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House File 265 - EnrolledAn Actrelating to midwife licensure, providing for fees, and
making penalties applicable.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 147.1, subsections 3 and 6, Code 2023,
are amended to read as follows:
3. “Licensed” or “certified”, when applied to a physician
and surgeon, podiatric physician, osteopathic physician and
surgeon, genetic counselor, physician assistant, psychologist,
chiropractor, nurse, dentist, dental hygienist, dental
assistant, optometrist, speech pathologist, audiologist,
pharmacist, physical therapist, physical therapist assistant,
occupational therapist, occupational therapy assistant,
orthotist, prosthetist, pedorthist, respiratory care
practitioner, practitioner of cosmetology arts and sciences,
practitioner of barbering, funeral director, dietitian,
behavior analyst, assistant behavior analyst, marital and
family therapist, mental health counselor, midwife, respiratory
care and polysomnography practitioner, polysomnographic
technologist, social worker, massage therapist, athletic
trainer, acupuncturist, nursing home administrator, hearing
aid specialist, or sign language interpreter or transliterator
means a person licensed under this subtitle.
6. “Profession” means medicine and surgery, podiatry,
osteopathic medicine and surgery, genetic counseling, practice
as a physician assistant, psychology, chiropractic, nursing,
dentistry, dental hygiene, dental assisting, optometry, speech
pathology, audiology, pharmacy, physical therapy, physical
therapist assisting, occupational therapy, occupational therapy
assisting, respiratory care, cosmetology arts and sciences,
barbering, mortuary science, applied behavior analysis, marital
and family therapy, mental health counseling, midwifery,
polysomnography, social work, dietetics, massage therapy,
athletic training, acupuncture, nursing home administration,
practice as a hearing aid specialist, sign language
interpreting or transliterating, orthotics, prosthetics, or
pedorthics.
Sec. 2. Section 147.13, subsection 7, Code 2023, is amended
to read as follows:
-1- 7. For nursing and midwifery, the board of nursing.
Sec. 3. Section 147.74, Code 2023, is amended by adding the
following new subsection:
NEW SUBSECTION. 28. A midwife licensed under chapter 148I
may use the words “licensed midwife” or the initials “L.M.”
after the person’s name.
Sec. 4. NEW SECTION. 148I.1 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Board” means the board of nursing created pursuant to
chapter 147.
2. “Certified nurse midwife” or “CNM” means a registered
nurse who holds a current, valid certification from the
American midwifery certification board.
3. “Certified professional midwife” or “CPM” means a person
who holds a current, valid certification with the North
American registry of midwives or its successor organization.
4. “Client” means a person under the care of a midwife and
such person’s fetus or newborn.
5. “Licensed midwife” means a person licensed under this
chapter to practice midwifery in Iowa.
6. “Midwife” means a person practicing midwifery.
7. “Midwifery” means the practice of providing primary
maternity care to a client during the preconception,
antepartum, intrapartum, and postpartum periods and newborn
care up to six weeks.
8. “Midwifery bridge certificate” or “MBC” means a
certificate issued by the North American registry of midwives
or its successor organization that documents completion of
accredited continuing education for certified professional
midwives based upon identified areas to address education
in emergency skills and other competencies set by the
international confederation of midwives.
Sec. 5. NEW SECTION. 148I.2 Licensure — licensed
midwifery.
-2- 1. Except as provided in section 148I.3, beginning July 1,
2024, every person practicing midwifery in this state shall be
licensed pursuant to this chapter. The board shall adopt rules
pursuant to chapters 17A, 147, and 272C establishing procedures
for the licensure of new and practicing midwives.
2. Prior to obtaining a license to practice midwifery, an
applicant shall meet all of the following requirements:
a. Be at least twenty-one years old.
b. Submit proof of a high school diploma or its equivalent.
c. Submit proof of a current national certification as a
certified professional midwife from the North American registry
of midwives or its successor organization.
d. (1) Submit proof of completion of an educational program
or pathway accredited by the midwifery education accreditation
council, except as otherwise provided in this paragraph.
(2) A certified professional midwife certified before July
1, 2024, and who received certification other than through
completion of an educational program or pathway described in
subparagraph (1) shall obtain a midwifery bridge certificate
from the North American registry of midwives or its successor
organization in order to obtain licensure in Iowa.
