H.F. 2086 Section 1. Section 147.1, subsections 3 and 6, Code 2014, 1 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, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and family 12 therapist, mental health counselor, social worker, massage 13 therapist, midwife, athletic trainer, acupuncturist, nursing 14 home administrator, hearing aid dispenser, or sign language 15 interpreter or transliterator means a person licensed under 16 this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, 25 mental health counseling, social work, dietetics, massage 26 therapy, midwifery, athletic training, acupuncture, nursing 27 home administration, hearing aid dispensing, sign language 28 interpreting or transliterating, orthotics, prosthetics, or 29 pedorthics. 30 Sec. 2. Section 147.2, subsection 1, Code 2014, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, podiatry, osteopathic medicine and surgery, 34 psychology, chiropractic, physical therapy, physical 35 -1- LSB 5039YH (7) 85 jr/nh 1/ 10

H.F. 2086 therapist assisting, nursing, dentistry, dental hygiene, 1 dental assisting, optometry, speech pathology, audiology, 2 occupational therapy, occupational therapy assisting, 3 orthotics, prosthetics, pedorthics, respiratory care, 4 pharmacy, cosmetology arts and sciences, barbering, social 5 work, dietetics, marital and family therapy or mental health 6 counseling, massage therapy, midwifery, mortuary science, 7 athletic training, acupuncture, nursing home administration, 8 hearing aid dispensing, or sign language interpreting 9 or transliterating, or shall not practice as a physician 10 assistant, unless the person has obtained a license for that 11 purpose from the board for the profession. 12 Sec. 3. Section 147.13, Code 2014, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 25. For midwifery, the board of midwifery. 15 Sec. 4. Section 147.14, subsection 1, Code 2014, is amended 16 by adding the following new paragraph: 17 NEW PARAGRAPH . x. For midwifery, a total of seven members, 18 three members who are licensed midwives under chapter 148G; 19 one member who is licensed under chapter 148, is a practicing 20 family physician, and has professional experience consulting 21 for and collaborating with direct-entry midwives; one member 22 who is an advanced registered nurse practitioner licensed under 23 chapter 152, is a certified nurse midwife, and has professional 24 experience consulting for and collaborating with direct-entry 25 midwives; and two members who are not licensed midwives or 26 licensed health care providers who have received direct-entry 27 midwifery services and who shall represent the general public. 28 Sec. 5. Section 147.74, Code 2014, is amended by adding the 29 following new subsection: 30 NEW SUBSECTION . 5A. A midwife licensed under chapter 148G 31 may use the words “licensed midwife” or the initials “L.M.” 32 after the person’s name. 33 Sec. 6. NEW SECTION . 148G.1 Definitions. 34 As used in this chapter, unless the context otherwise 35 -2- LSB 5039YH (7) 85 jr/nh 2/ 10

H.F. 2086 requires: 1 1. “Board” means the board of midwifery. 2 2. “Licensed midwife” means a person who is licensed to 3 practice midwifery as provided in this chapter. 4 3. “Out-of-hospital” means any facility, institution, or 5 place which is not an ambulatory surgical center or a hospital, 6 such as a birth center as defined in section 135.61 or a 7 private home. 8 4. “Practice of midwifery” means the provision of primary 9 maternity care during the antepartum, intrapartum, or 10 postpartum period by a person who is neither licensed to 11 practice under chapter 148 or 148C, nor a nurse recognized 12 by the Iowa board of nursing as an advanced registered nurse 13 practitioner who is a certified nurse midwife, and who is not 14 rendering emergency services without compensation. “Practice 15 of midwifery” may also include the carrying and administration 16 of certain medications during the practice of midwifery, 17 including oxytocin, as a postpartum antihemorrhagic agent, 18 oxygen, intravenous fluids for stabilization, vitamin K, eye 19 prophylactics, and other drugs or procedures as appropriate for 20 the scope of practice for licensed midwives as determined by 21 the board. 22 Sec. 7. NEW SECTION . 148G.2 Licensure —— licensed 23 midwifery. 24 1. Beginning July 1, 2015, every person practicing 25 midwifery in this state shall be licensed pursuant to this 26 chapter. The board shall adopt rules pursuant to chapters 17A, 27 147, and 272C establishing procedures for the licensing of new 28 and practicing midwives. 29 2. Prior to obtaining licensure, an applicant shall 30 successfully pass an examination prescribed and approved by 31 the board as determined in rule demonstrating competencies 32 in at least all of the following areas: risk assessment 33 and management; prenatal care; management of normal labor, 34 birth, and postpartum; newborn care up to six weeks; and adult 35 -3- LSB 5039YH (7) 85 jr/nh 3/ 10

