House File 2297 - Introduced HOUSE FILE 2297 BY MASCHER , ABDUL-SAMAD , BERRY , COHOON , KEARNS , JACOBY , THEDE , STECKMAN , HUNTER , LENSING , FICKEN , BEARD , GAYMAN , RUNNING-MARQUARDT , PETTENGILL , SORENSON , and KAUFMANN A BILL FOR An Act relating to the licensing of midwives and providing 1 for a fee and a penalty, and including effective date 2 provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5170HH (6) 83 jr/nh

H.F. 2297 Section 1. Section 147.1, subsections 3 and 6, Code 1 Supplement 2009, are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, respiratory care 9 practitioner, practitioner of cosmetology arts and sciences, 10 practitioner of barbering, funeral director, dietitian, marital 11 and family therapist, mental health counselor, social worker, 12 massage therapist, midwife, athletic trainer, acupuncturist, 13 nursing home administrator, hearing aid dispenser, or sign 14 language interpreter or transliterator means a person licensed 15 under this subtitle. 16 6. “Profession” means medicine and surgery, podiatry, 17 osteopathic medicine and surgery, practice as a physician 18 assistant, psychology, chiropractic, nursing, dentistry, 19 dental hygiene, dental assisting, optometry, speech pathology, 20 audiology, pharmacy, physical therapy, physical therapist 21 assisting, occupational therapy, occupational therapy 22 assisting, respiratory care, cosmetology arts and sciences, 23 barbering, mortuary science, marital and family therapy, 24 mental health counseling, social work, dietetics, massage 25 therapy, midwifery, athletic training, acupuncture, nursing 26 home administration, hearing aid dispensing, or sign language 27 interpreting or transliterating. 28 Sec. 2. Section 147.2, subsection 1, Code 2009, is amended 29 to read as follows: 30 1. A person shall not engage in the practice of medicine 31 and surgery, podiatry, osteopathic medicine and surgery, 32 psychology, chiropractic, physical therapy, physical therapist 33 assisting, nursing, dentistry, dental hygiene, dental 34 assisting, optometry, speech pathology, audiology, occupational 35 -1- LSB 5170HH (6) 83 jr/nh 1/ 8

H.F. 2297 therapy, occupational therapy assisting, respiratory care, 1 pharmacy, cosmetology arts and sciences, barbering, social 2 work, dietetics, marital and family therapy or mental health 3 counseling, massage therapy, midwifery, mortuary science, 4 athletic training, acupuncture, nursing home administration, 5 hearing aid dispensing, or sign language interpreting 6 or transliterating, or shall not practice as a physician 7 assistant, unless the person has obtained a license for that 8 purpose from the board for the profession. 9 Sec. 3. Section 147.13, Code Supplement 2009, is amended by 10 adding the following new subsection: 11 NEW SUBSECTION . 24. For midwifery, the board of midwifery. 12 Sec. 4. Section 147.14, subsection 1, Code Supplement 2009, 13 is amended by adding the following new paragraph: 14 NEW PARAGRAPH . x. For midwifery, a total of seven members, 15 three members who are licensed midwives under chapter 148F; 16 one member who is licensed under chapter 148, is a practicing 17 family physician, and has professional experience consulting 18 for and collaborating with direct-entry midwives; one member 19 who is an advanced registered nurse practitioner licensed under 20 chapter 152, is a certified nurse midwife, and has professional 21 experience consulting for and collaborating with direct-entry 22 midwives; and two members who are not licensed midwives or 23 licensed health care providers who have received direct-entry 24 midwifery services and who shall represent the general public. 25 Sec. 5. Section 147.74, Code 2009, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 5A. A midwife licensed under chapter 148F 28 may use the words “licensed midwife” or the initials “L.M.” 29 after the person’s name. 30 Sec. 6. NEW SECTION . 148F.1 Definitions. 31 As used in this chapter, unless the context otherwise 32 requires: 33 1. “Board” means the board of midwifery. 34 2. “Licensed midwife” means a person who is licensed to 35 -2- LSB 5170HH (6) 83 jr/nh 2/ 8