(3) A person licensed to practice midwifery for at least
two years in a state that does not require completion of an
educational program or pathway described in subparagraph (1),
shall obtain a midwifery bridge certificate from the North
American registry of midwives or its successor organization in
order to obtain licensure in Iowa.
e. Submit an application fee as prescribed by the board by
rule.
3. The board may request, at the applicant’s expense, that
the department of public safety perform a criminal history
check and the department of human services perform child and
dependent adult abuse record checks of the applicant. If an
applicant has a criminal record or a record of founded child or
dependent adult abuse, the board shall perform an evaluation to
-3-determine whether the record warrants denial of licensure.
Sec. 6. NEW SECTION. 148I.3 Exceptions.
1. This chapter does not do any of the following:
a. Limit or regulate the practice of qualified members
of other professions including but not limited to advanced
registered nurse practitioner midwives under chapter 152,
advanced practice registered nurse midwives under chapter 152E,
or certified nurse midwives, from providing services that would
constitute midwifery under this chapter.
b. Apply to a person who is a member of a Native American,
Mennonite, or Amish community who provides traditional midwife
services to such a community.
c. Apply to a person who, in good faith, engages in the
practice of the religious tenets of a church or a religious act
if no fee is contemplated, charged, or received.
d. Apply to a person rendering aid in an emergency.
e. Apply to a student midwife currently enrolled in an
accredited midwifery education program and providing services
to clients under the direct, on-site, in-person supervision of
a certified professional midwife who is licensed and registered
as a preceptor with the North American registry of midwives or
its successor organization.
f. Apply to an advanced registered nurse practitioner
licensed under chapter 152, an advanced practice registered
nurse under chapter 152E, or a certified nurse midwife.
2. The practice of midwifery shall not constitute the
practice of medicine, certified nurse midwifery, certified
midwifery, or emergency medical care to the extent that a
midwife advises, attends, or assists a person during pregnancy,
labor, childbirth, or the postpartum period.
Sec. 7. NEW SECTION. 148I.4 Board — rules.
1. The board shall adopt rules consistent with this chapter
and chapter 147 which are necessary for the performance of the
board’s duties. The rules shall do all of the following:
a. Regulate the practice of midwifery based on rules
-4-established by the national association of certified
professional midwives and the North American registry of
midwives or its successor organization.
b. Define professional and unprofessional conduct.
c. Permit a licensee to obtain appropriate screening and
testing for clients, including but not limited to laboratory
tests and ultrasounds.
d. Permit a licensee to obtain and administer all of the
following during the practice of midwifery:
(1) Antihemorrhagic agents including but not limited to
oxytocin, misoprostol, and methylergonovine.
(2) Intravenous fluids for stabilization of the laboring
person.
(3) Neonatal injectable vitamin K.
(4) Newborn antibiotic eye prophylaxis.
(5) Oxygen.
(6) Intravenous antibiotics for group B streptococcal
antibiotic prophylaxis.
(7) Rho (D) immune globulin.
(8) Local anesthetic.
(9) Epinephrine.
(10) Other drugs consistent with the practice of certified
professional midwifery, as approved by the board.
e. Permit a licensee to administer a drug prescribed by a
licensed health care provider for a client of a licensee.
f. Prohibit a licensee from using forceps or a vacuum
extractor.
g. Require a licensee to develop a written plan for the
consultation, collaboration, emergency transfer, and transport
of the birthing client and newborn when necessary, and to
submit that plan to the board.
h. Require a licensee to provide each client with, and
maintain a record of, a signed consent form that describes the
licensee’s qualifications, a copy of the licensee’s emergency
plan, whether the licensee carries professional liability
-5-insurance and a copy of the licensee’s professional liability
insurance, if any, and the benefits and risks of birth in the
client’s setting of choice.
i. Require a licensee to report client data to the
department of health and human services, the midwives alliance
of North America statistics registry, the American association
of birth centers perinatal data registry, or other similar
databases, and to verify the submission of such data with the
board.
j. Adopt continuing education requirements consistent with
those required by the North American registry of midwives or
its successor organization.
k. Establish requirements for peer review.
l. Require a licensee to file a birth certificate for each
birth.
m. Establish an annual license fee.
n. Require a licensee to comply with sections 136A.5 and
136A.5A.
