SB 482 — Certified Professional Midwife Licensing and Regulation

The Boardboard may deny, revoke, or suspend any license to provide midwife care issued or applied for in accordance with the provisions of this article, or to otherwise discipline a licensee or applicant upon proof that he or she:

(1) Is or was guilty of fraud or deceit in procuring or attempting to procure a license to provide midwife care;care, or has been convicted of a felony;

or has been convicted of a felony;

or Intr SB 2025R2963 (3) Is habitually intemperateintemperate, or is addicted to the use of habit-forming drugs;drugs or is mentally incompetent;

or is mentally incompetent;

or (5) Is calling themselveshimself or herself a Licensedlicensed Midwifemidwife without a current license;

or CS for SB 482 (7) Is providing or offering to provide services whichthat are outside of the scope of practice as defined by NARM or NACPM.

(1) An appropriate licensed health care provider ororotherperson other person from providing emergency care, including care of a precipitous delivery;

or (2) Any licensed midwife from delegating to an apprentice or personnel under his/herhis or her personal employ and supervised by the licensed midwife such activities or functions that are nondiscretionary and that do not require the exercise of professional judgment for their performance, if suchthose activities or functions are authorized byby, and performed forfor, the licensed midwife and responsibility for such activities or functions is assumed by the licensed midwife;

or (3) Any person from performing tasks related to midwife care under the direct and immediate supervision of a licensed doctor of medicine or osteopathy, a certified nurse-midwife, or a licensed midwife during completion of NARM requirements to achieve a CPM credential.

(a) It is a misdemeanor for any person to:

(1) Refer to themselveshimself or herself as a Licensedlicensed Midwifemidwife while theirhis licenseor her license, issued under the provisions of this articlearticle, is suspended or revokedrevoked; ;

(2) Use in connection with his or her name any designation tending to imply that he or she is licensed to provide midwife care unless duly licensed so to practice under the provisions of this article;

or(3) Intr SB 2025R2963 Provide midwife care with an active CPM credential without being licensed as a Licensedlicensed Midwife.midwife;

or (4) Otherwise violate any provisions of this article.

(b) Upon conviction, such misdemeanor shall be punishable by a fine noof not more than $250.

CS for SB 482 §30-44-9.

RegulationsRulemaking for providing midwife care.

(a) The Boardboard shallshallpropose adoptrules regulationsfor whichlegislative shall:approval in accordance with the provisions of §29A-3-1 et seq.

(1)of Bethis consistentcode withthat: the NARM current job description for the profession and the NACPM standards of practice.

(1) Are consistent with the NARM current job description for the profession and the NACPM standards of practice;

and (3) Provide for an appropriate license fee.

(b) The regulationsrulesmaynotrequire mayanyagreement, notwritten requireorotherwise, anywithanother agreement,health writtencare professional, or otherwise,require withthe assessment of a woman who is seeking midwife care services by another health care professional;professional.

or require the assessment of a woman who is seeking midwife care services by another health care professional.

(a) A licensed midwife may order medical testing, order medical devices, and obtain, prescribe, and use medications necessary for providing midwife care.

The(b) A licensed midwife may not obtain,obtain prescribe, or use any drug,drug in Schedule I through V of the Uniform Controlled Substances Act.Act, 21 U.S.C.

A§ licensed801. midwife may obtain medications and devices to treat conditions from entities including a pharmacy, or a manufacturer, medical equipment supplier, outsourcing facility, warehouser, or wholesale distributor.

An(c) entityA that provides a medication to a licensed midwife inmay accordanceobtain withmedications thisanddevices section,to andtreat whoconditions reliesfrom inentities goodincluding faitha uponpharmacy, themanufacturer, licensemedical informationequipment providedsupplier, byoutsourcing thefacility, licensedwarehouser, midwifeor iswholesale notdistributor. subject to liability for providing the medication.

All(d) An entity that provides a medication prescribedto and/ora administeredlicensed mustmidwife bein documentedaccordance with this section and who relies in good faith upon the client'slicense medicalinformation record.provided by the licensed midwife is not subject to liability for providing the medication.

Intr(e) SBAll 2025R2963medications §30-44-11.prescribed or administered must be documented in the client's medical records.

Licensed§30-44-11. Midwife responsibilities.

(a)Licensed Riskmidwife Assessment.responsibilities.

Upon(a) initiationRisk ofassessment. care, a licensed midwife shall request and review the client's medical history in order to identify pre-existing conditions or indicators that require disclosure of risk for a planned out-of-hospital birth.

If— theCS clientfor isSB under482 the(1) careUpon initiation of care, a licensed healthcaremidwife professionalshall forrequest anyand chronicreview medical condition, the licensedclient's midwifemedical shallhistory consultto withidentify anpre-existing appropriateconditions licensedor healthcareindicators providerthat asrequire partdisclosure of the risk assessment for evaluatinga appropriatenessplanned ofout-of-hospital birthbirth. outside of a hospital.