H.F. 2086 cardiopulmonary resuscitation and newborn resuscitation. 1 3. The applicant shall provide documentation, satisfactory 2 to the board, of all of the following: 3 a. Knowledge and proficiency of all didactic components 4 of midwifery, including definitions, signs and symptoms, 5 differential diagnosis for risk assessment, stabilization and 6 treatment, follow-up, referral, and transport. 7 b. Complete and thorough preparation as an assistant 8 midwife prior to assuming responsibility as a primary midwife. 9 Clinical care performed under supervision during training 10 including, at a minimum: 11 (1) Seventy-five prenatal exams. 12 (2) Twenty births as an assistant midwife. 13 (3) Twenty births as primary midwife from the onset of labor 14 to the delivery of the placenta and the stabilization of mother 15 and newborn. 16 (4) Twenty newborn exams. 17 (5) Forty postpartum exams. 18 c. Assessment and verification of performance of skills 19 during an intensive, hands-on skills assessment, performed for 20 and scored by an evaluator approved by the board. 21 d. Passage of a three-hundred-fifty-item national board 22 examination that covers all aspects of midwifery care as 23 identified by job analysis. 24 e. Evidence that the applicant has provided prenatal, 25 intrapartal, and postpartal care as well newborn assessment, 26 equivalent to a minimum of one thousand three hundred fifty 27 clinical contact hours under the direct supervision of one or 28 more instructors approved by the North American registry of 29 midwives. 30 4. The applicant shall hold a certified professional 31 midwife credential issued by the North American registry of 32 midwives or any other nationally accredited credential as 33 specified by the board. If an applicant has been subject to 34 prior revocation of a license to practice medicine or nursing, 35 -4- LSB 5039YH (7) 85 jr/nh 4/ 10

H.F. 2086 the applicant shall not be eligible for licensure under this 1 chapter, except as determined by the board. 2 5. The board may request, at the applicant’s expense, that 3 the department of public safety perform a criminal history 4 check and the department of human services perform child and 5 dependent adult abuse record checks of the applicant. If an 6 applicant has a criminal record or a record of founded child or 7 dependent adult abuse, the board shall perform an evaluation to 8 determine whether the record warrants denial of licensure. 9 Sec. 8. NEW SECTION . 148G.3 Use of title —— penalty. 10 A person shall not use the title licensed midwife, describe 11 or imply that the person is a licensed midwife, or represent 12 the person as a licensed midwife unless the person is licensed 13 under this chapter or is licensed as a nurse-midwife under 14 chapter 152. 15 Sec. 9. NEW SECTION . 148G.4 Rules. 16 1. The board shall: 17 a. Adopt rules relating to standards for professional 18 conduct of persons licensed under this chapter. 19 b. Adopt rules consistent with this chapter and with 20 chapters 147 and 272C which are necessary for the performance 21 of its duties. 22 c. Act on matters concerning licensure and the processes 23 of applying for, granting, suspending, imposing supervisory 24 or probationary conditions upon, reinstating, and revoking a 25 license. 26 d. Administer the provisions of this chapter requiring 27 documentation required to demonstrate competence as a midwife, 28 and the processing of applications for licenses and license 29 renewal. 30 e. Develop continuing education requirements as a condition 31 of license renewal. 32 f. Evaluate requirements for licensure in other states to 33 determine if reciprocity may be granted. 34 g. Establish and collect licensure fees as provided in 35 -5- LSB 5039YH (7) 85 jr/nh 5/ 10