2. The board shall not adopt rules that do any of the
following:
a. Permit a licensee to order or administer narcotic drugs.
b. Limit the location where a licensee may practice
midwifery.
c. Require a licensee to practice under the supervision of
or under a collaborative practice agreement with another health
care provider.
3. The board shall adopt rules requiring a licensee to
consult with a licensed physician or certified nurse midwife
according to the appropriate standard of care for high-risk
pregnancies and births in the United States. Such rules shall
not require an in-hospital birth due merely to a consultation
and shall, to the greatest degree medically responsible, allow
a licensee to maintain care of a client according to the
client’s wishes.
Sec. 8. NEW SECTION. 148I.5 Liability — limitation.
-6- A health care provider accepting a transfer of a client from
a licensed midwife shall not be civilly or criminally liable
for outcomes arising from actions or omissions of the licensed
midwife.
Sec. 9. NEW SECTION. 148I.6 Use of title — penalty.
A person shall not use the title “licensed midwife”, or
describe or imply that the person is a licensed midwife, or
represent that person as a licensed midwife unless the person
is licensed under this chapter.
Sec. 10. NEW SECTION. 148I.7 Midwifery advisory council.
1. A midwifery advisory council is established. The board
shall appoint members of the council, including four members
who are certified professional midwives eligible for licensure
under this chapter; one member who is licensed under chapter
148 and is certified by the American college of obstetrics and
gynecology; one member who is a certified nurse midwife; and
one member who is not a licensed midwife or a licensed health
care provider and who shall represent the general public.
2. Members of the council shall serve for terms of four
years. Vacancies on the council shall be filled for the
remainder of the term of the original appointment. Members
whose terms expire may be reappointed.
3. The council shall advise the board regarding licensure
and continuing education requirements, standards of practice,
professional ethics, disciplinary actions, and other issues
relating to midwifery.
Sec. 11. Section 272C.4, subsection 6, Code 2023, is amended
to read as follows:
6. Define by rule acts or omissions that are grounds for
revocation or suspension of a license under section 100D.5,
105.22, 147.55, 148.6, 148B.7, 152.10, 153.34, 154A.24, 169.13,
455B.219, 542.10, 542B.21, 543B.29, 544A.13, 544B.15, or
602.3203 or chapter 148I, 151, or 155, as applicable, and to
define by rule acts or omissions that constitute negligence,
careless acts, or omissions within the meaning of section
-7-272C.3, subsection 2, paragraph “b”, which licensees are
required to report to the board pursuant to section 272C.9,
subsection 2.
Sec. 12. NEW SECTION. 514C.12A Licensed midwife services.
1. Notwithstanding section 514C.6, a person who provides
an individual or group policy of accident or health insurance
or individual or group hospital or health care service
contract issued pursuant to chapter 509, 509A, 514, or 514A
or an individual or group health maintenance organization
contract issued and regulated under chapter 514B, which is
delivered, amended, or renewed on or after July 1, 1996, and
which provides maternity benefits, which are not limited to
complications of pregnancy, or newborn care benefits, shall
provide coverage for maternity services rendered by a midwife
licensed pursuant to chapter 148I, regardless of the site of
services, in accordance with guidelines adopted by rule by the
commissioner.
2. Coverage for maternity services provided by a licensed
midwife shall not be subject to any greater copayment,
deductible, or coinsurance than is applicable to any other
similar benefits provided by the plan.
3. A person who provides an individual or group policy of
accident or health insurance or individual or group hospital or
health care service contract issued pursuant to chapter 509,
509A, 514, or 514A or an individual or group health maintenance
organization contract issued and regulated under chapter 514B
may require that maternity services be provided by a licensed
midwife under contract with the person.
4. This section does not require payment for any cost,
charge, or fee relating to the location at which maternity
services were provided by a certified professional midwife.
