fetal gestation is less than 36 weeks and 0 days.
o Labor has not started before fetal gestation of 42 weeks and 1 day.
o The clinical needs of the patient fall outside the scope of practice of a health
care provider at the facility.
o Any other limiting factor established by LARA by rule.
However, a patient who meets a limiting factor described above could be allowed to deliver at
the facility if there is not enough time before the birth to transfer them to a hospital.
Plans and policies
A freestanding birth center would have to have a plan to identify needs caused by social
determinants of health (the social and economic conditions that influence individual and group
differences in health status) and to refer a patient, with their consent, to a support service (such
as a food assistance program, counseling service, early childhood development resource,
housing assistance program, or intimate partner violence support group) to address their needs.
A freestanding birth center would have to develop, implement, and enforce written policies
and procedures for its operations and make them available to health care providers and others
employed by or under contract with the facility. All of the following would apply to those
policies and procedures:
• They would have to be administered in a way that provides for quality health care
services in a safe environment.
• They would have to identify a process for hiring, credentialing, and training staff.
• They would have to uphold the right of a patient to informed consent and to refuse
treatment at every stage of care.
• They would have to include a process by which a patient’s medical record is provided
to another health care provider if the patient requests it or if the patient is transferred
or transported as described below.
• They would have to include a process that health care providers employed by or under
contract with the facility would have to comply with when doing any of the following:
o Referring a patient to services that the freestanding birth center does not
directly provide, such as outside laboratory testing services, lactation support
services, and childbirth education.
o Consulting with another health care provider.
o Referring a patient to another health care provider.
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 o With the patient’s informed consent, transferring the care of a patient to another
health care provider.
o When needed, initiating patient transport to a previously identified hospital in
close proximity (as described above) through 9-1-1, an ambulance operation,
or another means.
o Notify a previously identified hospital in close proximity (as described above)
of the freestanding birth center’s license.
A freestanding birth center also would have to develop policies and procedures for assessing a
patient seeking perinatal care to determine whether it is appropriate for the patient to deliver at
the facility (see the description of limiting factors under “Limitations,” above).
Immunizations and testing
A freestanding birth center would have to recommend that health care providers and other
personnel employed by or under contract with the facility receive an annual vaccination against
influenza and recommend that they are fully vaccinated against COVID-19. Upon request, the
facility would have to provide evidence of immunization, evidence of positive titer result, or
documentation of refusal for health care providers and other personnel employed by or under
contract with the facility for rubella, Tdap, hepatitis B, varicella, and any other disease LARA
requires by rule. A freestanding birth center would have to conduct tuberculosis testing before
employing or entering into a contract with an individual who will work there.
Departmental rules and limitations
LARA, in consultation with representatives of all of the following, would have to develop and
issue rules to implement the bill:
• Freestanding birth centers.
• The Michigan Affiliate of the American College of Nurse-Midwives.
• The Michigan Midwives Association.
• The Michigan Board of Nursing.
• The Michigan Board of Licensed Midwifery.
• The State of Birth Justice.
The rules would have to include professionally recognized standards of practice based on
standards issued by the following entities:
• The American Association of Birth Centers.
• The American College of Nurse-Midwives.
• The National Association of Certified Professional Midwives.
If any of the above entities revise their standards after the bill takes effect, LARA would have
to take notice of the revision and could, in consultation with entities in either bulleted list above,
develop and issue rules to incorporate by reference any revision.
The rules described above also would have to include limiting factors that, when present, would
preclude a patient from delivering at the freestanding birth center because the patient is not
considered a patient with a normal delivery. The rules also would have to allow a freestanding
birth center to develop policies that include additional limiting factors to preclude delivery at
the facility.
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 LARA could not require a freestanding birth center to do either of the following:
• Maintain a collaborative agreement with another health facility or agency or with a
health care provider who is not employed by or under contract with a freestanding birth
center.
• Provide care other than midwifery care.
However, the above provision would not limit a freesta