House Study Bill 123 - IntroducedA Bill ForAn Act 1relating to midwife licensure, providing for fees, and
2making penalties applicable.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  Section 147.1, subsections 3 and 6, Code 2021,
2are amended to read as follows:
   33.  “Licensed” or “certified”, when applied to a physician
4and surgeon, podiatric physician, osteopathic physician and
5surgeon, genetic counselor, physician assistant, psychologist,
6chiropractor, nurse, dentist, dental hygienist, dental
7assistant, optometrist, speech pathologist, audiologist,
8pharmacist, physical therapist, physical therapist assistant,
9occupational therapist, occupational therapy assistant,
10orthotist, prosthetist, pedorthist, respiratory care
11practitioner, practitioner of cosmetology arts and sciences,
12practitioner of barbering, funeral director, dietitian,
13behavior analyst, assistant behavior analyst, marital and
14family therapist, mental health counselor, midwife, respiratory
15care and polysomnography practitioner, polysomnographic
16technologist, social worker, massage therapist, athletic
17trainer, acupuncturist, nursing home administrator, hearing
18aid specialist, or sign language interpreter or transliterator
19means a person licensed under this subtitle.
   206.  “Profession” means medicine and surgery, podiatry,
21osteopathic medicine and surgery, genetic counseling, practice
22as a physician assistant, psychology, chiropractic, nursing,
23dentistry, dental hygiene, dental assisting, optometry, speech
24pathology, audiology, pharmacy, physical therapy, physical
25therapist assisting, occupational therapy, occupational therapy
26assisting, respiratory care, cosmetology arts and sciences,
27barbering, mortuary science, applied behavior analysis, marital
28and family therapy, mental health counseling, midwifery,
29 polysomnography, social work, dietetics, massage therapy,
30athletic training, acupuncture, nursing home administration,
31practice as a hearing aid specialist, sign language
32interpreting or transliterating, orthotics, prosthetics, or
33pedorthics.
34   Sec. 2.  Section 147.13, Code 2021, is amended by adding the
35following new subsection:
-1-1   NEW SUBSECTION.  25.  For midwifery, the board of midwifery.
2   Sec. 3.  Section 147.14, subsection 1, Code 2021, is amended
3by adding the following new paragraph:
4   NEW PARAGRAPH.  x.  For midwifery, a total of seven members,
5four members who are professional midwives eligible for
6licensure under chapter 148I; one member who is licensed under
7chapter 148, is certified by the American college of obstetrics
8and gynecology, and has professional experience consulting
9for and collaborating with direct-entry midwives; one member
10who is a nurse midwife; and one member who is not a licensed
11midwife or a licensed health care provider who has received
12direct-entry midwifery services and who shall represent the
13general public.
14   Sec. 4.  Section 147.74, Code 2021, is amended by adding the
15following new subsection:
16   NEW SUBSECTION.  28.  A midwife licensed under chapter 148I
17may use the words “licensed midwife” or the initials “L.M.”
18after the person’s name.
19   Sec. 5.  NEW SECTION.  148I.1  Definitions.
   20As used in this chapter, unless the context otherwise
21requires:
   221.  “Board” means the board of midwifery created pursuant to
23chapter 147.
   242.  “Certified nurse midwife” or “CNM” means a registered
25nurse who holds a current, valid certification from the
26American midwifery certification board.
   273.  “Certified professional midwife” or “CPM” means a person
28who holds a current, valid certification with the North
29American registry of midwives or its successor organization.
   304.  “Client” means a person under the care of a midwife and
31such person’s fetus or newborn.
   325.  “Licensed midwife” means a person licensed under this
33chapter to practice midwifery in Iowa.
   346.  “Midwife” means a person practicing midwifery.
   357.  “Midwifery” means the practice of providing primary
-2-1maternity care to a client during the preconception,
2antepartum, intrapartum, and postpartum periods and newborn
3care up to six weeks.
