[{"_1":2,"_99":-5,"_100":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6100834,"mediaKeyId","2812129-a656107d9d1a2078f5f32628ff3933b9","parentId",2812129,"title","Committee Probes Safety, Transfer Plans and Inspection Regime for Proposed Freestanding Birth Centers","audioSeconds",940,"startMs",773705,"endMs",1714540,"viewUrl","/Search/View?dp=1&key=2812129-a656107d9d1a2078f5f32628ff3933b9&start=773&end=1714","thumbnailUrl","https://assets.pipeline.soar.com/2812129-a656107d9d1a2078f5f32628ff3933b9/thumbnail_773705.jpg","articleUrl","/articles/6100834/Vermont/Committee-Probes-Safety-Transfer-Plans-and-Inspection-Regime-for-Proposed-Freestanding-Birth-Centers","mediaUrl","https://secure.pipeline.soar.com/6100834-a305eb464770c7850c9311d6a3e966fb/orig.mp4?Expires=1770721022&Signature=foMj0PV3GLAp77i7daF6l3p8-0lIqDRjJebcDTYzv1aHqEnuVyuXMx83wlbvnPQP4PKWC9F3qkaQzsetXRn3Cx6xprw1yvvEscq2qRYaiuJON2lTYn82qVeCz4Y-azQ1wOAfwXc5CxCmx-joxs4~wYzrYBSvH0LYay01TRhi86-m4I2xtatjmwHQyAphb5-f0CXUX9X8EGTfmHLjh059Ayy6iJjdQ~A3yjJUqKPoKzhJFg7VR3rstnXEyOSLGYGodngiSpglgXp5oLAyWv3P-X3BwlPyVyPh7KyXsu0Qufmoitj7LveCq1YrmUTDxfMvzrUSsYrR5Cq2xgxHdKvmiQ__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-03-28T19:57:11.917Z","article","Committee members questioned how freestanding birth centers would operate, how they would handle emergencies and what inspection and oversight mechanisms VDH would apply if S.18 becomes law.

Erin Mandeville, a certified nurse midwife with nearly 20 years’ experience, described typical birth-center operations and capacity. She said most birth centers have two birth rooms, may provide prenatal and postpartum care on site, and typically do four to eight births a month in ordinary practice; “even the busiest birth center I worked at in Fairbanks, Alaska, we did somewhere between 15 to 20 babies a month,” she said. Mandeville and other midwife witnesses emphasized continuity of care, prenatal risk screening and the midwifery model as contributors to lower intervention and c-section rates.

On inspections and licensing, Lauren Laymon, general counsel for the Department of Health, said VDH would establish rules covering pharmaceuticals, scope of services, staffing, complaint processes, equipment and quality improvement; inspections would be performed by trained nurses familiar with the standards. “We would help establish rules for the operation of the center,” Laymon said, and noted pre-licensure inspection is required by the bill language.

Witnesses also discussed transfer agreements and emergency transport. Laurie Foster, legislative liaison for the Vermont affiliate of the American College of Nurse Midwives and a long-practicing midwife, told the committee that intrapartum transfer rates for birth centers are typically about 10 percent and that emergent transports are rare; she said non-emergent transfers frequently involve patients driving themselves or being transported to the hospital for higher-level care. Foster recommended written transfer guidelines and said coordinated relationships with local EMS and receiving hospitals are standard practice.

Committee members asked how often inspections would occur and whether inspection workload would strain the Division for Licensing and Protection (DLP). Laymon said the bill requires an initial inspection as a condition of licensure, DLP nurses conduct inspections under current practice, and follow-up inspections would occur in response to complaints or at the department’s discretion. The department did not specify a fixed recurring inspection interval in testimony and said it would address frequency in rulemaking.

Other operational topics included medication authority (certified nurse midwives can prescribe; CPMs can administer emergency medications within scope), opportunities for perinatal classes and postpartum supports at centers, and the typical small scale and nonprofit nature of many birth centers. Witnesses said centers often serve as community resources for prenatal classes, postpartum support groups and team-based care when births are not actively occurring.

