SB258: SB258 Access to Midwife-led Birth Centers Grant Program; establish

25 LC 62 0114 Senate Bill 258 By: Senator James of the 28th A BILL TO BE ENTITLED AN ACT To amend Title 31 of the Official Code of Georgia Annotated, re lating to health, so as to 1 establish the Access to Midwife-led Birth Centers Grant Program ; to repeal provisions2 relating to the practice of midwifery; to amend Title 43 of the Official Code of Georgia3 Annotated, relating to professions and businesses, so as to pro vide for the licensure and4 regulation of midwives; to provide for a grant program promoting midwife-led birth centers;5 to provide for an application process for the grant program; to provide for procedures for6 administering the grant program; to provide for eligibility to receive funds under the7 program; to provide for requirements of how the funds are to be spent; to provide for audits8 of the grant program; to provide for reporting to the General Assembly; to provide for a short9 title; to provide for legislative findings; to provide for definitions; to provide for the creation10 of the Advisory Board for Licensed Midwives; to provide for its membership and duties; to11 provide for licensure requirements; to provide for the issuance, renewal, and revocation of12 licenses; to require written disclosures to clients; to provide for authorized acts and duties of13 licensed midwives; to provide for statutory construction; to provide for nuisances; to provide14 for related matters; to provide for an effective date; to repeal conflicting laws; and for other15 purposes.16 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:17 S. B. 258 - 1 - 25 LC 62 0114 SECTION 1.18 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Chapter19 2A, relating to the Department of Public Health, by adding a new article to read as follows:20 "ARTICLE 421 31-2A-60.22 As used in this article, the term:23 (1) 'Client' means a person seeking or receiving prenatal, int rapartum, and postpartum24 maternal care.25 (2) 'Contract management agency' or 'agency' means a nongovern mental organization26 whose mission and practice is to provide access to birth centers and prenatal, intrapartum,27 and postpartum maternal care.28 (3) 'Direct client service provider' or 'provider' means an organization with a contractual29 relationship with the contract management agency and that provi des access to birth30 centers and prenatal, intrapartum, and postpartum maternal care.31 (4) 'Program' means the Access to Midwife-led Birth Centers Grant Program established32 by this article.33 31-2A-61.34 There is established within the department the Access to Midwife-led Birth Centers Grant35 Program. The purpose of the program shall be to develop a state-wide effort that promotes36 access to midwife-led birth centers by awarding grants to organizations that operate birth37 centers and provide prenatal, intrapartum, and postpartum maternal care.38 S. B. 258 - 2 - 25 LC 62 0114 31-2A-62.39 (a) The department shall oversee the program and is authorized to contract with a contract40 management agency to administer the program.41 (b) The contract management agency selected by the department shall meet the definition42 of a contract management agency as defined in paragraph (3) of Code Section 31-2A-6043 and shall:44 (1) Create a grant application process;45 (2) Evaluate grant applications and make recommendations to the department;46 (3) Communicate acceptance or denial of grant applications to direct client service47 providers;48 (4) Monitor compliance with the terms and conditions of the grant;49 (5) Maintain records for each grant applicant and award; and50 (6) Coordinate activities and correspondence between the department and direct client51 service providers.52 31-2A-63.53 The services which shall be funded by the program include:54 (1) Medical care and information, including but not limited to pregnancy tests; sexually55 transmitted disease tests; other health screenings; ultrasound services; prenatal,56 intrapartum, and postpartum maternal care; and birth classes and planning;57 (2) Nutritional services and education;58 (3) Housing, education, and employment assistance during pregnancy and up to one year59 following a birth;60 (4) Child care assistance if necessary for the client to receive pregnancy support services;61 (5) Material items which are supportive of pregnancy and childbirth, including but not62 limited to cribs, car seats, clothing, formula, or other safety devices;63 S. B. 258 - 3 - 25 LC 62 0114 (6) Information regarding healthcare benefits, including but n ot limited to available64 Medicaid coverage for the client for pregnancy care that provides health coverage for the65 client's child upon his or her birth;66 (7) Postpartum care for a period of one year following a birth, miscarriage, stillbirth, or67 neonatal death. Such care shall include physiological assessme nts, mental health68 evaluations, nutritional evaluations, and