   48.  “Midwifery bridge certificate” or “MBC” means a
5certificate issued by the North American registry of midwives
6or its successor organization that documents completion of
7accredited continuing education for certified professional
8midwives based upon identified areas to address education
9in emergency skills and other competencies set by the
10international confederation of midwives.
11   Sec. 6.  NEW SECTION.  148I.2  Licensure — licensed
12midwifery.
   131.  Except as provided in section 148I.3, beginning July 1,
142022, every person practicing midwifery in this state shall be
15licensed pursuant to this chapter. The board shall adopt rules
16pursuant to chapters 17A, 147, and 272C establishing procedures
17for the licensure of new and practicing midwives.
   182.  Prior to obtaining a license to practice midwifery, an
19applicant shall meet all of the following requirements:
   20a.  Be at least twenty-one years old.
   21b.  Submit proof of a high school diploma or its equivalent.
   22c.  Submit proof of a current national certification as a
23certified professional midwife from the North American registry
24of midwives or its successor organization.
   25d.  (1)  Submit proof of completion of an educational program
26or pathway accredited by the midwifery education accreditation
27council, except as otherwise provided in this paragraph.
   28(2)  A certified professional midwife certified before
29January 1, 2021, and who received certification other than
30through completion of an educational program or pathway
31described in subparagraph (1) shall obtain a midwifery bridge
32certificate from the North American registry of midwives or its
33successor organization in order to obtain licensure in Iowa.
   34(3)  A person licensed to practice midwifery in a state
35that does not require completion of an educational program or
-3-1pathway described in subparagraph (1), shall obtain a midwifery
2bridge certificate from the North American registry of midwives
3or its successor organization in order to obtain licensure in
4Iowa.
   5e.  Submit an application fee as prescribed by the board by
6rule.
   73.  The board may request, at the applicant’s expense, that
8the department of public safety perform a criminal history
9check and the department of human services perform child and
10dependent adult abuse record checks of the applicant. If an
11applicant has a criminal record or a record of founded child or
12dependent adult abuse, the board shall perform an evaluation to
13determine whether the record warrants denial of licensure.
14   Sec. 7.  NEW SECTION.  148I.3  Exceptions.
   151.  This chapter does not do any of the following:
   16a.  Limit or regulate the practice of qualified members
17of other professions including but not limited to advanced
18registered nurse practitioner midwives under chapter 152,
19advanced practice registered nurse midwives under chapter 152E,
20or certified nurse midwives, from providing services that would
21constitute midwifery under this chapter.
   22b.  Apply to a person who is a member of a Native American or
23Amish community who provides traditional midwife services to
24such a community.
   25c.  Apply to a person who, in good faith, engages in the
26practice of the religious tenets of a church or a religious act
27if no fee is contemplated, charged, or received.
   28d.  Apply to a person rendering aid in an emergency.
   29e.  Apply to a student midwife currently enrolled in an
30accredited midwifery education program and providing services
31to clients under the direct, on-site, in-person supervision of
32a certified professional midwife who is licensed and registered
33as a preceptor with the North American registry of midwives or
34its successor organization.
   35f.  Apply to an advanced registered nurse practitioner
-4-1licensed under chapter 152, an advanced practice registered
2nurse under chapter 152E, or a certified nurse midwife.
   32.  The practice of midwifery shall not constitute the
4practice of medicine, certified nurse midwifery, certified
5midwifery, or emergency medical care to the extent that a
6midwife advises, attends, or assists a person during pregnancy,
7labor, childbirth, or the postpartum period.
8   Sec. 8.  NEW SECTION.  148I.4  Board — rules.
   91.  The board shall adopt rules consistent with this chapter
10and chapter 147 which are necessary for the performance of the
11board’s duties. The rules shall do all of the following:
   12a.  Regulate the practice of midwifery based on rules
13established by the national association of certified
14professional midwives and the North American registry of
15midwives or its successor organization.
