SENATE BILL No. 508 DIGEST OF INTRODUCED BILL

Transcription

1 Intrduced Versin SENATE BILL N. 508 DIGEST OF INTRODUED BILL itatins Affected: I ; I ; I ; I ; I ; I ; I ; I ; I ; I Snsis: Midwives. Establishes the midwifer bard (bard). Sets qualificatins fr a certified rfessinal midwife (PM). Requires the bard t: (1) devel eer review rcedures; (2) require the urchase f liabilit insurance as a cnditin fr licensure if the bard determines liabilit insurance is sufficientl available; and (3) adt rules limiting the sce f ractice f PMs t nnhsital settings. Makes it a lass B misdemeanr t ractice midwifer withut a license. Adds culabilit standards t the crimes f racticing medicine r steathic medicine and acting as a hsician assistant withut a license. Allws the bard t secif circumstances under which a PM ma administer certain rescritin drugs. Allws certain individuals t act under the suervisin f a PM. Requires the ffice f Medicaid lic and lanning t seek a waiver frm the United States Deartment f Health and Human Services t allw Medicaid reimbursement fr PMs. Reeals the definitin f "midwife" in the medical malractice law, and adds a definitin f "certified nurse midwife". Effective: Jul 1, Dilln Januar 15, 2009, read first time and referred t mmittee n Health and Prvider Services.

2 Intrduced First Regular Sessin 116th General Assembl (2009) PRINTING ODE. Amendments: Whenever an existing statute (r a sectin f the Indiana nstitutin) is being amended, the text f the existing rvisin will aear in this stle te, additins will aear in this stle te, and deletins will aear in this stle te. Additins: Whenever a new statutr rvisin is being enacted (r a new cnstitutinal rvisin adted), the text f the new rvisin will aear in this stle te. Als, the wrd NEW will aear in that stle te in the intrductr clause f each SETION that adds a new rvisin t the Indiana de r the Indiana nstitutin. nflict recnciliatin: Text in a statute in this stle te r this stle te recnciles cnflicts between statutes enacted b the 2008 Regular Sessin f the General Assembl. SENATE BILL N. 508 A BILL FOR AN AT t amend the Indiana de cncerning rfessins and ccuatins. Be it enacted b the General Assembl f the State f Indiana: 1 SETION 1. I , AS AMENDED BY P.L , 2 SETION 2, IS AMENDED TO READ AS FOLLOWS [EFFETIVE 3 JULY 1, 2009]: Sec (a) "Health care rvider", fr urses f 4 I and I 16-41, means an f the fllwing: 5 (1) An individual, a artnershi, a crratin, a rfessinal 6 crratin, a facilit, r an institutin licensed r legall 7 authrized b this state t rvide health care r rfessinal 8 services as a licensed hsician, a schiatric hsital, a hsital, 9 a health facilit, an emergenc ambulance service (I ), 10 a dentist, a registered r licensed ractical nurse, a certified 11 nurse midwife, a certified rfessinal midwife, an tmetrist, 12 a harmacist, a diatrist, a chirractr, a hsical theraist, a 13 resiratr care ractitiner, an ccuatinal theraist, a 14 schlgist, a aramedic, an emergenc medical technician, an 15 emergenc medical technician-basic advanced, an emergenc 16 medical technician-intermediate, r a ersn wh is an fficer, 17 emlee, r agent f the individual, artnershi, crratin,