TheIf the client is under the care of a licensed health care professional for any chronic medical condition, the licensed midwife shall offerconsult standardwith testsan andappropriate screeningsobstetrical forhealth evaluatingcare risksprovider andas shallpart documentof clientthe responserisk toassessment suchfor recommendations.evaluating appropriateness of birth outside of a hospital.

(2) The licensed midwife shall offer standard tests and screenings for evaluating risks and shall document client response to any recommendations.

(3) The licensed midwife shall review the client's pregnancy history, including records of the current or previous pregnancies, if available.

If, on initial or subsequent assessment, one (1) of the conditions listed in this section exists, the licensed midwife shall consult with an appropriate licensedobstetrical healthcare provider and shall select either independentcollaboration management, collaboration, or referralreferral, as appropriateappropriate, and shall document that recommendation in the client record:

(1)(A) Complete placenta previa;

(2)(B) Partial placenta previa persisting after 32 weeks;

(3)(C) HIV infection;

(4)(D) Cardiovascular disease, including hypertension;

(5)(E) Severe psychiatric illness;

(6)(F) Pre-eclampsia or eclampsia;

(7)(G) Intrauterine growth restriction;

(8)(H) Known potentially serious anatomic fetal abnormalities;

(9)(I) Any type of diabetes not controlled by diet and exercise;

Intr(J) SB 2025R2963 (10) Labor prior to 37 weeksweeks; (11) Substance use disorder with current or recent use;

or(K) (12)Substance Anyuse otherdisorder conditionwith orcurrent symptom which may threaten the life of the client or fetus,recent asuse; assessed by the licensed midwife exercising reasonable skill and knowledge.

(13)or IfCS afor clientSB with482 a(L) conditionAny listedother incondition thisor sectionsymptom declinesthat tomay acceptthreaten an indicated consultation, collaboration, or referral, the licensedlife midwifeof shall document the refusalclient inor writingfetus, andas shallassessed referby the clientlicensed tomidwife anexercising appropriatereasonable higherskill leveland ofknowledge. care.

(14)(4) If a riskclient factorwith firsta developscondition duringlisted laborin orthis delivery,section thedeclines licensedto midwifeaccept mustan useindicated judgment,consultation, takingcollaboration, intoor accountreferral, the healthlicensed andmidwife conditionshall ofdocument the motherrefusal in writing and babyshall inrefer determiningthe whetherclient to proceedan withappropriate anhigher outlevel of hospitalcare. birth or arrange transportation to a hospital.

(5) If thea conditionrisk putsfactor thefirst clientdevelops during labor or babydelivery, acutelythe inlicensed jeopardy,midwife butshall theuse clientjudgment, refusestaking theinto transferaccount tothe ahealth higherand levelcondition of care, the licensedmother midwifeand shallbaby, callin 911determining andwhether provideto careproceed untilwith anotheran appropriateout-of-hospital licensedbirth healthcareor providerarrange assumestransportation care.to a hospital.

If the condition puts the client or baby acutely in jeopardy, but the client refuses the transfer to a higher level of care, the licensed midwife shall call 911 and provide care until another appropriate obstetrical provider assumes care.

— (1) Every licensed midwife shall have a written plan for emergency transfer, transport of an infant to a newborn nursery or neonatal intensive care nursery, or transport of an individual to an appropriate obstetrical department or patient care area.

(B) Provide emergency stabilization until emergency medical services arrive or transfer is completed;

and,and notify(C) Notify the receiving provider or hospital, if possible, of:

Intr SB 2025R2963 (iii) A brief relevant clinical history;

CS for SB 482 (iv) The planned mode of transport;

(B)(D) The licensed midwife may continue to provide routine or urgent care en route in coordination with any emergency services personnel and may address the psychosocial needs of the client during the change of birth setting;setting.

— (1) The licensed midwife shall maintain a record for each client.

(D) Medications prescribed and/oror administered;

(1)(2) The licensed midwife shall comply with all state and federal laws and regulations regarding the confidentiality of the client's recordsrecords, suchincluding, asbut pursuantnot tolimited to, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Pub.L.42 U.S.C.

No.§ 1320d et al.

104-191, 110 Stat.

1936.

— The customary scope of care of a newborn up to six weeks of age by a licensed midwife includes, but is not limited toto, clinical assessment, treatment, education, supportsupport, and referral.

Intr SB 2025R2963 A licensed midwife shall not willfully or negligently breach the confidentiality between a licensed midwife and a client.

CS for SB 482 §30-44-13.

Except as otherwise provided by law, no other licensed midwife, doctor of medicine or osteopathy, nurse, advanced practice registered nurse, prehospital emergency medical personnel, or hospital or agents thereof, may be exempt from liabilityliability: (1) for their own subsequent and independent negligent, grossly negligent or willful and wanton acts or omissions or (2) if that person has a business relationship with the licensed midwife who provided care to the patient.

(1) For their own subsequent and independent negligent, grossly negligent, or willful and wanton acts or omissions;

or (2) if that person has a business relationship with the licensed midwife who provided care to the patient.

NOTE:

The purpose of this bill is to create the Certified Professional Midwife Licensing and Regulation Act.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.