The committee asked for further detail on the department’s proposed rules and for evidence of inspection capacity; no formal decisions or votes appear in the transcript.","mediaType","Video","parentTitle","House Healthcare - 2025-03-28 - 1:00 PM","oneSentenceSummary","Witnesses described clinical staffing, transfer rates and inspections for freestanding birth centers; Department of Health said inspections would be nurse-led and initial licensure would require a pre-licensure inspection.","taxTitle","Health Care, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30956,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6100839,"Hospitals, Medical Society Urge Caution on Certificates of Need, Reimbursement as Birth Centers Are Considered",361,2391630,2753085,"/Search/View?dp=1&key=2812129-a656107d9d1a2078f5f32628ff3933b9&start=2391&end=2753","https://assets.pipeline.soar.com/2812129-a656107d9d1a2078f5f32628ff3933b9/thumbnail_2391630.jpg","/articles/6100839/Vermont/Hospitals-Medical-Society-Urge-Caution-on-Certificates-of-Need-Reimbursement-as-Birth-Centers-Are-Considered","https://secure.pipeline.soar.com/6100839-ea1fec72ae9533c315e737f701cfe158/orig.mp4?Expires=1770721022&Signature=NXuGgZ82d2XgTVr1kzdQtrdP6skDd5BKKmF~Pw299R0fL87JHwltoU1BJiG9Dh73Fb7OY4Vev~Vg-6Rd9zQY2PfhRA82TTBWdp2Om14~HmuBzbApBvcy42Q0PF19KKmNVc8vXYRuDMRMWc1HOn4XnyFtCLGnGMchR9D-USVC0BWAOBIsi-wF9-xna1TklkKdtrsTc0PquuBb0g4U9zfXzUxYIfjRPmz0eszse46GpOC4Gau-VF44jPEt9urSFF7h7bDvetE0RkigAOQkccCCuhdGDPtkhaAAavjXKw3aiC8tLor5T-~~JdKmjVQv0J6gsW-vr2jFtjkzoVxgAVXDNw__&Key-Pair-Id=KUT5TJCACFTXG","Hospital representatives and the Vermont Medical Society told a legislative committee considering S.18 that freestanding birth centers should be an option for pregnant people, but they asked lawmakers to address financial risks to hospital labor-and-delivery units and the state’s reimbursement structure.

\"We support accredited birth centers as safe places to birth and support patient choice,\" Jessa Barnard, executive director of the Vermont Medical Society, told the committee. At the same time she said hospital labor-and-delivery services “need to be sustainable so that when there is a higher risk delivery, there are safe places for all patients to give birth.”

Hospital witnesses described narrow financial margins for obstetric services. Barnard cited a hospital executive’s public comment that the hospital was losing $3 million to $5 million a year on obstetrics and noted prior closures of rural units. Devon Green of the Vermont Association of Hospitals and Health Systems told the committee that some small hospitals perform about one birth per day and that a loss of “two births a month” could make a rural unit unsustainable; she urged lawmakers to consider raising Medicaid reimbursement rates for comprehensive prenatal, delivery and postpartum care.

Several witnesses pressed the committee to revisit the bill’s language on certificates of need (CON). The draft of S.18 would exempt freestanding birth centers from CON review. Supporters argued that CON requirements are a high barrier for small, often nonprofit birth centers and that exemptions have become common nationally; opponents said CON or another statewide review could help the state plan locations to avoid weakening hospital services in areas that already struggle to sustain obstetrics.

\"We do think it's worth the committee spending more time, discussing whether removing birth centers from CON review is appropriate,\" Barnard said, noting the value of a statewide planning approach to preserve higher-risk capacity. Proponents, including midwifery coalition witnesses, countered that CON processes impose up-front legal and administrative costs that can prevent community birth centers from opening or from being sold to a new operator if an owner leaves.

Policy fixes discussed: hospital and medical-society witnesses proposed (1) increasing Medicaid reimbursement for comprehensive prenatal-to-postpartum care (suggesting an enhanced primary care rate under Medicaid fee schedules), (2) requiring more detailed written transfer agreements or clearer rule guidance so transfers go to facilities with comprehensive obstetric services rather than generic emergency departments, and (3) asking the committee to consider other statewide resource-planning mechanisms (such as a health resource allocation plan) if CON is not applied.

Committee members asked agencies for data to quantify how many births might move to birth centers, where out-of-state births currently go, and whether the presence of a birth center has historically led to closures of hospital birthing units; witnesses and staff said the committee lacked definitive Vermont-specific data. Several members asked hospital and agency witnesses to submit detailed financial and utilization modeling to inform the committee’s work.