guidance on personal and newborn care. Such69 care shall include:70 (A) At least four visits to a birth center as follows:71 (i) An initial visit within 24 hours of a birth, miscarriage, stillbirth, or neonatal death;72 (ii) A follow-up visit within the first three weeks postpartum;73 (iii) A follow-up visit within the first eight weeks postpartum; and74 (iv) A comprehensive visit no later than 12 weeks postpartum; and75 (B) Intermediary and ongoing care as needed; and76 (8) Establishing new birth centers.77 31-2A-64.78 (a) Grants shall be awarded annually on a competitive basis to direct client service79 providers that display competent experience in providing any of the services included in80 Code Section 31-2A-63 pursuant to guidelines and criteria estab lished pursuant to this81 article and where such services are provided by midwives. Grants shall also be awarded82 on a competitive basis to direct client service providers that establish new birth centers in83 counties where none previously existed.84 (b) The department shall, with input from the agency, determin e the maximum grant85 amount to be awarded to each direct client service provider, and such grant amount shall86 not exceed 85 percent of the annual revenue for the prior year of any provider or 85 percent87 of the cost of building a new birth center.88 S. B. 258 - 4 - 25 LC 62 0114 (c) The grant agreement entered into between the agency and a direct client service89 provider shall stipulate that the grant shall be used to provide any or all pregnancy support90 services at the discretion of the provider pursuant to Code Section 31-2A-63 or to fund the91 construction of a new birth center.92 31-2A-65.93 (a) In order to be considered for a grant under this article, each direct client service94 provider shall:95 (1) Have a primary mission of promoting healthy pregnancies an d midwife-led birth96 centers;97 (2) Have a system of financial accountability consistent with generally accepted98 accounting principles, including an annual budget;99 (3) Have a board that hires and supervises a director who mana ges the organization's100 operations;101 (4) Have provided midwife-led prenatal, intrapartum, and postp artum maternal care102 services for a minimum of one year;103 (5) Offer, at a minimum, pregnancy tests and counseling for women who are or may be104 experiencing unplanned pregnancies;105 (6) Provide confidential and free pregnancy support services;106 (7) Have a proposal to build a birth center in a county which does not currently have one;107 and108 (8) Maintain confidentiality of all data, files, and records of clients related to the services109 provided and in compliance with state and federal laws.110 (b) The department shall publish the direct client service provider criteria on its website.111 S. B. 258 - 5 - 25 LC 62 0114 31-2A-66.112 Each direct client service provider shall maintain accurate records and report data annually113 on forms and in the manner required by the department. Each pr ovider may be required114 to provide additional information and data at the discretion of the department.115 31-2A-67.116 Confidentiality of all data, files, and records of clients rela ted to the services provided117 under this article shall be maintained by the department, contract management agency, and118 direct client service provider pursuant to federal and state la ws related to privacy of119 medical records, including requirements under the federal Health Insurance Portability and120 Accountability Act of 1996, P.L. 104-191.121 31-2A-68.122 The agency shall conduct an annual audit of each direct client service provider by an123 independent certified public accountant within 120 days of the completion of its fiscal year124 verifying that it has complied with all requirements of this ar ticle and any other125 requirements of the department.126 31-2A-69.127 (a) The department shall annually report to the General Assemb ly on its use of funds128 appropriated to the department pursuant to this article.129 (b) The department shall also provide an annual report no later than September 30 of each130 year beginning September 30, 2026, which shall provide the following information for the131 immediately preceding fiscal year:132 (1) The amount of any contributions or other funding received;133 (2) The total amount of expenses; and134 (3) The amount of funds disbursed through the agency to direct client service providers.135 S. B. 258 - 6 - 25 LC 62 0114 (c) The reports required by this Code section shall be made available to the public free of136 charge by electronic means and in such other manner as the department deems appropriate.137 31-2A-70.138 The department is authorized to accept donations, contributions , and gifts and receive,139 hold, and use grants, devises, and bequests of real, personal, and mixed property on behalf140 of the state to enable the department to carry out the functions and purposes of this article."141 