______________________________
PAT GRASSLEYSpeaker of the House______________________________
AMY SINCLAIRPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 265, Ninetieth General Assembly.______________________________
MEGHAN NELSONChief Clerk of the HouseApproved _______________, 2023______________________________
KIM REYNOLDSGovernorss/rh/md
making penalties applicable.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 147.1, subsections 3 and 6, Code 2023,
are amended to read as follows:
3. “Licensed” or “certified”, when applied to a physician
and surgeon, podiatric physician, osteopathic physician and
surgeon, genetic counselor, physician assistant, psychologist,
chiropractor, nurse, dentist, dental hygienist, dental
assistant, optometrist, speech pathologist, audiologist,
pharmacist, physical therapist, physical therapist assistant,
occupational therapist, occupational therapy assistant,
orthotist, prosthetist, pedorthist, respiratory care
practitioner, practitioner of cosmetology arts and sciences,
practitioner of barbering, funeral director, dietitian,
behavior analyst, assistant behavior analyst, marital and
family therapist, mental health counselor, midwife, respiratory
care and polysomnography practitioner, polysomnographic
technologist, social worker, massage therapist, athletic
trainer, acupuncturist, nursing home administrator, hearing
aid specialist, or sign language interpreter or transliterator
means a person licensed under this subtitle.
6. “Profession” means medicine and surgery, podiatry,
osteopathic medicine and surgery, genetic counseling, practice
as a physician assistant, psychology, chiropractic, nursing,
dentistry, dental hygiene, dental assisting, optometry, speech
pathology, audiology, pharmacy, physical therapy, physical
therapist assisting, occupational therapy, occupational therapy
assisting, respiratory care, cosmetology arts and sciences,
barbering, mortuary science, applied behavior analysis, marital
and family therapy, mental health counseling, midwifery,
polysomnography, social work, dietetics, massage therapy,
athletic training, acupuncture, nursing home administration,
practice as a hearing aid specialist, sign language
interpreting or transliterating, orthotics, prosthetics, or
pedorthics.
Sec. 2. Section 147.13, subsection 7, Code 2023, is amended
to read as follows:
-1- 7. For nursing and midwifery, the board of nursing.
Sec. 3. Section 147.74, Code 2023, is amended by adding the
following new subsection:
NEW SUBSECTION. 28. A midwife licensed under chapter 148I
may use the words “licensed midwife” or the initials “L.M.”
after the person’s name.
Sec. 4. NEW SECTION. 148I.1 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Board” means the board of nursing created pursuant to
chapter 147.
2. “Certified nurse midwife” or “CNM” means a registered
nurse who holds a current, valid certification from the
American midwifery certification board.
3. “Certified professional midwife” or “CPM” means a person
who holds a current, valid certification with the North
American registry of midwives or its successor organization.
4. “Client” means a person under the care of a midwife and
such person’s fetus or newborn.
5. “Licensed midwife” means a person licensed under this
chapter to practice midwifery in Iowa.
6. “Midwife” means a person practicing midwifery.
7. “Midwifery” means the practice of providing primary
maternity care to a client during the preconception,
antepartum, intrapartum, and postpartum periods and newborn
care up to six weeks.
8. “Midwifery bridge certificate” or “MBC” means a
certificate issued by the North American registry of midwives
or its successor organization that documents completion of
accredited continuing education for certified professional
midwives based upon identified areas to address education
in emergency skills and other competencies set by the
international confederation of midwives.
Sec. 5. NEW SECTION. 148I.2 Licensure — licensed
midwifery.
-2- 1. Except as provided in section 148I.3, beginning July 1,
2024, every person practicing midwifery in this state shall be
licensed pursuant to this chapter. The board shall adopt rules
pursuant to chapters 17A, 147, and 272C establishing procedures
for the licensure of new and practicing midwives.
2. Prior to obtaining a license to practice midwifery, an
applicant shall meet all of the following requirements:
a. Be at least twenty-one years old.
b. Submit proof of a high school diploma or its equivalent.
c. Submit proof of a current national certification as a
certified professional midwife from the North American registry
of midwives or its successor organization.
d. (1) Submit proof of completion of an educational program
or pathway accredited by the midwifery education accreditation
council, except as otherwise provided in this paragraph.
(2) A certified professional midwife certified before July
1, 2024, and who received certification other than through
completion of an educational program or pathway described in
subparagraph (1) shall obtain a midwifery bridge certificate
from the North American registry of midwives or its successor
organization in order to obtain licensure in Iowa.
