H.F. 2169 Section 1. Section 147.1, subsections 3 and 6, Code 2018, 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, respiratory care and 13 polysomnography practitioner, polysomnographic technologist, 14 social worker, massage therapist, midwife, athletic trainer, 15 acupuncturist, nursing home administrator, hearing aid 16 specialist, or sign language interpreter or transliterator 17 means a person licensed under this subtitle . 18 6. “Profession” means medicine and surgery, podiatry, 19 osteopathic medicine and surgery, practice as a physician 20 assistant, psychology, chiropractic, nursing, dentistry, 21 dental hygiene, dental assisting, optometry, speech pathology, 22 audiology, pharmacy, physical therapy, physical therapist 23 assisting, occupational therapy, occupational therapy 24 assisting, respiratory care, cosmetology arts and sciences, 25 barbering, mortuary science, marital and family therapy, mental 26 health counseling, polysomnography, social work, dietetics, 27 massage therapy, midwifery, athletic training, acupuncture, 28 nursing home administration, practice as a hearing aid 29 specialist, sign language interpreting or transliterating, 30 orthotics, prosthetics, or pedorthics. 31 Sec. 2. Section 147.13, Code 2018, is amended by adding the 32 following new subsection: 33 NEW SUBSECTION . 25. For midwifery, the board of midwifery. 34 Sec. 3. Section 147.14, subsection 1, Code 2018, is amended 35 -1- LSB 5840YH (3) 87 ss/rh 1/ 8

H.F. 2169 by adding the following new paragraph: 1 NEW PARAGRAPH . x. For midwifery, a total of seven members, 2 four members who are licensed midwives under chapter 148H; 3 one member who is licensed under chapter 148, is a practicing 4 family physician, and has professional experience consulting 5 for and collaborating with direct-entry midwives; and two 6 members who are not licensed midwives or licensed health care 7 providers who have received direct-entry midwifery services and 8 who shall represent the general public. 9 Sec. 4. Section 147.74, Code 2018, is amended by adding the 10 following new subsection: 11 NEW SUBSECTION . 26. A midwife licensed under chapter 148H 12 may use the words “licensed midwife” or the initials “L.M.” 13 after the person’s name. 14 Sec. 5. NEW SECTION . 148H.1 Midwifery licensure —— 15 legislative findings and intent. 16 The general assembly recognizes the need for a person to have 17 the freedom to choose the manner, cost, and setting for giving 18 birth. The general assembly finds that access to prenatal care 19 and delivery services is limited by the inadequate number of 20 providers of such services and that the practice of midwifery 21 may help to reduce this shortage. The general assembly also 22 recognizes the need for the safe and effective delivery of 23 newborn babies and the health, safety, and welfare of their 24 mothers in the delivery process. The general assembly, in 25 the interest of public health, promotes the regulation of the 26 practice of midwifery in Iowa for the purpose of protecting the 27 health and welfare of women and infants. The general assembly 28 recognizes that midwifery is a profession in its own right and 29 that it is not the practice of medicine or nursing. 30 Sec. 6. NEW SECTION . 148H.2 Definitions. 31 As used in this chapter, unless the context otherwise 32 requires: 33 1. “Board” means the board of midwifery created pursuant to 34 chapter 147. 35 -2- LSB 5840YH (3) 87 ss/rh 2/ 8

H.F. 2169 2. “Licensed midwife” means a person who is licensed to 1 practice midwifery as provided in this chapter and has obtained 2 national certification from the North American registry of 3 midwives or a successor organization. 4 3. “Midwife” means a person who is trained to give the 5 necessary care and advice to a woman during pregnancy, labor, 6 and the post-birth period, to conduct normal deliveries on 7 the midwife’s own responsibility, and to care for the newly 8 born infant, and who is able to recognize the warning signs of 9 abnormal conditions requiring referral to or collaboration with 10 a physician. 11 4. “Midwifery” means the practice of attending to a woman 12 experiencing a low-risk pregnancy during pregnancy, labor, and 13 the post-birth period with the informed consent of the woman, 14 and the provision of comprehensive care of the pregnant woman 15 during the antepartum phase, intrapartum phase, and postpartum 16 phase, and the application of emergency care when necessary. 17 5. “Out-of-hospital” means any facility, institution, or 18 place which is not an ambulatory surgical center or a hospital, 19 such as a birth center as defined in section 135.61 or a 20 private home. 21 Sec. 7. NEW SECTION . 148H.3 Licensure —— licensed 22 midwifery. 23 1. Except as provided in section 148H.7, subsection 1, 24 beginning July 1, 2018, every person practicing as a licensed 25 midwife 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 licensure of new 28 and practicing midwives. 29 2. Prior to obtaining licensure, an applicant shall 30 successfully pass an examination prescribed and approved by the 31 board by rule demonstrating competencies in at least all of 32 the following areas: risk assessment and management; prenatal 33 care; management of normal labor, birth, and postpartum; 34 newborn care up to six weeks; and adult cardiopulmonary 35 -3- LSB 5840YH (3) 87 ss/rh 3/ 8