H.F. 2086 section 147.80 and retain fees as provided in section 147.82. 1 h. Establish procedures for the issuance, renewal, and 2 revocation or suspension of a license under this chapter. 3 i. Maintain a registry of licensed midwives and statistics 4 on the practice of midwifery utilizing vital statistics data. 5 2. In developing rules, the board may consult with 6 persons knowledgeable regarding the prenatal and postpartum 7 birth process, particularly those possessing experience with 8 out-of-hospital births, including but not limited to persons 9 licensed under chapter 148, certified professional midwives, 10 advanced registered nurse practitioners who are certified nurse 11 midwives, and women who have given birth in an out-of-hospital 12 setting. In developing rules relating to the practice of 13 midwifery, the board shall reflect the knowledge and skills 14 identified by the North American registry of midwives’ current 15 job description for the profession and the standards of 16 practice of midwifery established by the national association 17 of certified professional midwives or a successor organization. 18 3. Rules relating to the practice of midwifery shall be 19 consistent with the North American registry of midwives’ 20 current job description for the profession and the standards 21 of practice of midwifery established by the national 22 association of certified professional midwives or a successor 23 organization, and shall not expand the scope of practice of 24 midwifery established by the national association of certified 25 professional midwives or a successor organization. 26 4. At such time as the board determines that liability 27 insurance is available at an affordable price to certified 28 professional midwives, the board may mandate such coverage. 29 Until that time, each midwife shall comply with the disclosure 30 requirements in section 148G.5. 31 Sec. 10. NEW SECTION . 148G.5 Client disclosure. 32 Prior to accepting a patient for midwifery care, a licensed 33 midwife shall provide information indicating all of the 34 following: 35 -6- LSB 5039YH (7) 85 jr/nh 6/ 10

H.F. 2086 1. Evidence that the care provider is a licensed midwife 1 meeting the requirements of this chapter. 2 2. Whether the licensed midwife has malpractice liability 3 insurance coverage and the policy limits of such coverage. 4 3. The midwife’s educational background and relevant 5 experience, including experience in various birth settings. 6 4. The nature, scope, and location of the care to be 7 given, including the possibility of and the guidelines for 8 consultation, referral, or transfer of the patient to a 9 hospital from an out-of-hospital setting. 10 Sec. 11. NEW SECTION . 148G.6 Exceptions. 11 1. This chapter does not prevent qualified members of other 12 professions including but not limited to individuals licensed 13 under chapter 148 or 152 from providing services consistent 14 with the nature of the practice of midwifery. 15 2. This chapter does not prevent or prohibit a student 16 midwife from performing tasks related to the practice of 17 midwifery under the supervision of a licensed midwife, a 18 certified nurse midwife, or a licensed physician during 19 completion of the licensure process. 20 3. The practice of midwifery in this state prior to July 21 1, 2015, shall not constitute grounds for disciplinary action 22 by the board. The board may issue a license to a person who 23 has practiced midwifery in this state prior to that date upon 24 application and compliance with the provisions of this chapter 25 and the rules adopted pursuant to this chapter. 26 Sec. 12. NEW SECTION . 148G.7 Prohibited practice. 27 A person shall not practice midwifery, or represent that the 28 person is a midwife, unless the person is licensed as provided 29 in this chapter. 30 Sec. 13. NEW SECTION . 148G.8 Requirements for licensure —— 31 temporary license. 32 Beginning July 1, 2015, an individual who does not meet the 33 requirements for licensure by examination pursuant to section 34 148G.2 may apply for a one-year temporary license as determined 35 -7- LSB 5039YH (7) 85 jr/nh 7/ 10