SECTION 2.142 Said title is further amended by repealing in its entirety Chapter 26, relating to the practice143 of midwifery, and designating said chapter as reserved.144 SECTION 3.145 Title 43 of the Official Code of Georgia Annotated, relating to professions and businesses,146 is amended by adding a new chapter to read as follows:147 "CHAPTER 24B148 43-24B-1.149 This chapter shall be known and may be cited as the 'Georgia Licensed Midwife Act.'150 43-24B-2.151 The General Assembly finds that:152 (1) Childbirth is the culmination of pregnancy and is a natural process, not a disease;153 (2) Regulating the practice of midwifery promotes access to safe and effective prenatal,154 childbirth, and postpartum care, providing for the health, safety, and welfare of mothers155 and their newborns;156 S. B. 258 - 7 - 25 LC 62 0114 (3) Midwifery has always been a highly valued part of life in this state;157 (4) Parents are entitled to freedom in choosing their provider and setting for childbirth;158 (5) Potential parents in this state desire alternatives to currently available hospital based159 maternity care;160 (6) Costs of out-of-hospital childbirth tend to be lower than in-hospital childbirth;161 (7) Planned out-of-hospital childbirth is safer when assisted by trained midwives;162 (8) Midwives can assist women and their families with safe and effective childbirth163 while guiding the health, safety, and welfare of mothers and their newborns through the164 childbearing year;165 (9) Certified professional midwives are specialists in out-of-hospital births;166 (10) Many parts of this state currently experience a crisis in access to safe and effective167 care for mothers and their newborns during the prenatal, childb irth, and postpartum168 periods;169 (11) Numerous counties in this state are underserved by obstetricians;170 (12) Improved access to midwives in all settings is associated with significantly higher171 rates of spontaneous vaginal delivery, vaginal birth after cesa rean delivery, and172 breastfeeding at birth and at six months and significantly lower rates of cesarean section,173 preterm birth, and low birth weight infants;174 (13) Midwifery care improves pregnancy outcomes for both low-r isk and high-risk175 women in underserved rural and urban communities;176 (14) Lack of access to licensed midwives compels families to h ave unattended177 out-of-hospital births or travel long distances to get care; and178 (15) For healthy women, midwife assisted childbirth in out-of-hospital settings has lower179 maternity and infant morbidity rates than in-hospital childbirth.180 43-24B-3.181 As used in this chapter, the term:182 S. B. 258 - 8 - 25 LC 62 0114 (1) 'Advisory board' means the Advisory Board for Licensed Mid wives established183 pursuant to Code Section 43-24B-4.184 (2) 'Certified nurse midwife' means a midwife who has been certified by the American185 Midwifery Certification Board or its successor organization and is licensed by the186 Georgia Board of Nursing.187 (3) 'Certified professional midwife' means a midwife who has been certified by the North188 American Registry of Midwives or its successor organization.189 (4) 'Consultation' means a communication between a midwife and another healthcare190 professional when assessing a condition during the prenatal, ch ildbirth, or postpartum191 periods.192 (5) 'Informed consent' means a verbal or written agreement from a client to consent to193 procedures, protocols, and treatments or recommended diagnostic t e s t s a f t e r f u l l194 disclosure of the current standard of care and its purpose, ben efits, known risks,195 contraindications, and associated risks, as well as any alternative options.196 (6) 'Informed refusal' means a verbal or written agreement from a client indicating that,197 after full disclosure of the current standard of care and its purpose, benefits, known risks,198 contraindications, and risks associated with its refusal, the client has the legal authority199 in all but the rarest of emergency circumstances to decline pro cedures, protocols,200 treatments, or diagnostic tests that such client finds unacceptable for any reason.201 (7) 'License' means a license issued pursuant to this chapter to practice midwifery.202 (8) 'Licensed midwife' means a midwife who has a license to practice midwifery in this203 state pursuant to this chapter, including certified nurse midwi ves and certified204 professional midwives.205 (9) 'Midwifery' means the assistance given to women during the prenatal, childbirth, and206 postpartum periods, including wellness screening and education.207 (10) 'Midwifery assistant' means any person working under the supervision of a licensed208 midwife as defined in this chapter.209 S. B. 258 - 9 - 25 LC 62 0114 (11) 'Out-of-hospital birth' means a birth that occurs at home or at a birth center.210 (12) 'Referral' means a request made by a midwife to a physici an or other healthcare211 professional