House advances bill to license freestanding birth centers, sends amended plan to Senate

The Vermont House of Representatives on April 16 voted to propose amendments and advance S.18, an act to license freestanding birth centers, sending the amended bill back to the Senate and ordering third reading.

Supporters said the measure would create a regulated option for low‑risk births outside hospitals, require state licensure and rules based on national standards, and direct the Agency of Human Services to seek federal approval for Medicaid coverage.

S.18 would add a new chapter to 18 V.S.A. to define birth centers and license their operation through the Department of Health. The bill, as described on the House floor, would prohibit birth centers from providing epidural anesthesia or cesarean delivery; require applications, renewals and transfers to include a $250 fee; make licenses nontransferable and specific to premises and the named applicant; and require rules based on the American Association of Birth Centers’ National Birth Center Standards. Representative Goldman, speaking for the House Committee on Health Care, said the centers would serve "healthy, low risk pregnancies" and provide a "warm, home‑like environment outside of a hospital setting."

The bill adds birth centers to entities that private health plans with maternity benefits must cover and directs the Agency of Human Services to seek Centers for Medicare & Medicaid Services approval to allow Vermont Medicaid to cover professional and facility fees for services at certified birth centers. The Certificate of Need process would not apply to birth centers under an amendment to 18 V.S.A. §94.35, with that exclusion effective July 1, 2025, per the amendment as explained on the floor. The licensing provisions would take effect Jan. 1, 2027, or on the effective date of Department of Health rules, whichever comes first; insurance coverage changes were slated to take effect Jan. 1, 2027; and Medicaid coverage would begin upon CMS approval or the effective date of the Department of Health rules, whichever is later.

Representative Brannigan, speaking for the Committee on Ways and Means, described the fiscal impact as nominal initially and noted the $250 fee would be deposited into the hospital licensing fee special fund to offset licensing costs. "This bill is really all about the delivery," Brannigan said. Representative Yacoboni, speaking for Appropriations, said the committee agreed with the Joint Fiscal Office that the fiscal impact to the state was de minimis and that, over time, savings to Medicaid were conceivable if more births occurred at birth centers instead of hospitals.

On the floor, Representative Goldman reviewed the bill’s sections in detail, including licensure procedures, appeal rights to Superior Court for adverse licensing actions, inspection and enforcement procedures, confidentiality requirements for Department of Health materials, and a rulemaking mandate in 3 V.S.A. chapter 25. The House also heard, according to the floor summary, testimony from numerous stakeholders, including the Vermont Medical Society, the Vermont Birth Center Coalition, nurse‑midwives, the Vermont Association of Hospitals and Health Services, representatives of Blue Cross Blue Shield, UMass Chan Medical School obstetrics faculty, and other advocates and health officials.

During questions, a member from Fairfax asked whether doulas would be considered "licensed maternity care providers" under the bill. Goldman replied that doulas would not be classified as licensed maternity care providers under the language as drafted, and that the committee had not heard specific proposals in the bill to guarantee doula availability at birth centers. The member from Fairfax said she would support the bill but expressed concern that certain support systems, such as doula access, were not explicitly addressed.

Votes at a glance

- JRS 22 (weekend adjournment to meet no later than 04/22/2025): adopted in concurrence by voice vote (House concurrence recorded on the floor). Vote tally not specified on the record.

- H.C.R. 37 (congratulating Mira Siri, Miss Vermont 2024): read on the floor and ordered transmitted to the Secretary of State as directed in the resolution language (adopted pursuant to the consent calendar). Vote tally not specified on the floor.

- H.C.R. 71 (celebrating the 40th anniversary of Landmark College): read on the floor and ordered transmitted to the Secretary of State as directed in the resolution language (adopted pursuant to the consent calendar). Vote tally not specified on the floor.

- H.B. 253 (relating to workforce housing zones): the member from Callus moved that the Committee on General and Housing be relieved of H.B. 253 and that it be committed to the Committee on Environment; voice vote carried. Vote tally not specified on the record.

- S.18 (licensure of freestanding birth centers): the House voted to propose to the Senate to amend the bill as recommended by the Health Care Committee; voice vote carried and the House ordered third reading. Vote tallies were not specified on the floor.

- S.28 (access to certain legally protected health care services): the member from Winooski moved to postpone action for one legislative day; the motion passed by voice vote. Vote tally not specified.

What the House did and what happens next

By proposing the Health Care Committee’s amendment and ordering third reading, the House sent S.18 back to the Senate with the committee’s strike‑all amendment; the bill still requires final passage in both chambers and, for Medicaid coverage, federal approval from CMS. Rulemaking by the Department of Health and administrative steps required by the bill will determine the timing of implementation. The House’s action on S.18 addresses licensure, insurance coverage, and Certificate of Need exclusion, but questions about how auxiliary supports such as doulas would be incorporated were raised on the floor and were not resolved in the amendments.

Notes on floor procedure and recordkeeping

Floor summaries referenced a range of witnesses who testified in committee; the public hearing record and committee reports will contain the full list of written and oral testimony and the joint fiscal analyses that informed committee reports. Where the transcript records only voice votes or the chair’s determination that "the ayes do have it," the House record does not contain a roll‑call tally in the transcript segment provided.