   16b.  Define professional and unprofessional conduct.
   17c.  Permit a licensee to obtain appropriate screening and
18testing for clients, including but not limited to laboratory
19tests and ultrasounds.
   20d.  Permit a licensee to obtain and administer all of the
21following during the practice of midwifery:
   22(1)  Antihemorrhagic agents including but not limited to
23oxytocin, misoprostol, and methylergonovine.
   24(2)  Intravenous fluids for stabilization of the laboring
25person.
   26(3)  Neonatal injectable vitamin K.
   27(4)  Newborn antibiotic eye prophylaxis.
   28(5)  Oxygen.
   29(6)  Intravenous antibiotics for group B streptococcal
30antibiotic prophylaxis.
   31(7)  Rho (D) immune globulin.
   32(8)  Local anesthetic.
   33(9)  Epinephrine.
   34(10)  Other drugs consistent with the practice of certified
35professional midwifery.
-5-
   1e.  Permit a licensee to administer a drug prescribed by a
2licensed health care provider for a client of a licensee.
   3f.  Prohibit a licensee from using forceps or a vacuum
4extractor.
   5g.  Require a licensee to develop a written plan for the
6consultation, collaboration, emergency transfer, and transport
7of the birthing client and newborn when necessary, and to
8submit that plan to the board.
   9h.  Require a licensee to provide each client with, and
10maintain a record of, a signed consent form that describes the
11licensee’s qualifications, a copy of the licensee’s emergency
12plan, whether the licensee carries professional liability
13insurance, and the benefits and risks of birth in the client’s
14setting of choice.
   15i.  Require a licensee to report client data to the midwives
16alliance of North America statistics registry, the American
17association of birth centers perinatal data registry, or other
18similar databases, and to verify the submission of such data
19with the board.
   20j.  Adopt continuing education requirements consistent with
21those required by the North American registry of midwives or
22its successor organization.
   23k.  Establish requirements for peer review.
   24l.  Require a licensee to file a birth certificate for each
25birth.
   26m.  Establish an annual license fee.
   27n.  Require a licensee to comply with sections 136A.5 and
28136A.5A.
   292.  The board shall not adopt rules that do any of the
30following:
   31a.  Permit a licensee to order or administer narcotic drugs.
   32b.  Limit the location where a licensee may practice
33midwifery.
   34c.  Require a licensee to practice under the supervision of
35or under a collaborative practice agreement with another health
-6-1care provider.
2   Sec. 9.  NEW SECTION.  148I.5  Liability — limitation.
   3A health care provider accepting a transfer of a client from
4a licensed midwife shall not be liable for outcomes arising
5from actions of the licensed midwife.
6   Sec. 10.  NEW SECTION.  148I.6  Use of title — penalty.
   7A person shall not use the title “licensed midwife”, or
8describe or imply that the person is a licensed midwife, or
9represent that person as a licensed midwife unless the person
10is licensed under this chapter.
11   Sec. 11.  Section 272C.1, subsection 6, Code 2021, is amended
12by adding the following new paragraph:
13   NEW PARAGRAPH.  ah.  The board of midwifery, created pursuant
14to chapter 147.
15   Sec. 12.  Section 272C.4, subsection 6, Code 2021, is amended
16to read as follows:
   176.  Define by rule acts or omissions that are grounds for
18revocation or suspension of a license under section 100D.5,
19105.22, 147.55, 148.6, 148B.7, 152.10, 153.34, 154A.24, 169.13,
20455B.219, 542.10, 542B.21, 543B.29, 544A.13, 544B.15, or
21602.3203 or chapter 148I, 151, or 155, as applicable, and to
22define by rule acts or omissions that constitute negligence,
23careless acts, or omissions within the meaning of section
24272C.3, subsection 2, paragraph “b”, which licensees are
25required to report to the board pursuant to section 272C.9,
26subsection 2.