(3) A person licensed to practice midwifery for at least
two years in a state that does not require completion of an
educational program or pathway described in subparagraph (1),
shall obtain a midwifery bridge certificate from the North
American registry of midwives or its successor organization in
order to obtain licensure in Iowa.
e. Submit an application fee as prescribed by the board by
rule.
3. The board may request, at the applicant’s expense, that
the department of public safety perform a criminal history
check and the department of human services perform child and
dependent adult abuse record checks of the applicant. If an
applicant has a criminal record or a record of founded child or
dependent adult abuse, the board shall perform an evaluation to
-3-determine whether the record warrants denial of licensure.
Sec. 6. NEW SECTION. 148I.3 Exceptions.
1. This chapter does not do any of the following:
a. Limit or regulate the practice of qualified members
of other professions including but not limited to advanced
registered nurse practitioner midwives under chapter 152,
advanced practice registered nurse midwives under chapter 152E,
or certified nurse midwives, from providing services that would
constitute midwifery under this chapter.
b. Apply to a person who is a member of a Native American,
Mennonite, or Amish community who provides traditional midwife
services to such a community.
c. Apply to a person who, in good faith, engages in the
practice of the religious tenets of a church or a religious act
if no fee is contemplated, charged, or received.
d. Apply to a person rendering aid in an emergency.
e. Apply to a student midwife currently enrolled in an
accredited midwifery education program and providing services
to clients under the direct, on-site, in-person supervision of
a certified professional midwife who is licensed and registered
as a preceptor with the North American registry of midwives or
its successor organization.
f. Apply to an advanced registered nurse practitioner
licensed under chapter 152, an advanced practice registered
nurse under chapter 152E, or a certified nurse midwife.
2. The practice of midwifery shall not constitute the
practice of medicine, certified nurse midwifery, certified
midwifery, or emergency medical care to the extent that a
midwife advises, attends, or assists a person during pregnancy,
labor, childbirth, or the postpartum period.
Sec. 7. NEW SECTION. 148I.4 Board — rules.
1. The board shall adopt rules consistent with this chapter
and chapter 147 which are necessary for the performance of the
board’s duties. The rules shall do all of the following:
a. Regulate the practice of midwifery based on rules
-4-established by the national association of certified
professional midwives and the North American registry of
midwives or its successor organization.
b. Define professional and unprofessional conduct.
c. Permit a licensee to obtain appropriate screening and
testing for clients, including but not limited to laboratory
tests and ultrasounds.
d. Permit a licensee to obtain and administer all of the
following during the practice of midwifery:
(1) Antihemorrhagic agents including but not limited to
oxytocin, misoprostol, and methylergonovine.
(2) Intravenous fluids for stabilization of the laboring
person.
(3) Neonatal injectable vitamin K.
(4) Newborn antibiotic eye prophylaxis.
(5) Oxygen.
(6) Intravenous antibiotics for group B streptococcal
antibiotic prophylaxis.
(7) Rho (D) immune globulin.
(8) Local anesthetic.
(9) Epinephrine.
(10) Other drugs consistent with the practice of certified
professional midwifery, as approved by the board.
e. Permit a licensee to administer a drug prescribed by a
licensed health care provider for a client of a licensee.
f. Prohibit a licensee from using forceps or a vacuum
extractor.
g. Require a licensee to develop a written plan for the
consultation, collaboration, emergency transfer, and transport
of the birthing client and newborn when necessary, and to
submit that plan to the board.
h. Require a licensee to provide each client with, and
maintain a record of, a signed consent form that describes the
licensee’s qualifications, a copy of the licensee’s emergency
plan, whether the licensee carries professional liability
-5-insurance and a copy of the licensee’s professional liability
insurance, if any, and the benefits and risks of birth in the
client’s setting of choice.
i. Require a licensee to report client data to the
department of health and human services, the midwives alliance
of North America statistics registry, the American association
of birth centers perinatal data registry, or other similar
databases, and to verify the submission of such data with the
board.
j. Adopt continuing education requirements consistent with
those required by the North American registry of midwives or
its successor organization.
k. Establish requirements for peer review.
l. Require a licensee to file a birth certificate for each
birth.
m. Establish an annual license fee.
n. Require a licensee to comply with sections 136A.5 and
136A.5A.