H.F. 2086 by the board in rules. Renewal of the temporary license shall 1 be determined by the board. The board may revoke a temporary 2 license if it determines that the temporary licensee has 3 violated standards established by rule. 4 Sec. 14. NEW SECTION . 148G.9 Limits on liability. 5 If a midwife does not have malpractice liability insurance, 6 a health care provider caring for a patient that has been 7 transferred to the health care provider’s care from an 8 out-of-hospital setting shall be immune from liability for 9 treatment of the patient and the patient’s child. Such 10 immunity shall not apply to acts or omissions constituting 11 gross negligence, recklessness, or intentional misconduct. 12 For purposes of this section, “health care provider” means 13 a physician or surgeon, osteopathic physician or surgeon, 14 physician assistant, or nurse licensed in this state, or a 15 hospital licensed pursuant to chapter 135B. 16 Sec. 15. Section 272C.1, subsection 6, Code 2014, is amended 17 by adding the following new paragraph: 18 NEW PARAGRAPH . ag. The board of midwifery, created pursuant 19 to chapter 147. 20 Sec. 16. Section 272C.4, subsection 6, Code 2014, is amended 21 to read as follows: 22 6. Define by rule acts or omissions that are grounds for 23 revocation or suspension of a license under section 100D.5 , 24 105.22 , 147.55 , 148.6 , 148B.7 , 148G.4, 152.10 , 153.34 , 154A.24 , 25 169.13 , 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , 26 or 602.3203 or chapter 151 or 155 , as applicable, and to define 27 by rule acts or omissions that constitute negligence, careless 28 acts, or omissions within the meaning of section 272C.3, 29 subsection 2 , paragraph “b” , which licensees are required to 30 report to the board pursuant to section 272C.9, subsection 2 . 31 Sec. 17. INITIAL APPOINTMENTS. 32 1. Notwithstanding any provision to the contrary in this 33 Act, the initial midwife appointees to the board of midwifery 34 shall fulfill the national certification requirements of the 35 -8- LSB 5039YH (7) 85 jr/nh 8/ 10

H.F. 2086 North American registry of midwives. 1 2. One of the initial midwife appointments to the board 2 shall be appointed for a one-year term, one shall be appointed 3 for a two-year term, and one shall be appointed for a 4 three-year term. The members who are licensed under chapter 5 148 or 152 shall each be appointed for a two-year term, and the 6 members representing the general public shall each be appointed 7 to a three-year term. 8 Sec. 18. EFFECTIVE DATE. The following provision or 9 provisions of this Act take effect July 1, 2015: 10 1. The section of this Act amending section 147.2, 11 subsection 1. 12 2. The section of this Act enacting section 148G.7. 13 EXPLANATION 14 The inclusion of this explanation does not constitute agreement with 15 the explanation’s substance by the members of the general assembly. 16 This bill creates new Code chapter 148G that provides for 17 the licensure of midwives beginning July 1, 2015. A midwife 18 is not an allopathic or osteopathic physician licensed under 19 Code chapter 148 or a nurse licensed under Code chapter 20 152 providing primary maternity care during the antepartum, 21 intrapartum, or postpartum period. 22 The bill provides for the establishment of a seven-member 23 board of midwifery consisting of three members who are 24 midwives, one physician, one nurse, and two members who 25 represent the general public. The bill provides for fees to 26 fund the board and provides penalties for violation of the 27 licensure requirement; those penalties are set out for all 28 health-related boards in Code chapters 147 and 272C. Code 29 section 147.86 provides that it is a serious misdemeanor to 30 violate a provision of the licensing laws. 31 The board is similar in composition and responsibilities to 32 other health-related licensing boards. 33 The bill provides that a health care provider caring for a 34 patient transferred from an out-of-hospital setting is immune 35 -9- LSB 5039YH (7) 85 jr/nh 9/ 10