Lawmakers review bill to license freestanding birth centers in Vermont

A legislative committee reviewed S.18, a bill to create a state licensure process for freestanding birth centers and to require health insurers and, if approved by CMS, Medicaid to cover prenatal, maternity, postpartum and newborn services provided at licensed birth centers.

Legislative counsel Jen Carby, of the Office of Legislative Council, told the committee S.18 was “voted out of…as amended by Senate Health and Welfare” and that the language being reviewed reflected the committee amendment; she also said the Senate was on a reconsideration day and the bill had not been sent to the House.

The bill would add a new chapter in Title 18 establishing a birth center license for facilities whose primary purpose is midwifery care, low‑risk deliveries and newborn care for stays generally under 24 hours. The bill defines eligible providers, requires an application and inspection by the Department of Health or its designee, and sets a $250 application fee deposited into the Hospital Licensing Fees Special Fund to offset licensing costs. It would require the Department to adopt rules based on the National Birth Center Standards published by the American Association of Birth Centers.

Key procedural and scope provisions require the Department of Health to inspect facilities and, after notice and an opportunity for hearing, to condition, deny, suspend, revoke or refuse to renew licenses for substantial failures to comply. The bill directs that violation summaries be posted on the Department website while inspection records that identify individuals or facilities remain confidential to the extent allowed by law. It also clarifies that licensing a birth center would not expand or limit the scope of practice of licensed midwives, certified nurse midwives or other licensed providers who practice there.

S.18 would add birth centers to the list of covered locations for private health insurance; the bill also directs the Agency of Human Services to seek Centers for Medicare and Medicaid Services approval to allow Vermont Medicaid to reimburse separately for birth center professional and facility fees. The bill excludes licensed birth centers from the state certificate‑of‑need (CON) subchapter (the committee was told the exclusion would operate regardless of project cost thresholds). Effective dates in the draft language include a January 1, 2027 effective date for the licensing and insurance coverage provisions (or earlier if the Department’s rules take effect sooner), a July 1, 2025 effective date for the CON exclusion, and immediate effect on passage for the instruction to the Agency of Human Services to submit a CMS request by July 1.

Testimony came from proponents and clinicians. Shayla Livingston, a member of the Vermont Birth Center Coalition, said, “We are supportive of the bill as passed by the Senate,” and described birth centers as a setting between home birth and hospital birth that is intended for low‑risk pregnancies and coordinated transfers when needed. Lindsay Lachant, a certified nurse midwife who practised in an out‑of‑state freestanding birth center, described the model as “low tech, high touch,” listing monitoring equipment, comfort items (birthing tubs, birthing balls), emergency supplies (oxygen, ambu bag, suction), hemorrhage medications and transfer protocols consistent with national standards.

Obstetrician‑gynecologist Tim Fisher, who has worked with birth centers and regional perinatal networks, told the committee that evidence supports birth centers as complementary to hospital care and cited the federal Strong Start evaluation showing lower preterm birth, low birth weight and cesarean rates and lower costs among birth center participants. Consumer Carolyn Barnwell described traveling out of state for a birth center birth and said the model provided close prenatal visits, extensive postpartum support and a “relaxing” setting that matched her preferences.

Committee members asked about the qualifications of inspectors, how transfer protocols and EMS coordination would be ensured, whether distance rules should be required, and workforce implications. Witnesses and legislative counsel said inspections would be performed by the Department of Health or its designee (often the Department of Disabilities, Aging and Independent Living survey unit), rulemaking would adopt the national standards and would set staffing and transfer requirements, and distance‑based limits were not recommended because they can become impractical in a rural state. Witnesses stressed written transfer protocols and regular drills with EMS as best practice.

No final committee vote was recorded in the transcript. Legislative counsel noted the bill contains a license fee and therefore would go to the Ways and Means Committee. The Department of Health, Agency of Human Services and other stakeholders are expected to testify further during the rulemaking and committee review process.