No formal action was recorded in the transcript; the discussion closed with requests for more data and for the agencies and stakeholders to continue work on reimbursement, CON thresholds and transfer language.","Hospital groups and the Vermont Medical Society supported patient choice for freestanding birth centers but warned of financial strain on rural obstetrics units and urged higher Medicaid reimbursement and careful review of certificate-of-need exemptions.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6100843,"Legislators Hear Bill to License Freestanding Birth Centers as Lower-cost, Midwifery-led Option",2059,160,2059270,"/Search/View?dp=1&key=2812129-a656107d9d1a2078f5f32628ff3933b9&start=0&end=2059","https://assets.pipeline.soar.com/2812129-a656107d9d1a2078f5f32628ff3933b9/thumbnail_160.jpg","/articles/6100843/Vermont/Legislators-Hear-Bill-to-License-Freestanding-Birth-Centers-as-Lower-cost-Midwifery-led-Option","https://secure.pipeline.soar.com/6100843-8fb7b7958a1b461da5bc433904f1ecef/orig.mp4?Expires=1770721022&Signature=MLVNXeHmOZyYz7eQbU5Op2-Hvn2UJIbX6AkIKmYPNj04b37EyKKx3HcDzbBec5BV-3jdMU-XBEfbGoe0v1OrW5JXPVag8drfJdCPgZSomsxNEpgJDC6RQI1jEzoiHDATmejBScGca~CNgoLTxTPjZY5oaHFxf1seH5oCkSuXq6tA0WE~tU8qh1s7D5LiMKuq9YhfCLER26RQPccCnraVTmo~fuQoOsDTPd13qGXTdJeppRTwu~RHgGZ~6gRogd8HCt9vbPopOSO3dogJuwWEq-XABsaG7iJhg0JG9m6~Amrs6SkUQ8yz1X3ZNONNTxCr6KskQyP4axK6qtjmldJvTA__&Key-Pair-Id=KUT5TJCACFTXG","Senator Gulick, the Senate sponsor of S.18, told a legislative committee that the bill would create a legal pathway for freestanding birth centers in Vermont and that it has strong support in the Senate. “This bill that is near and dear to my heart,” she said, adding that it passed her committee unanimously and drew no questions on the floor.

The bill would establish licensure, inspection and rulemaking for freestanding birth centers through the Vermont Department of Health. Lauren Laymon, general counsel at the Department of Health, told the committee the department would oversee an application, inspection and licensing process and lead rulemaking on staffing, equipment, complaint processes and quality assurance. “We would collaborate with the Department of Disabilities, Aging and Independent Living,” Laymon said, and implement the licensing language as written.

Why it matters: proponents and some state health officials told the committee that freestanding birth centers are an evidence-based option for low-risk pregnant people and could expand choice while lowering per-delivery costs for payers. Senator Gulick cited national endorsements and federal guidance, saying the White House maternal health blueprint and major professional groups endorse birth centers as “a safe and evidence based option for low risk people.” Alice McCracken, Director of Communications and Legislative Affairs for the Department of Vermont Health Access (DVHA), confirmed Medicaid already covers home and hospital births and that “Vermont Medicaid covered nearly 2,000 deliveries or about 37 percent of all births in the state” in 2023, adding that a state plan amendment would be required to reimburse services in freestanding birth centers.

Proponents pointed to cost comparisons and published data. Senator Gulick cited a payer document saying a vaginal birth at a tertiary hospital could cost about $17,100 while a freestanding birth center delivery could cost about $2,870. She also cited Agency of Human Services vital statistics and local hospital delivery counts to argue that some births currently occur out of state or at home and could be captured by a birth center.

Administrative and payer issues raised at the hearing include the need for VDH rulemaking on facility standards and a federal state plan amendment (SPA) to get Centers for Medicare & Medicaid Services (CMS) approval for Medicaid reimbursement of birth-center services. DVHA asked the committee to remove or change a hard deadline in the bill for submitting a SPA so the agency would have “adequate time to pursue the requested state plan amendment.”

Supporters at the hearing included certified nurse midwives and the Vermont Birth Center Coalition, who described typical birth-center staffing, capacity and prenatal/postpartum services; Erin Mandeville, a certified nurse midwife, said many birth centers average four to eight births a month, with busier centers doing 15–20 a month. The Vermont Medical Society also testified in favor of patient choice and accredited birth centers while urging attention to sustaining hospital labor-and-delivery services that accept transfers when higher-risk care is needed. “We support accredited birth centers as safe places to birth and support patient choice,” Jessa Barnard, executive director of the Vermont Medical Society, said.

The committee did not take a formal vote during the transcripted hearing. Staff and agencies were asked to supply data and to work with VDH and DVHA on implementation details, including the timing and mechanics of a SPA and the rulemaking process for licensure.

Looking ahead: the key next steps raised in testimony were (1) VDH rule development for licensing standards and inspection practice, (2) DVHA and the Agency of Human Services coordinating a SPA request to CMS for Medicaid reimbursement, and (3) additional data requests on hospital catchment deliveries and financial modeling to quantify expected programmatic and fiscal impacts.","A committee hearing on bill S.18 covered provisions to license freestanding birth centers in Vermont, testimony on evidence of safety and cost savings, and administrative roles for the Department of Health and Medicaid payer issues.","actionData","errors"]

Article not found

Committee Probes Safety, Transfer Plans and Inspection Regime for Proposed Freestanding Birth Centers

Hospitals, Medical Society Urge Caution on Certificates of Need, Reimbursement as Birth Centers Are Considered

Legislators Hear Bill to License Freestanding Birth Centers as Lower-cost, Midwifery-led Option