H.F. 2297 practice midwifery as provided in this chapter. 1 3. “Out-of-hospital” means any facility, institution, or 2 place which is not an ambulatory surgical center or a hospital, 3 such as a birth center as defined in section 135.61 or a 4 private home. 5 4. “Practice of midwifery” means the provision of primary 6 maternity care during the antepartum, intrapartum, and 7 postpartum periods by a person who is neither licensed to 8 practice under chapter 148, nor a nurse recognized by the Iowa 9 board of nursing as an advanced registered nurse practitioner 10 who is a certified nurse midwife, and who is not rendering 11 emergency services without compensation. “Practice of 12 midwifery” may also include the carrying and administration 13 of certain medications during the practice of midwifery, 14 including oxytocin, as a postpartum antihemorrhagic agent, 15 oxygen, intravenous fluids for stabilization, vitamin K, eye 16 prophylactics, and other drugs or procedures as appropriate for 17 the scope of practice for licensed midwives as determined by 18 the board. 19 Sec. 7. NEW SECTION . 148F.2 Licensure —— licensed 20 midwifery. 21 Beginning July 1, 2011, every person practicing midwifery in 22 this state shall be licensed pursuant to this chapter. The 23 board shall adopt rules pursuant to chapters 17A, 147, and 272C 24 establishing procedures for the licensing of new and practicing 25 midwives. Prior to obtaining licensure, an applicant shall 26 successfully pass an examination prescribed and approved by 27 the board as determined in rule demonstrating competencies 28 in at least all of the following areas: risk assessment 29 and management; prenatal care; management of normal labor, 30 birth, and postpartum; newborn care up to six weeks; and adult 31 cardiopulmonary resuscitation and newborn resuscitation. 32 Sec. 8. NEW SECTION . 148F.3 Use of title —— penalty. 33 A person shall not use the title licensed midwife, describe 34 or imply that the person is a licensed midwife, or represent 35 -3- LSB 5170HH (6) 83 jr/nh 3/ 8

H.F. 2297 the person as a licensed midwife unless the person is granted a 1 license under this chapter or is licensed as a nurse-midwife 2 under chapter 152. 3 Sec. 9. NEW SECTION . 148F.4 Rules. 4 1. The board shall: 5 a. Adopt rules relating to standards for professional 6 conduct of persons licensed under this chapter. 7 b. Adopt rules consistent with this chapter and with 8 chapters 147 and 272C which are necessary for the performance 9 of its duties. 10 c. Act on matters concerning licensure and the processes 11 of applying for, granting, suspending, imposing supervisory 12 or probationary conditions upon, reinstating, and revoking a 13 license. 14 d. Administer the provisions of this chapter requiring 15 documentation required to demonstrate competence as a midwife, 16 and the processing of applications for licenses and license 17 renewal. 18 e. Develop continuing education requirements as a condition 19 of license renewal. 20 f. Evaluate requirements for licensure in other states to 21 determine if reciprocity may be granted. 22 g. Establish and collect licensure fees as provided in 23 section 147.80 and retain fees as provided in section 147.82. 24 h. Adopt guidelines encouraging the development 25 of collaborative relationships with other health care 26 practitioners who can provide care outside of the scope of the 27 practice of midwifery when necessary. 28 i. Establish procedures for the issuance, renewal, and 29 revocation or suspension of a license under this chapter. 30 j. Maintain a registry of licensed midwives and statistics 31 on the practice of midwifery utilizing vital statistics data. 32 2. In establishing rules, the board shall consult with 33 persons knowledgeable regarding the prenatal and postpartum 34 birth process, particularly those possessing experience with 35 -4- LSB 5170HH (6) 83 jr/nh 4/ 8

H.F. 2297 out-of-hospital births, including but not limited to persons 1 licensed under chapter 148, certified professional midwives, 2 advanced registered nurse practitioners who are certified nurse 3 midwives, and women who have given birth in an out-of-hospital 4 setting. 5 3. Rules relating to the practice of midwifery shall 6 not be inconsistent with the North American registry of 7 midwives’ current job description for the profession and the 8 standards of practice of midwifery established by the national 9 association of certified professional midwives or a successor 10 organization, and shall not expand the scope of practice of 11 midwifery established by the national association of certified 12 professional midwives or a successor organization. 13 Sec. 10. NEW SECTION . 148F.5 Client disclosure. 14 Prior to accepting a patient for midwifery care, a licensed 15 midwife shall provide information indicating all of the 16 following: 17 1. Evidence that the care provider is a licensed midwife 18 meeting the requirements of this chapter. 19 2. Whether the licensed midwife has malpractice liability 20 insurance coverage and the policy limits of such coverage. 21 3. The midwife’s educational background and relevant 22 experience, including experience in various birth settings. 23 4. The nature, scope, and location of the care to be 24 given, including the possibility of and the guidelines for 25 consultation, referral, or transfer of the patient to a 26 hospital from an out-of-hospital setting. 27 Sec. 11. NEW SECTION . 148F.6 Exceptions. 28 1. This chapter does not prevent qualified members of other 29 professions including but not limited to individuals licensed 30 under chapter 148 or 152 from providing services consistent 31 with the nature of the practice of midwifery. 32 2. This chapter does not prevent or prohibit a student 33 midwife from performing tasks related to the practice of 34 midwifery under the supervision of a licensed midwife, a 35 -5- LSB 5170HH (6) 83 jr/nh 5/ 8