3 2 1 rfessinal crratin, facilit, r institutin acting in the 2 curse and sce f the ersn's emlment. 3 (2) A cllege, universit, r junir cllege that rvides health 4 care t a student, a facult member, r an emlee, and the 5 gverning bard r a ersn wh is an fficer, emlee, r agent 6 f the cllege, universit, r junir cllege acting in the curse 7 and sce f the ersn's emlment. 8 (3) A bld bank, cmmunit mental health center, cmmunit 9 mental retardatin center, cmmunit health center, r migrant 10 health center. 11 (4) A hme health agenc (as defined in I ). 12 (5) A health maintenance rganizatin (as defined in 13 I ). 14 (6) A health care rganizatin whse members, sharehlders, r 15 artners are health care rviders under subdivisin (1). 16 (7) A crratin, artnershi, r rfessinal crratin nt 17 therwise qualified under this subsectin that: 18 (A) rvides health care as ne (1) f the crratin's, 19 artnershi's, r rfessinal crratin's functins; 20 (B) is rganized r registered under state law; and 21 () is determined t be eligible fr cverage as a health care 22 rvider under I fr the crratin's, artnershi's, r 23 rfessinal crratin's health care functin. 24 verage fr a health care rvider qualified under this subdivisin is 25 limited t the health care rvider's health care functins and des nt 26 extend t ther causes f actin. 27 (b) "Health care rvider", fr urses f I 16-35, has the 28 meaning set frth in subsectin (a). Hwever, fr urses f I 16-35, 29 the term als includes a health facilit (as defined in sectin 167 f this 30 chater). 31 (c) "Health care rvider", fr urses f I , means an 32 individual licensed r authrized b this state t rvide health care r 33 rfessinal services as: 34 (1) a licensed hsician; 35 (2) a registered nurse; 36 (3) a licensed ractical nurse; 37 (4) an advanced ractice nurse; 38 (5) a licensed certified nurse midwife r a certified rfessinal 39 midwife; 40 (6) a aramedic; 41 (7) an emergenc medical technician; 42 (8) an emergenc medical technician-basic advanced;

4 3 1 (9) an emergenc medical technician-intermediate; r 2 (10) a first resnder, as defined under I The term includes an individual wh is an emlee r agent f a 4 health care rvider acting in the curse and sce f the individual's 5 emlment. 6 (d) "Health care rvider", fr urses f I , means an 7 f the fllwing: 8 (1) An individual, a artnershi, a crratin, a rfessinal 9 crratin, a facilit, r an institutin licensed r authrized b 10 the state t rvide health care r rfessinal services as a 11 licensed hsician, a schiatric hsital, a hsital, a health 12 facilit, an emergenc ambulance service (I ), an 13 ambulatr utatient surgical center, a dentist, an tmetrist, a 14 harmacist, a diatrist, a chirractr, a schlgist, r a 15 ersn wh is an fficer, emlee, r agent f the individual, 16 artnershi, crratin, rfessinal crratin, facilit, r 17 institutin acting in the curse and sce f the ersn's 18 emlment. 19 (2) A bld bank, labratr, cmmunit mental health center, 20 cmmunit mental retardatin center, cmmunit health center, 21 r migrant health center. 22 (3) A hme health agenc (as defined in I ). 23 (4) A health maintenance rganizatin (as defined in 24 I ). 25 (5) A health care rganizatin whse members, sharehlders, r 26 artners are health care rviders under subdivisin (1). 27 (6) A crratin, artnershi, r rfessinal crratin nt 28 therwise secified in this subsectin that: 29 (A) rvides health care as ne (1) f the crratin's, 30 artnershi's, r rfessinal crratin's functins; 31 (B) is rganized r registered under state law; and 32 () is determined t be eligible fr cverage as a health care 33 rvider under I fr the crratin's, artnershi's, r 34 rfessinal crratin's health care functin. 35 (7) A ersn that is designated t maintain the recrds f a ersn 36 described in subdivisins (1) thrugh (6). 37 (e) "Health care rvider", fr urses f I , has the 38 meaning set frth in 47 FR (a). 39 SETION 2. I , AS AMENDED BY P.L , 40 SETION 444, IS AMENDED TO READ AS FOLLOWS 41 [EFFETIVE JULY 1, 2009]: Sec (a) An abrtin shall nt be 42 erfrmed excet with the vluntar and infrmed cnsent f the