for an assessment of a client or newborn in order to determine appropriate212 care.213 43-24B-4.214 (a) There is created within the division the Advisory Board for Licensed Midwives which215 shall consist of six members appointed by the Governor as follows:216 (1) Three certified professional midwives;217 (2) One consumer member who has firsthand experience with out-of-hospital births and218 who does not derive a substantial livelihood from the provision of any services related219 to prenatal, childbirth, or postpartum care;220 (3) One certified nurse midwife; and221 (4) One licensed physician who has firsthand experience with out-of-hospital births.222 (b) Each member of the advisory board shall be a citizen of th e United States and shall223 have been a resident of Georgia for at least five years immediately preceding appointment. 224 Members of the advisory board may serve for unlimited terms, except that no member may225 serve more than two consecutive terms.226 (c) The members of the advisory board shall serve for staggered terms of three years each;227 provided, however, that initial appointments shall be made as follows:228 (1) One certified professional midwife and one certified nurse midwife for a term of229 three years;230 (2) One certified professional midwife and one licensed physic ian for a term of two231 years; and232 (3) One certified professional midwife and one consumer member for a term of one year.233 (d) Each member of the advisory board shall receive the expense allowance as provided234 by subsection (b) of Code Section 45-7-21 and the same mileage allowance for the use of235 S. B. 258 - 10 - 25 LC 62 0114 a personal car as that received by other state officials and employees or a travel allowance236 of actual transportation cost if traveling by public carrier within this state. Each advisory237 board member shall also be reimbursed for any conference or mee ting registration fee238 incurred in the performance of his or her duties as an advisory board member. For each239 day's service outside of the state as an advisory board member, such member shall receive240 actual expenses as an expense allowance as well as the mileage allowance for the use of241 a personal car equal to that received by other state officials and employees or a travel242 allowance of actual transporta tion cost if tr aveling by public carrier or by rental motor243 vehicle. Expense vouchers submitted by advisory board members are subject to the244 approval of the chairperson. Out-of-state travel by advisory b oard members must be245 approved by the advisory board chairperson.246 (e) Any vacancy on the advisory board shall be filled in the s ame manner as the regular247 appointments. The Governor may remove members of the advisory board for248 incompetence, neglect of duty, unprofessional conduct, conviction of any felony, failure249 to meet the qualifications of this chapter, or committing any act prohibited by this chapter.250 (f) The advisory board shall elect a chairperson from among its membership and may elect251 other officers at the discretion of the advisory board, who shall each serve for one year.252 (g) The advisory board shall meet at least once per year or as otherwise called by the253 chairperson.254 43-24B-5.255 No person shall identify himself or herself as a licensed midwi fe in this state unless256 licensed as such pursuant to this chapter. On and after July 1, 2025, no person without a257 license issued pursuant to this chapter shall use the title 'li censed midwife' or the258 abbreviation 'L.M.'.259 S. B. 258 - 11 - 25 LC 62 0114 43-24B-6.260 Each applicant for a license under this chapter shall be at least 18 years of age, shall have261 submitted a completed application upon a form and in such manner as the advisory board262 prescribes, accompanied by applicable fees, and shall meet the following requirements:263 (1) Possessing:264 (A) A national certification by the North American Registry of Midwives as a certified265 professional midwife; or266 (B) A national certification recognized by the advisory board and substantially267 equivalent to the North American Registry of Midwives for certi fied professional268 midwives;269 (2) Having completed:270 (A) An educational program or pathway accredited by the Midwif ery Education271 Accreditation Council and obtained the certified professional midwife credential; or272 (B) An educational pathway not accredited by the Midwifery Education Accreditation273 Council and:274 (i) Possessing the Midwifery Bridge Certificate issued by the North American275 Registry of Midwives; or276 (ii) For certified professional midwives who have maintained licensure in a state that277 does not require completion of an educational program or pathway accredited by the278 Midwifery Education Accreditation Council, obtaining the Midwif ery Bridge279 Certificate regardless of the date of such certification;280 (3) Having satisfactory results from a criminal background check report conducted by281 the Georgia Crime Information Center and the Federal Bureau of Investigation, as282 determined by the advisory board. Application for a license un der this chapter shall283 constitute express consent and aut horization for the advisory b oard to perform such284 criminal background check. Each applicant who submits an appli cation for licensure285 agrees to provide the advisory board with any and all information necessary to run such286 S. B. 258 - 12 - 25 LC 62 0114 criminal background check, including, but not limited to, classifiable sets of fingerprints. 