H.F. 2169 resuscitation and newborn resuscitation. 1 3. The applicant shall hold a certified professional 2 midwife credential issued by the North American registry of 3 midwives or any other nationally accredited credential as 4 specified by the board. If an applicant has been subject to 5 prior revocation of a license to practice medicine or nursing, 6 the applicant shall not be eligible for licensure under this 7 chapter, except as determined by the board. 8 4. The board may request, at the applicant’s expense, that 9 the department of public safety perform a criminal history 10 check and the department of human services perform child and 11 dependent adult abuse record checks of the applicant. If an 12 applicant has a criminal record or a record of founded child or 13 dependent adult abuse, the board shall perform an evaluation to 14 determine whether the record warrants denial of licensure. 15 Sec. 8. NEW SECTION . 148H.4 Use of title —— penalty. 16 A person shall not use the title “licensed midwife”, 17 describe or imply that the person is a licensed midwife, or 18 represent the person as a licensed midwife unless the person is 19 licensed under this chapter or is licensed as a nurse-midwife 20 under chapter 152. 21 Sec. 9. NEW SECTION . 148H.5 Rules. 22 1. The board shall: 23 a. Adopt rules relating to standards for professional 24 conduct of persons licensed under this chapter. 25 b. Adopt rules consistent with this chapter and with 26 chapters 17A, 147, and 272C which are necessary for the 27 performance of the board’s duties. 28 c. Act on matters concerning licensure and the processes 29 of applying for, granting, suspending, imposing supervisory 30 or probationary conditions upon, reinstating, and revoking a 31 license. 32 d. Administer the provisions of this chapter requiring 33 documentation required to demonstrate competence as a midwife, 34 and the processing of applications for licenses and license 35 -4- LSB 5840YH (3) 87 ss/rh 4/ 8

H.F. 2169 renewal. 1 e. Develop continuing education requirements as a condition 2 of license renewal. 3 f. Evaluate requirements for licensure in other states to 4 determine if reciprocity may be granted. 5 g. Establish and collect licensure fees as provided in 6 section 147.80 and retain fees as provided in section 147.82. 7 h. Establish procedures for the issuance, renewal, and 8 revocation or suspension of a license under this chapter. 9 i. Maintain a registry of licensed midwives and statistics 10 on the practice of midwifery utilizing vital statistics data. 11 2. In developing rules, the board may consult with 12 persons knowledgeable regarding the prenatal and postpartum 13 birth process, particularly those possessing experience 14 with out-of-hospital births, including but not limited to 15 persons licensed under chapter 148, certified professional 16 midwives, advanced registered nurse practitioners who are 17 certified nurse-midwives, and women who have given birth in 18 an out-of-hospital setting. In developing rules relating 19 to the practice of midwifery, the board shall reflect the 20 knowledge and skills identified by the North American registry 21 of midwives’ current job description for the profession and the 22 standards of practice of midwifery established by the national 23 association of certified professional midwives or a successor 24 organization. 25 3. Rules relating to the practice of midwifery shall be 26 consistent with the North American registry of midwives’ 27 current job description for the profession and the standards 28 of practice of midwifery established by the national 29 association of certified professional midwives or a successor 30 organization, and shall not expand the scope of practice of 31 midwifery established by the national association of certified 32 professional midwives or a successor organization. 33 Sec. 10. NEW SECTION . 148H.6 Client disclosure. 34 Prior to accepting a patient for midwifery care, a licensed 35 -5- LSB 5840YH (3) 87 ss/rh 5/ 8