5 4 1 regnant wman un whm the abrtin is t be erfrmed. Excet 2 in the case f a medical emergenc, cnsent t an abrtin is vluntar 3 and infrmed nl if the fllwing cnditins are met: 4 (1) At least eighteen (18) hurs befre the abrtin and in the 5 resence f the regnant wman, the hsician wh is t erfrm 6 the abrtin, the referring hsician r a hsician assistant (as 7 defined in I ), an advanced ractice nurse (as 8 defined in I (b)), a certified rfessinal midwife (as 9 defined in I ) r a certified nurse midwife (as 10 defined in I ) I ) t whm the 11 resnsibilit has been delegated b the hsician wh is t 12 erfrm the abrtin r the referring hsician has rall 13 infrmed the regnant wman f the fllwing: 14 (A) The name f the hsician erfrming the abrtin. 15 (B) The nature f the rsed rcedure r treatment. 16 () The risks f and alternatives t the rcedure r treatment. 17 (D) The rbable gestatinal age f the fetus, including an 18 ffer t rvide: 19 (i) a icture r drawing f a fetus; 20 (ii) the dimensins f a fetus; and 21 (iii) relevant infrmatin n the tential survival f an 22 unbrn fetus; 23 at this stage f develment. 24 (E) The medical risks assciated with carring the fetus t 25 term. 26 (F) The availabilit f fetal ultrasund imaging and 27 auscultatin f fetal heart tne services t enable the regnant 28 wman t view the image and hear the heartbeat f the fetus 29 and hw t btain access t these services. 30 (2) At least eighteen (18) hurs befre the abrtin, the regnant 31 wman will be rall infrmed f the fllwing: 32 (A) That medical assistance benefits ma be available fr 33 renatal care, childbirth, and nenatal care frm the lcal 34 ffice f the divisin f famil resurces. 35 (B) That the father f the unbrn fetus is legall required t 36 assist in the surt f the child. In the case f rae, the 37 infrmatin required under this clause ma be mitted. 38 () That adtin alternatives are available and that adtive 39 arents ma legall a the csts f renatal care, childbirth, 40 and nenatal care. 41 (3) The regnant wman certifies in writing, befre the abrtin 42 is erfrmed, that the infrmatin required b subdivisins (1)

6 5 1 and (2) has been rvided. 2 (b) Befre an abrtin is erfrmed, the regnant wman ma, un 3 the regnant wman's request, view the fetal ultrasund imaging and 4 hear the auscultatin f the fetal heart tne if the fetal heart tne is 5 audible. 6 SETION 3. I IS AMENDED TO READ AS 7 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec. 1. As used in this 8 chater, "ersn in attendance at birth" means ne (1) f the fllwing: 9 (1) A licensed attending hsician. 10 (2) An attending A certified rfessinal midwife r a certified 11 nurse midwife. 12 (3) Anther individual wh: 13 (A) hlds a license f the te designated b the gverning 14 bard f a hsital, after cnsultatin with the hsital's 15 medical staff, t attend births at the hsital; and 16 (B) is in attendance at the birth. 17 SETION 4. I IS AMENDED TO READ AS 18 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec. 4. A lcal health fficer 19 ma accet a certificate f birth resented fr filing nt mre than fur 20 (4) ears after the birth ccurred if the attending hsician, certified 21 nurse midwife, certified rfessinal midwife, r ther ersn 22 desiring t file the certificate states the reasn fr the dela in writing. 23 This statement shall be made a art f the certificate f birth. 24 SETION 5. I IS AMENDED TO READ AS 25 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec. 9. (a) ertified nurse 26 midwives, certified rfessinal midwives, and individuals and 27 entities described in sectin 7(a)(2) f this chater shall rert each 28 cnfirmed case f a birth rblem that is recgnized at the time f birth 29 t the registr nt later than sixt (60) das after the birth. An 30 individual r entit described in sectin 7(a)(2) f this chater wh 31 recgnizes a birth rblem in a child after birth but befre the child is 32 five (5) ears f age shall rert the birth rblem t the registr nt 33 later than sixt (60) das after recgnizing the birth rblem. 34 Infrmatin ma be rvided t amend r clarif an earlier rerted 35 case. 36 (b) A ersn required t rert infrmatin t the registr under this 37 sectin ma use, when cmleting rerts required b this chater, 38 infrmatin submitted t an ther ublic r rivate registr r required 39 t be filed with federal, state, r lcal agencies. Hwever, the state 40 deartment ma require additinal, definitive infrmatin. 41 (c) Exchange f infrmatin between state deartment registries is 42 authrized. The state deartment ma use infrmatin frm anther

