Committee reviews S.18 to create licensure, rules and Medicaid pathway for freestanding birth centers

Jen Carbine, legislative counsel with the Office of Legislative Counsel, presented a strike-all draft of S.18 on licensure for freestanding birth centers and walked the committee through definition, licensing, rules and coverage changes.

The draft would create a new chapter (chapter 53) governing birth-center licensing, revise definitions (including clarifying that a “certified nurse midwife” means an advanced practice registered nurse pursuant to existing statute with specialized training in childbirth and newborn care), and clean up language about licensed providers and midwives. "This is an act relating to licensure of freestanding birth centers," Carbine said.

The draft bars birth centers from providing epidural anesthesia or cesarean delivery, and requires the Department of Health to adopt rules "based on the National Birth Center Standards published by the American Association of Birth Centers." The rules must include written practice guidelines and procedures for transferring a patient to a hospital if circumstances warrant and, at a minimum, require written policies and procedures for collaboration with hospitals and other providers for services such as laboratory and diagnostic services, childbirth education, obstetric and pediatric consultation, transport services, acute care at licensed hospitals, and home health care.

Carbine noted the draft includes a requirement that a birth center provide the health record of the patient or newborn to the receiving provider upon referral or transfer "in accordance with applicable privacy laws." She also clarified that transport policies need not require an on-site ambulance; the rule language requires written procedures and arrangements for transport rather than a specific vehicle.

The bill would add a standalone certificate-of-need (CON) exemption for birth centers that are "licensed pursuant to chapter 53 of this title or are proposed to be established and licensed in accordance with chapter 53 of this title," which would capture both new proposals and existing licensed centers undergoing transfer or expansion. Carbine said she ran the language by the board's attorney earlier and adjusted the drafting so the exemption would apply appropriately to proposed centers as well as licensed ones.

On coverage, the draft removes an earlier explicit cross-reference to home births and instead names birth centers among the settings where a health insurance or benefit plan that provides maternity benefits must cover services rendered by licensed midwives and certified nurse midwives within their scope of practice. Carbine told the committee the change was intentionally narrower and that some contracting requirements will be covered by a separate reorganization bill (S.30) that will apply across the subchapter; she said she had told the Blue Cross stakeholder she would add language if S.30 does not move.

Carbine also walked through an effective-date provision tied to federal approval for Medicaid coverage. The draft requires the agency to seek federal approval for Medicaid coverage of births in licensed birth centers and sets Medicaid coverage to begin on the later of federal approval or the effective date of the birth-center rules. "Right now, it is not in our Medicaid state plan that sets up all the things that are covered," Carbine said, explaining why federal approval is necessary.

Committee members asked clarifying questions about whether written policies must be kept on-site and about the scope of transport-service requirements; Carbine confirmed the rules must require written policies that may be provided to relevant service providers upon request but are not statutory reports to the legislature or Office of Professional Regulation. She also said she would do additional punctuation and cleanup for drafting and circulate a subsequent draft (1.3) and that Kristen would host the posted draft.

The committee did not take a vote on S.18 during this meeting; the chair said the item is scheduled for a floor vote later the same day. No formal action was recorded in committee.

Ending: The committee moved on to S.30 after the S.18 review; staff said they would circulate the revised draft to stakeholders and prepare the bill for the floor.