H.F. 2169 midwife shall provide information to the patient indicating all 1 of the following: 2 1. Evidence that the care provider is a licensed midwife 3 meeting the requirements of this chapter. 4 2. Whether the licensed midwife has malpractice liability 5 insurance coverage and the policy limits of such coverage. 6 3. The midwife’s educational background and relevant 7 experience, including experience in various birth settings. 8 4. The nature, scope, and location of the care to be 9 given, including the possibility of and the guidelines for 10 consultation, referral, or transfer of the patient to a 11 hospital from an out-of-hospital setting. 12 Sec. 11. NEW SECTION . 148H.7 Exceptions. 13 1. This chapter does not prevent qualified members of other 14 professions including but not limited to individuals licensed 15 under chapter 148 or 152 from providing services consistent 16 with the nature of the practice of midwifery. 17 2. This chapter does not prevent or prohibit a student 18 midwife from performing tasks related to the practice of 19 midwifery under the supervision of a licensed midwife, a 20 certified nurse-midwife, or a licensed physician during 21 completion of the licensure process. 22 3. The practice of midwifery in this state prior to July 1, 23 2018, shall not constitute grounds for disciplinary action by 24 the board. The board may issue a license to a person who has 25 practiced midwifery in this state prior to that date upon that 26 person’s application and compliance with the provisions of this 27 chapter and the rules adopted pursuant to this chapter. 28 Sec. 12. NEW SECTION . 148H.8 Requirements for licensure —— 29 temporary license. 30 Beginning July 1, 2018, an individual who does not meet 31 the requirements for licensure by examination pursuant to 32 section 148H.3 may apply for a one-year temporary license, the 33 qualifications for which shall be determined by the board by 34 rule. Renewal of the temporary license shall be determined 35 -6- LSB 5840YH (3) 87 ss/rh 6/ 8

H.F. 2169 by the board. The board may revoke a temporary license if it 1 determines that the temporary licensee has violated standards 2 established by rule. 3 Sec. 13. Section 272C.1, subsection 6, Code 2018, is amended 4 by adding the following new paragraph: 5 NEW PARAGRAPH . ah. The board of midwifery, created pursuant 6 to chapter 147. 7 Sec. 14. Section 272C.4, subsection 6, Code 2018, is amended 8 to read as follows: 9 6. Define by rule acts or omissions that are grounds for 10 revocation or suspension of a license under section 100D.5 , 11 105.22 , 147.55 , 148.6 , 148B.7 , 148H.5, 152.10 , 153.34 , 154A.24 , 12 169.13 , 455B.219 , 542.10 , 542B.21 , 543B.29 , 544A.13 , 544B.15 , 13 or 602.3203 or chapter 151 or 155 , as applicable, and to define 14 by rule acts or omissions that constitute negligence, careless 15 acts, or omissions within the meaning of section 272C.3, 16 subsection 2 , paragraph “b” , which licensees are required to 17 report to the board pursuant to section 272C.9, subsection 2 . 18 Sec. 15. INITIAL APPOINTMENTS. 19 1. Notwithstanding any provision to the contrary in this 20 Act, the initial midwife appointees to the board of midwifery 21 created pursuant to this Act shall fulfill the national 22 certification requirements of the North American registry of 23 midwives or a successor organization. 24 2. One of the initial midwife appointments to the board 25 shall be appointed for a one-year term, one shall be appointed 26 for a two-year term, and one shall be appointed for a 27 three-year term. The member who is licensed under chapter 28 148 shall be appointed for a two-year term, and the members 29 representing the general public shall each be appointed to a 30 three-year term. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill creates new Code chapter 148H that provides for 35 -7- LSB 5840YH (3) 87 ss/rh 7/ 8

H.F. 2169 the licensure of midwives beginning July 1, 2018. A midwife, 1 as defined by the bill, provides comprehensive maternity care 2 to low-risk women during the antepartum, intrapartum, or 3 postpartum period. 4 The bill provides for the establishment of a seven-member 5 board of midwifery consisting of four members who are midwives, 6 one physician, and two members who represent the general 7 public. The bill provides for fees to fund the board and 8 provides penalties for violation of the licensure requirement; 9 those penalties are set out for all health-related boards in 10 Code chapters 147 and 272C. Code section 147.86 provides that 11 it is a serious misdemeanor to violate a provision of the 12 licensing laws. 13 The board is similar in composition and responsibilities to 14 other health-related licensing boards. 15 The bill provides that a midwife practicing prior to 16 the effective date of the bill is not required to take an 17 examination for licensure. 18 -8- LSB 5840YH (3) 87 ss/rh 8/ 8