H.F. 2297 certified nurse midwife, or a licensed physician during 1 completion of the licensure process. 2 3. The practice of midwifery in this state prior to July 3 1, 2011, shall not constitute grounds for disciplinary action 4 by the board. The board may issue a license to a person who 5 has practiced midwifery in this state upon application and 6 compliance with the provisions of this chapter and the rules 7 adopted pursuant to this chapter. 8 Sec. 12. NEW SECTION . 148F.7 Prohibited practice. 9 A person shall not practice midwifery, or represent that the 10 person is a midwife, unless the person is licensed as provided 11 in this chapter. 12 Sec. 13. NEW SECTION . 148F.8 Requirements for licensure —— 13 temporary license. 14 Beginning July 1, 2011, an individual who does not meet the 15 requirements for licensure by examination pursuant to section 16 148F.2 may apply for a one-year temporary license as determined 17 by the board in rules. Renewal of the temporary license shall 18 be determined by the board. The board may revoke a temporary 19 license if it determines that the temporary licensee has 20 violated standards established by rule. 21 Sec. 14. Section 272C.1, subsection 6, Code Supplement 22 2009, is amended by adding the following new paragraph: 23 NEW PARAGRAPH . ag. The board of midwifery, created pursuant 24 to chapter 147. 25 Sec. 15. Section 272C.4, subsection 6, Code Supplement 26 2009, is amended to read as follows: 27 6. Define by rule acts or omissions that are grounds for 28 revocation or suspension of a license under section 100D.5, 29 105.22, 147.55, 148.6, 148B.7, 148F.4, 152.10, 153.34, 154A.24, 30 169.13, 455B.219, 542.10, 542B.21, 543B.29, 544A.13, 544B.15, 31 or 602.3203 or chapter 151 or 155, as applicable, and to define 32 by rule acts or omissions that constitute negligence, careless 33 acts, or omissions within the meaning of section 272C.3, 34 subsection 2, paragraph “b” , which licensees are required to 35 -6- LSB 5170HH (6) 83 jr/nh 6/ 8

H.F. 2297 report to the board pursuant to section 272C.9, subsection 2. 1 Sec. 16. INITIAL APPOINTMENTS. 2 1. Notwithstanding any provision to the contrary in this 3 Act, initial professional appointees to the board of midwifery 4 shall fulfill the national certification requirements of the 5 North American registry of midwives. 6 2. One of the initial professional appointments to the 7 board shall be appointed for a one-year term, one member shall 8 be appointed for a two-year term, and one member shall be 9 appointed for a three-year term. The members who are licensed 10 under chapter 148 or 152 shall each be appointed for a two-year 11 term, and the members representing the general public shall 12 each be appointed to a three-year term. 13 Sec. 17. EFFECTIVE DATE. These sections of this Act 14 amending section 147.2, subsection 1, and enacting section 15 148F.8 take effect July 1, 2011. 16 EXPLANATION 17 This bill creates new Code chapter 148F that provides for 18 the licensure of midwives beginning July 1, 2011. A midwife 19 is not an allopathic or osteopathic physician licensed under 20 Code chapter 148 or a nurse licensed under Code chapter 21 152 providing primary maternity care during the antepartum, 22 intrapartum, and postpartum periods. 23 The bill provides for the establishment of a seven-member 24 board of midwifery consisting of three members who are 25 midwives, one physician, one nurse, and two members who 26 represent the general public. The bill provides for fees to 27 fund the board and provides penalties for violation of the 28 practice requirement; those penalties are set out for all 29 health-related boards in Code chapters 147 and 272C. Code 30 section 147.86 provides that it is a serious misdemeanor to 31 violate a provision of the licensing laws. 32 The board is similar in composition and responsibilities to 33 other health-related licensing boards. 34 The provisions of the bill amending Code section 147.2 and 35 -7- LSB 5170HH (6) 83 jr/nh 7/ 8