2. The board shall not adopt rules that do any of the
following:
a. Permit a licensee to order or administer narcotic drugs.
b. Limit the location where a licensee may practice
midwifery.
c. Require a licensee to practice under the supervision of
or under a collaborative practice agreement with another health
care provider.
3. The board shall adopt rules requiring a licensee to
consult with a licensed physician or certified nurse midwife
according to the appropriate standard of care for high-risk
pregnancies and births in the United States. Such rules shall
not require an in-hospital birth due merely to a consultation
and shall, to the greatest degree medically responsible, allow
a licensee to maintain care of a client according to the
client’s wishes.
Sec. 8. NEW SECTION. 148I.5 Liability — limitation.
-6- A health care provider accepting a transfer of a client from
a licensed midwife shall not be civilly or criminally liable
for outcomes arising from actions or omissions of the licensed
midwife.
Sec. 9. NEW SECTION. 148I.6 Use of title — penalty.
A person shall not use the title “licensed midwife”, or
describe or imply that the person is a licensed midwife, or
represent that person as a licensed midwife unless the person
is licensed under this chapter.
Sec. 10. NEW SECTION. 148I.7 Midwifery advisory council.
1. A midwifery advisory council is established. The board
shall appoint members of the council, including four members
who are certified professional midwives eligible for licensure
under this chapter; one member who is licensed under chapter
148 and is certified by the American college of obstetrics and
gynecology; one member who is a certified nurse midwife; and
one member who is not a licensed midwife or a licensed health
care provider and who shall represent the general public.
2. Members of the council shall serve for terms of four
years. Vacancies on the council shall be filled for the
remainder of the term of the original appointment. Members
whose terms expire may be reappointed.
3. The council shall advise the board regarding licensure
and continuing education requirements, standards of practice,
professional ethics, disciplinary actions, and other issues
relating to midwifery.
Sec. 11. Section 272C.4, subsection 6, Code 2023, is amended
to read as follows:
6. Define by rule acts or omissions that are grounds for
revocation or suspension of a license under section 100D.5,
105.22, 147.55, 148.6, 148B.7, 152.10, 153.34, 154A.24, 169.13,
455B.219, 542.10, 542B.21, 543B.29, 544A.13, 544B.15, or
602.3203 or chapter 148I, 151, or 155, as applicable, and to
define by rule acts or omissions that constitute negligence,
careless acts, or omissions within the meaning of section
-7-272C.3, subsection 2, paragraph “b”, which licensees are
required to report to the board pursuant to section 272C.9,
subsection 2.
Sec. 12. NEW SECTION. 514C.12A Licensed midwife services.
1. Notwithstanding section 514C.6, a person who provides
an individual or group policy of accident or health insurance
or individual or group hospital or health care service
contract issued pursuant to chapter 509, 509A, 514, or 514A
or an individual or group health maintenance organization
contract issued and regulated under chapter 514B, which is
delivered, amended, or renewed on or after July 1, 1996, and
which provides maternity benefits, which are not limited to
complications of pregnancy, or newborn care benefits, shall
provide coverage for maternity services rendered by a midwife
licensed pursuant to chapter 148I, regardless of the site of
services, in accordance with guidelines adopted by rule by the
commissioner.
2. Coverage for maternity services provided by a licensed
midwife shall not be subject to any greater copayment,
deductible, or coinsurance than is applicable to any other
similar benefits provided by the plan.
3. A person who provides an individual or group policy of
accident or health insurance or individual or group hospital or
health care service contract issued pursuant to chapter 509,
509A, 514, or 514A or an individual or group health maintenance
organization contract issued and regulated under chapter 514B
may require that maternity services be provided by a licensed
midwife under contract with the person.
4. This section does not require payment for any cost,
charge, or fee relating to the location at which maternity
services were provided by a certified professional midwife.
______________________________
PAT GRASSLEYSpeaker of the House______________________________
AMY SINCLAIRPresident of the Senate I hereby certify that this bill originated in the House and is known as House File 265, Ninetieth General Assembly.______________________________
MEGHAN NELSONChief Clerk of the HouseApproved _______________, 2023______________________________
KIM REYNOLDSGovernorss/rh/md