House Appropriations Committee advances S.18 to license freestanding birth centers

The Vermont House Appropriations Committee on April 11 voted to report S.18 to the floor, sending a bill to establish state licensure for freestanding birth centers to the full House after a brief, high-level discussion.

The bill would create a new chapter in title 18 for birth-center licensing, define a birth center as a facility whose primary purposes are midwifery care, low-risk deliveries and newborn care with stays generally under 24 hours, and require a state license to operate. It would bar certain high-intervention procedures at licensed birth centers, require rules based on the National Birth Center Standards from the American Association of Birth Centers, and require written transfer procedures to hospitals and collaboration with transport services. S.18 would also add birth centers as a covered site for private health insurance maternity care, exempt birth centers from the Green Mountain Care Board certificate-of-need process, and direct the Agency of Human Services (AHS) to seek federal approval so Vermont Medicaid can reimburse for birth-center services.

The Office of Legislative Council attorney Jen Carby, who presented the bill summary, said, “It requires a license in order to operate a birth center.” Carby described that the statute would prohibit epidurals and cesareans at birth centers, require inspections and an appeals process, set a $250 licensure fee (a ways-and-means matter), and require Department of Health rules that reference national standards.

Representative Leslie Goldman (House Health Care Committee), who joined the committee for questions, said the bill aims to fill “a gap, in the ability of people to access services.” Goldman said some Vermonters travel out of state (New Hampshire and New York were cited) for freestanding birth centers and that her intent is to provide a home-like option for low-risk births and to help attract midwives to Vermont.

Fiscal staff noted the short-term fiscal impact is unknown. Fiscal presenter Nolan Langwell told the committee: “So long story short, there's no appropriation needed this year, and the savings or costs will be determined way out to the future.” He reported that the state employee health plan paid for an average of 203 births per year (2022–2024) and that Vermont Medicaid covered an average of 2,033 births per year (2021–2023), and said any state cost or savings would depend on timing of birth centers coming online, CMS approval, and utilization by beneficiaries.

Key timing provisions in S.18: the licensure requirement takes effect when the Department of Health’s birth-center rules take effect; the health-insurance coverage provision would take effect Jan. 1, 2027; the certificate-of-need exemption is effective earlier so prospective operators can proceed without a CON; and the AHS directive to seek CMS approval takes effect on passage, with Medicaid coverage to begin on the later of federal approval or the Department of Health rules’ effective date.

Committee members moved to report the committee’s health-care report on S.18 and, when the clerk called the roll, multiple representatives recorded “yes,” and the committee advanced the bill to the floor. Committee discussion at the Appropriations hearing remained high-level; members were advised the measure passed the House Health Care Committee and had been to Ways and Means. The committee chair reminded members this committee will focus on appropriations aspects rather than policy details and that additional amendments could still arise on the floor.