287 The applicant shall be responsible for all fees associated with the performance of such288 background check; and289 (4) Completing such other requirements as may be prescribed by the advisory board.290 43-24B-7.291 After evaluation of an application and other evidence submitted, the advisory board shall292 notify each applicant that such application and evidence submit ted are satisfactory and293 accepted or unsatisfactory and rejected. If rejected, the noti ce shall state the reasons for294 the rejection.295 43-24B-8.296 (a) A license issued by the advisory board is the property of the advisory board and must297 be surrendered on demand.298 (b) The licensee shall display the license in an appropriate and public manner.299 (c) The licensee shall inform the advisory board of any change of address.300 (d) The license shall be renewed biennially if the licensee is not in violation of this chapter301 at the time of application for renewal.302 (e) Each person licensed under this chapter is responsible for renewing his or her license303 before the expiration date.304 (f) Under procedures and conditions established by the advisor y board, a licensee may305 request that his or her license be declared inactive. The licensee may apply for active status306 at any time, and upon meeting the conditions set by the advisory board, such license shall307 be declared active.308 S. B. 258 - 13 - 25 LC 62 0114 43-24B-9.309 (a) The advisory board may revoke, suspend, deny, or refuse to issue or renew a license;310 place a licensee on probation; or issue a letter of admonition upon proof that the licensee311 or applicant has:312 (1) Procured or attempted to procure a license by fraud, decei t, misrepresentation,313 misleading omission, or material misstatement of fact;314 (2) Been convicted of a felony or of any crime involving moral turpitude as provided315 under state law;316 (3) Willfully or negligently acted in a manner inconsistent with the health or safety of317 persons under such licensee's care;318 (4) Had a license to practice a business or profession suspend ed or revoked or has319 otherwise been subject to discipline related to such licensee's practice of a business or320 profession in any other jurisdiction;321 (5) Committed a fraudulent act that materially affects the fit ness of the licensee or322 applicant to practice a business or profession;323 (6) Excessively or habitually used alcohol or drugs, provided that the advisory board324 shall not discipline a licensee under this paragraph if such li censee is enrolled in a325 substance abuse program approved by the advisory board; or326 (7) A physical or mental disability that renders such licensee incapable of safely327 practicing midwifery.328 (b) The advisory board is authorized to conduct investigations into allegations of conduct329 described in subsection (a) of this Code section.330 (c) In addition to revoking, suspending, denying, or refusing to renew a license, the331 advisory board may fine a licensee found to have violated any provision of this chapter or332 any rule adopted by the advisory board under this chapter in an amount not less than333 $100.00 nor more than $500.00 for each such violation.334 S. B. 258 - 14 - 25 LC 62 0114 (d) The provisions of Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,'335 shall be applicable to the advisory board and the provisions of this chapter.336 (e) Any person may file a complaint with the advisory board wi th respect to a licensed337 midwife.338 43-24B-10.339 (a) Before performing midwifery services, a licensed midwife shall provide, in a language340 that is understandable to the client, a written disclosure containing:341 (1) The midwife's name, address, telephone number, and license number;342 (2) Relevant information about the licensed midwife's training, qualifications, expertise,343 and disciplinary sanctions, if any;344 (3) The midwife's fees and method of billing;345 (4) The relevant state laws and regulations pertaining to the practice of midwifery in this346 state;347 (5) The method by which a client may file a complaint with the advisory board;348 (6) Whether the licensed midwife has liability insurance; and349 (7) Any other relevant information required by the advisory board.350 (b) A licensed midwife shall obtain a signed written informed consent or informed refusal351 