State regulators back freestanding birth centers but ask clarifying language on scope, pharmacy oversight

The Secretary of State's Office and the Office of Professional Regulation told the Vermont House Committee on Health Care that they support S.18, legislation to license freestanding birth centers, but asked lawmakers to tighten definitions and rulemaking consultation around medication storage and scope of services.

Deputy Secretary of State Lauren Hibbert, representing the Secretary of State and OPR, said the agencies "support the creation of freestanding birth centers" and recommended amending the bill to define what counts as a "low risk" birth and to state explicitly that epidurals and cesarean deliveries are prohibited on site. "We think that the definition for what is a low risk birth should be added to the bill," Hibbert said.

Why it matters: the bill would create a licensing pathway for facilities intended to serve people with uncomplicated pregnancies who want a non‑hospital setting. Regulators want the statute and later rules to make clear which procedures and medications are allowed so pharmacies, clinicians and inspectors apply consistent safety standards.

Key points from testimony and discussion

- Scope and definitions: OPR recommended adding a statutory definition of "low risk" because the draft bill repeatedly uses the term without specifying medical criteria. The office also asked legislators to explicitly prohibit onsite epidurals and cesarean sections to limit the centers' procedural scope.

- Pharmacy and medication oversight: OPR said it does not expect freestanding birth centers to require a full hospital pharmacy and that creating that requirement would be "extremely burdensome, probably cost prohibitive." Still, OPR asked that the Board of Pharmacy be consulted during the Department of Health's rulemaking so rules about medication storage and dispensing are consistent with existing pharmacy standards and with OPR's ongoing review of clinic 'brown bag' and 'white bag' medication practices.

- Workforce and licensing: OPR noted most professions expected to work in the centers — certified nurse‑midwives, licensed midwives, naturopathic physicians with childbirth endorsements and others — are already regulated by the office, so the new centers are not expected to add large licensing workloads. Hibbert said she did not expect a major increase in unprofessional‑conduct cases attributable to the centers.

- Ownership and governance questions: Committee members asked whether hospitals or private entities could open centers. The bill's draft definition of a freestanding birth center excludes facilities that "are a hospital, part of a hospital, or owned by a hospital," which led to follow‑up discussion about whether hospitals could establish a separately licensed entity or provide birth‑center‑style services as part of a hospital unit. OPR told the committee that the current language would not license a hospital‑owned unit under the freestanding birth center chapter; such a unit would remain governed under hospital chapters.

- Inspections and surveys: Pamela Cota of the Department of Aging and Independent Living said her division — the state's CMS survey agency — would conduct licensing inspections for the Department of Health under an existing memorandum of understanding. Cota told the committee the division has 17 nurse surveyors and felt confident it could absorb oversight for an estimated one to two Vermont centers, but she said she could not yet predict complaint‑investigation volume.

- Certificate of Need (CON) and transfer of ownership: Laura Bellabo of the Green Mountain Care Board said the board supports exempting freestanding birth centers from the CON subchapter but prefers a standalone statutory exemption rather than tacking the exemption onto an existing practitioner‑office exclusion. The board asked for more time to consider how transfer‑of‑ownership provisions should apply if centers later change hands.

- Payer and cost concerns: Sarah Teachout of Blue Cross and Blue Shield of Vermont said the insurer is generally supportive but urged removing a clause that would mandate payment of "birth center facility fees" from the required‑coverage section. Teachout argued the bill mixes coverage requirements with contracting language and that network and contracting implications should be resolved outside this statutory coverage mandate. In committee discussion Teachout cited data comparing facility charges in New Hampshire: "A freestanding facility was $2,870" for a vaginal delivery, compared with higher facility charges at several hospitals.

Committee dynamics and next steps

Committee members asked how many centers Vermont might expect; OPR said it had not done an economic study and had heard estimates of "1 or 2"; it also noted Vermonters already travel out of state for birth‑center services or give birth at home. Questions raised by members included whether centers would draw patients away from hospitals and how ownership rules could limit or enable private investors or outside groups to buy centers in the future.

Hibbert and other witnesses urged clearer statutory language on definitions and pharmacy rulemaking consultation to guide subsequent administrative rules and consistent inspection standards.

The committee did not take formal votes during the hearing. The bill's supporters and OPR indicated they will propose specific drafting language to add a definition of "low risk," expressly prohibit cesarean delivery and epidural analgesia on site, clarify the definitions relating to who may own or operate a center, and require the Board of Pharmacy to be consulted during Department of Health rulemaking.

Looking ahead: testimony established that Vermont has no current licensing category for a freestanding birth center and that S.18 would create one. OPR and the Department of Aging and Independent Living said they are prepared to participate in rulemaking and inspections, and the Green Mountain Care Board recommended a standalone CON exemption and asked for more time to consider transfer‑of‑ownership language.