Subject: Health; health insurance; home births; licensed midwife; 4certified

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1 01 Page 1 of 6 1 H.777 Introduced by Committee on Health Care Date: Subject: Health; health insurance; home births; licensed midwife; certified nurse midwife Statement of purpose: This bill proposes to clarify health insurance 6 coverage requirements for home births and other services provided by licensed 7 midwives and certified nurse midwives; to ensure that all midwives 8 submit data to a nationwide database; to require the midwife appointees to9 the office of professional regulation s advisory board, not the commissioner 10of health, to access the database to obtain relevant data; and to require licensed 11midwives to 1 maintain certification in neonatal resuscitation. An act relating to licensed midwives and certified nurse midwives 1 It is hereby enacted by the General Assembly of the State of Vermont: 1 1 Sec V.S.A. 099d is amended to read: 099d. MIDWIFERY COVERAGE; HOME BIRTHS (a) A health insurance plan or health benefit plan providing maternity 17 0 benefits shall also provide coverage for services rendered by a midwife midwives licensed pursuant to 6 V.S.A. chapter 8 of Title 6 or an and by advanced practice registered nurse nurses licensed pursuant to 6 V.S.A.

2 01 Page of 6 chapter 8 of Title 6 who is are certified as a nurse midwife midwives 1 for covered services that are within the licensed midwife s or certified nurse midwife s scope of practice and, whether provided in a hospital orother health care facility or at home. (b) Coverage for services provided by a licensed midwife or certified nurse midwife shall not be subject to any greater co-payment, deductible, 6 or coinsurance than is applicable to any other similar benefits provided 7 by the 8 plan. (c) A health insurance plan may require that the maternity services 9 be provided by a licensed midwife or certified nurse midwife under 10 contract with 11 the plan. (d) As used in this section, health insurance plan means any1 health insurance policy or health benefit plan offered by a health insurer, 1as defined in V.S.A. 90, as well as Medicaid, the Vermont health access 1plan, and any other public health care assistance program offered or administered 1 by the state or by any subdivision or instrumentality of the state. The term shall not include policies or plans providing coverage for specific disease or 17other limited benefit coverage.

3 01 Page of Sec. 1a. INSURANCE COVERAGE FOR MIDWIFERY (a) Notwithstanding 8 V.S.A. 099d(c), until July 1, 01, for home birth services to be provided by a licensed midwife or a certified nurse midwife, a health insurance plan shall not: (1) require that the licensed midwife or certified nurse midwife be under contract with the plan or participate in the plan s network; or () offer a plan that only covers midwifery services provided by a licensed midwife or certified nurse midwife when a network provider 8 is used (b) Notwithstanding 8 V.S.A. 099d(c), until July 1, 01, a licensed midwife or certified nurse midwife who does not participate in a health insurance plan s network shall not be subject to or required to meet the plan s network requirements, including the requirement to maintain professional liability insurance, provided that a licensed midwife or certified nurse midwife who is not in the plan s network shall disclose in writing to each patient whether the midwife is covered by a professional liability policy and shall obtain a signed and dated acknowledgment from each such patient of such disclosure. Sec.. 6 V.S.A. 1 is amended to read: 1. APRN RENEWAL An APRN license renewal application shall include: (1) documentation of completion of the APRN practice requirement; 1

4 01 Page of 6 () a current certification by a national APRN specialty certifying 1 organization; () current practice guidelines; and () a current collaborative provider agreement if required for transition to practice; and () for a certified nurse midwife, verification that the midwife has submitted to the database maintained by the Division of Research of the Midwives Alliance of North America data for each home birth he or she attended. Sec.. 6 V.S.A. 7 is amended to read: 7. RENEWALS (a)(1) Biennially, the director shall forward a renewal form to1 each licensed midwife. The completed form shall include verification that during 1 the 1 preceding two years, the licensed midwife has: (A) completed 0 hours of continuing education approved 1 by the 17 director by rule; (B) participated in at least four peer reviews; (C) submitted individual practice data; (D) maintained current cardiopulmonary resuscitation certification 0 for adults and newborns and for neonatal resuscitation; and

5 01 Page of 6 (E) filed a timely certificate of birth for each birth at which 1 he or she was the attending midwife, as required by law; and (F) submitted to the database maintained by the Division of Research of the Midwives Alliance of North America data for each home birth he or she attended. () Upon receipt of the completed form and of the renewal fee, 6 the director shall issue a renewal license to applicants who qualify under 7 this 8 section * * * Sec.. Sec. 8 of No. of the Acts of 011 is amended to read: Sec. 8. DEPARTMENT OF HEALTH; REPORTING REQUIREMENT 11 1 (a) The department of health licensed midwives appointed as advisors to the office of professional regulation pursuant to 6 V.S.A. 61 shall access the database maintained by the Division of Research of the Midwives 1 Alliance of North America to obtain information relating to care provided1 in Vermont by midwives licensed pursuant to 6 V.S.A. chapter 8 of Title 6 and by advanced practice registered nurses licensed pursuant to 6 V.S.A. 17chapter 8 0 of Title 6 who are certified as nurse midwives. The advisor appointees shall provide the full aggregate data available from the database to the commissioner of health by February 1 of each year from 01 through 0, inclusive, to

6 01 Page 6 of 6 1 enable the commissioner or designee to comply with subsection (b) of this section. (b) No later than March 1 of each year from 01 through 0, inclusive, the commissioner of health or designee, in collaboration with the director of the office of professional regulation, shall provide testimony to the house committee on health care and the senate committee on health and welfare 6 regarding the activities of licensed midwives and certified nurse midwives 7 performing home births and providing prenatal and postnatal care 8in a nonmedical environment during the preceding year. The testimony9 shall include the number of home births in Vermont, the number of hospital 10 transports associated with home births, the treatment of high-risk11 patients, and other relevant data, as well as the level of compliance of the licensed 1 midwives and certified nurse midwives with the laws and rules governing their 1 scope of practice. Sec.. EFFECTIVE DATES (a) Sec. 1 of this act shall take effect on October 1, 01, and shall apply to all health insurance plans and health benefit plans on and after October 1, 01, on such date as a health insurer issues, offers, or renews the plan, but in no event later than October 1, 01. (b) The remaining sections of this act shall take effect on passage.

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