Senate committee debates licensure, safety rules and insurance coverage for freestanding birth centers in S.18

The Senate Health Committee continued work on S.18, a bill to license freestanding birth centers and set standards for their operation, transfers and insurance coverage.

Legislative counsel Jen Harvey described the bill as a senate‑passed measure to create licensure and rulemaking authority for birth centers. Members and witnesses focused discussion on several substantive points: how to define “low risk” deliveries, what services should be prohibited or reserved for hospitals, written transfer and collaboration procedures, ownership and staffing questions, insurance payment of facility fees, and whether birth centers should be exempt from certificate‑of‑need requirements.

Why it matters: S.18 would create a licensure pathway and regulatory framework for freestanding birth centers in Vermont. The statute’s definitions, the scope of permitted services and the approach to transfers and insurance coverage directly affect patient safety, payment and whether Medicaid will cover births at licensed centers.

Key outcomes and committee directions - Definitions and rulemaking: Committee members declined to adopt an expanded statutory definition of “low risk perinatal care” proposed by the Office of Professional Regulation (OPR) because that language would cover the entire perinatal period and could be broader than the committee intends. Instead the committee asked counsel to rely on rulemaking to define risk factors that would preclude labor and delivery at a licensed birth center. Jen Harvey: “You could have some of that fleshed out more in rulemaking if that seems important.” - Transfers and written policies: The committee agreed that birth centers must maintain written practice guidelines and policies that include procedures for transferring a patient to a hospital when circumstances warrant. Members asked counsel to separate (a) a requirement to have written policies from (b) the narrower question of which documents are provided to receiving hospitals on transfer; they directed counsel to draft clearer language for the rules and statute so hospitals receive appropriate information without requiring transmission of entire institutional policy manuals at the time of an emergency. - Scope of services (epidurals and caesarean delivery): Committee members discussed whether to list prohibited services in statute or leave detail to rulemaking. Multiple members said they wanted an explicit statutory bar on epidurals and cesarean delivery so the law is clear to colleagues and the public; others urged leaving technical service definitions to rulemaking. A compromise recorded in the discussion was to remove the broad label “surgical services” (which could capture routine suturing) and focus any statutory prohibition on epidural anesthesia and cesarean delivery, with operational detail left to rulemaking. Leslie (committee member) summed up the concern: an explicit prohibition “acknowledg[es] upfront that that's not happening.” - Ownership and licensed provider language: OPR had queried whether a birth center must be owned by a licensed maternity‑care provider. Committee members and counsel agreed the statute should make clear that licensed maternity‑care providers may own birth centers but ownership is not limited to clinicians; draft language to clarify that a birth center may be owned by a licensed maternity‑care provider “or any other person who meets the requirements of this chapter” will be proposed. - Certified nurse‑midwife and APRN language: The committee asked counsel to revise the definitions so that certified nurse‑midwives are referenced as a type of advanced practice registered nurse (APRN) licensed under the APRN statute, with a brief qualification that the midwife holds specialized training — avoiding an exclusive list that could be read to exclude other APRN types. - Insurance coverage and facility fees: Blue Cross Blue Shield had urged striking language that would require coverage of “birth center facility fees,” arguing that mandating payment could raise contractual and network issues if insurers do not have contracts with every birth center. Committee members debated whether to require insurers to cover birth center facility fees and whether coverage language should be limited to in‑network birth centers. Some members argued that requiring facility‑fee coverage ensures parity with hospitals and prevents surprise out‑of‑pocket bills; others asked counsel to seek input from the Department of Financial Regulation and insurers to clarify network adequacy and practical impact. Jen Harvey agreed to follow up with written testimony and DFR guidance. - Medicaid coverage and timing: The bill includes a mechanism for the Agency of Human Services to request federal approval for Vermont Medicaid to cover birth‑center services; stakeholders asked to remove a fixed statutory date for submission and instead allow AHS discretion on timing to seek a federal waiver or state plan amendment because federal review timing can vary. The committee agreed to remove the specific July 1 date and allow AHS to apply when appropriate. - Certificate of Need (CON): Members signaled consensus with the Green Mountain Care Board recommendation to exempt licensed birth centers from the state certificate‑of‑need process (an exemption consistent with testimony from multiple witnesses). The committee asked counsel to place birth centers in a separate subsection of the statutes that enumerate CON exceptions.

What the committee asked staff to do - Legislative counsel to draft clarified statutory language per the directions above (rulemaking‑based definition of risk factors, separate and clearer transfer/collaboration language, refined definitions for licensed providers and certified nurse‑midwives, a targeted statutory prohibition (epidural/cesarean) if members choose to keep it in statute, and removal of a fixed Medicaid application date). Counsel was asked to circulate draft language to stakeholders and to return to the committee with revised language before the next meeting.

Context and next steps The committee spent much of the hearing working through OPR and stakeholder comments and identifying which matters should be resolved in statute and which are better suited to administrative rulemaking. Counsel will prepare revised bill language and the committee scheduled further consideration at a subsequent meeting; members said they expect additional stakeholder input and written testimony from insurers and DFR before final action.

Ending: The committee left several technical and timing items for legislative staff to resolve and planned to revisit S.18 after staff circulate revised language and receive additional stakeholder input.