in a language that is understandable to the client.352 (c) Written disclosures, written informed consents, and written informed refusals shall be353 signed by the client and retained by the licensed midwife for at least six years.354 43-24B-11.355 (a) A licensed midwife shall be authorized to:356 (1) Order prenatal, postpartum, and wellness laboratory analyses to be performed by a357 licensed laboratory for screening purposes;358 (2) Order obstetric ultrasounds;359 S. B. 258 - 15 - 25 LC 62 0114 (3) Administer prescription drugs prescribed by a licensed physician or other authorized360 healthcare professional; and361 (4) Precept apprentices and student midwives and supervise mid wifery assistants,362 provided that apprentices, student midwives, and midwifery assistants work only under363 the direction of the licensed midwife.364 (b) A licensed midwife shall:365 (1) Provide midwifery services consistent with the job analysis of the North American366 Registry of Midwives or its successor organization and consistent with the standards of367 practice of the National Association of Certified Professional Midwives or another368 national midwifery organization approved by the advisory board;369 (2) Keep current with continuing education consistent with sta ndards established by a370 national organization recognized by the advisory board;371 (3) Provide clients with access to written plans for consultation, referral, and transport;372 (4) Provide clients with access to practice guidelines as requ ired by the midwife's373 certifying organization;374 (5) Notify clients about relevant state governmental requirements affecting newborns;375 (6) File a birth certificate for each birth in accordance with the laws of this state; and376 (7) Purchase, possess, carry, or administer prescription supplies, including intravenous377 bags for fluid replenishment, Rho(D) immunoglobulin, vitamin K for administering orally378 or through intramuscular injection, postpartum antihemorrhagic agents, local anesthetics379 for suturing childbirth related lacerations or episiotomies, ox ygen, prophylactic eye380 agents for newborns, and other prescription medications or rest ricted medical items381 approved by the advisory board.382 43-24B-12.383 A licensed midwife shall not practice midwifery when:384 (1) Impaired due to any physical, mental, or substance abuse related problem; or385 S. B. 258 - 16 - 25 LC 62 0114 (2) Circumstances reasonably make the practice of midwifery by the licensed midwife386 amount to reckless disregard for a client's health, safety, or welfare.387 43-24B-13.388 A licensed midwife may terminate services to a client for any r eason, provided that the389 client has reasonable access to other professional care.390 43-24B-14.391 A licensed midwife may seek discretionary consultation with a l icensed physician or392 certified nurse midwife and such physician or certified nurse m idwife shall not be held393 liable for any acts or omissions on the part of such licensed midwife, unless such physician394 or certified nurse midwife directly contributes to acts or omis sions of such licensed395 midwife involving reckless disregard for the health, safety, or welfare of a client or396 newborn.397 43-24B-15.398 (a) Nothing in this chapter shall be construed to affect or prevent:399 (1) Any licensed healthcare professionals from engaging in the authorized scope of400 practice of their profession;401 (2) Members of a client's family from providing incidental care;402 (3) Representatives of a client's culture or religion from providing care consistent with403 tenets or practices relying on spiritual care of the physical body;404 (4) Care providers from acting under the orders or direction o f licensed healthcare405 professionals; or406 (5) Anyone providing incidental support or information to a pregnant woman.407 (b) Midwifery shall not constitute the practice of medicine in this state.408 S. B. 258 - 17 - 25 LC 62 0114 (c) Nothing in this chapter shall be construed to change the r egulation of physicians as409 provided for in the laws of this state.410 43-24B-16.411 Any health insurance policy, health maintenance organization plan, or other form of health412 insurance coverage, including Medicaid, that covers maternity care shall not deny coverage413 for maternity care provided by a licensed midwife in any settin g and shall reimburse414 maternity care by a licensed midwife at the same rate as for other providers of maternity415 care covered by the insurance policy.416 43-24B-17.417 Any violation of this chapter or any rules and regulations adopted pursuant to this chapter418 is declared to be a public nuisan ce subject to abatement as pro vided in Code419 Section 31-5-9."420 SECTION 4.421 This Act shall become effective upon its approval by the Governor or upon its becoming law422 without such approval.423 SECTION 5.424 All laws and parts of laws in conflict with this Act are repealed.425 S. B. 258 - 18 -