27   Sec. 13.  NEW SECTION.  514C.12A  Licensed midwife services.
   281.  Notwithstanding section 514C.6, a person who provides
29an individual or group policy of accident or health insurance
30or individual or group hospital or health care service
31contract issued pursuant to chapter 509, 509A, 514, or 514A
32or an individual or group health maintenance organization
33contract issued and regulated under chapter 514B, which is
34delivered, amended, or renewed on or after July 1, 1996, and
35which provides maternity benefits, which are not limited to
-7-1complications of pregnancy, or newborn care benefits, shall
2provide coverage for maternity services rendered by a midwife
3licensed pursuant to chapter 148I, regardless of the site of
4services, in accordance with guidelines adopted by rule by the
5commissioner.
   62.  Coverage for maternity services provided by a licensed
7midwife shall not be subject to any greater copayment,
8deductible, or coinsurance than is applicable to any other
9similar benefits provided by the plan.
   103.  A person who provides an individual or group policy of
11accident or health insurance or individual or group hospital or
12health care service contract issued pursuant to chapter 509,
13509A, 514, or 514A or an individual or group health maintenance
14organization contract issued and regulated under chapter 514B
15may require that maternity services be provided by a licensed
16midwife under contract with the person.
17   Sec. 14.  INITIAL APPOINTMENTS.
   181.  Notwithstanding any provision to the contrary in this
19Act, the initial midwife appointees to the board of midwifery
20created pursuant to this Act shall fulfill the national
21certification requirements of the North American registry of
22midwives or its successor organization.
   232.  One of the initial midwife appointments to the board
24shall be appointed for a one-year term, one shall be appointed
25for a two-year term, one shall be appointed for a three-year
26term, and one shall be appointed for a four-year term. The
27member who is licensed under chapter 148 shall be appointed for
28a two-year term, the member representing the general public
29shall be appointed to a three-year term, and the member who is
30a certified nurse midwife shall be appointed to a four-year
31term.
32EXPLANATION
33The inclusion of this explanation does not constitute agreement with
34the explanation’s substance by the members of the general assembly.
   35This bill relates to the practice of midwifery in Iowa.
-8-
   1The bill requires a person practicing midwifery in Iowa
2to obtain a license to practice beginning July 1, 2022. The
3bill exempts from regulation health care providers providing
4services consistent with midwifery, members of Native American
5tribes or Amish communities providing traditional midwife
6services, persons who gratuitously engage in the practice of
7the religious tenets of a church or a religious act, student
8midwives, and persons rendering emergency aid. Prior to
9obtaining a midwifery license, a person must be at least
1021 years of age, submit proof of a high school diploma or
11equivalent, submit a fee, submit proof of having completed an
12educational program or pathway, and hold a current certified
13professional midwife certificate from the North American
14registry of midwives. The bill prohibits any person other than
15a licensed midwife from using the title “licensed midwife”.
16The bill provides an alternative means to completion of an
17educational program or pathway for persons who received a
18certified professional midwife certification prior to January
191, 2021, or who received a license from a state that does not
20require completion of an educational program or pathway.
   21The bill creates the board of midwifery to regulate the
22practice of midwifery in Iowa and makes conforming changes to
23Code chapters 147 and 272C. The bill requires the board to
24adopt certain rules for the practice of midwifery and prohibits
25the board from adopting rules allowing a licensed midwife to
26order or administer narcotics, limiting the locations where
27a midwife may practice, or requiring a midwife to practice
28under a collaborative practice agreement with another health
29care provider. The bill provides certain requirements for
30membership on the board of midwifery.
   31The bill limits the liability of a health care provider
32accepting a transfer of clients from a licensed midwife with
33respect to outcomes that are the result of actions of the
34midwife. The bill also requires insurance providers that
35provide maternity benefits to cover maternity services provided
-9-1by licensed midwives on the same terms as for similar benefits
2provided by other providers.
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