7 6 1 registr administered b the state deartment. Infrmatin used frm 2 ther registries remains subject t the cnfidentialit restrictins n the 3 ther registries. 4 SETION 6. I , AS AMENDED BY P.L , 5 SETION 57, IS AMENDED TO READ AS FOLLOWS [EFFETIVE 6 JULY 1, 2009]: Sec. 3. (a) There is established the Indiana rfessinal 7 licensing agenc. The agenc shall erfrm all administrative 8 functins, duties, and resnsibilities assigned b law r rule t the 9 executive directr, secretar, r ther statutr administratr f the 10 fllwing: 11 (1) Bard f chirractic examiners (I ). 12 (2) State bard f dentistr (I ). 13 (3) Indiana state bard f health facilit administratrs 14 (I ). 15 (4) Medical licensing bard f Indiana (I ). 16 (5) Indiana state bard f nursing (I ). 17 (6) Indiana tmetr bard (I 25-24). 18 (7) Indiana bard f harmac (I 25-26). 19 (8) Bard f diatric medicine (I ). 20 (9) Bard f envirnmental health secialists (I 25-32). 21 (10) Seech-language athlg and audilg bard 22 (I ). 23 (11) State schlg bard (I 25-33). 24 (12) Indiana bard f veterinar medical examiners 25 (I ). 26 (13) ntrlled substances advisr cmmittee (I ). 27 (14) mmittee f hearing aid dealer examiners (I 25-20). 28 (15) Indiana hsical thera cmmittee (I 25-27). 29 (16) Resiratr care cmmittee (I ). 30 (17) Occuatinal thera cmmittee (I ). 31 (18) Scial wrker, marriage and famil theraist, and mental 32 health cunselr bard (I ). 33 (19) Phsician assistant cmmittee (I ). 34 (20) Indiana athletic trainers bard (I ). 35 (21) Indiana dietitians certificatin bard (I ). 36 (22) Indiana hntist cmmittee (I ). 37 (23) Midwifer bard (I ). 38 (b) Nthing in this chater ma be cnstrued t give the agenc 39 lic making authrit, which authrit remains with each bard. 40 SETION 7. I , AS AMENDED BY P.L , 41 SETION 4, IS AMENDED TO READ AS FOLLOWS [EFFETIVE 42 JULY 1, 2009]: Sec. 2. (a) This article, as it relates t the unlawful r

8 7 1 unauthrized ractice f medicine r steathic medicine, des nt 2 al t an f the fllwing: 3 (1) A student in training in a medical schl arved b the 4 bard, r while erfrming duties as an intern r a resident in a 5 hsital under the suervisin f the hsital's staff r in a 6 rgram arved b the medical schl. 7 (2) A ersn wh renders service in case f emergenc where n 8 fee r ther cnsideratin is cntemlated, charged, r received. 9 (3) A aramedic (as defined in I ), an emergenc 10 medical technician-basic advanced (as defined in 11 I ), an emergenc medical technician-intermediate 12 (as defined in I ), an emergenc medical 13 technician (as defined in I ), r a ersn with 14 equivalent certificatin frm anther state wh renders advanced 15 life surt (as defined in I ) r basic life surt (as 16 defined in I ): 17 (A) during a disaster emergenc declared b the gvernr 18 under I in resnse t an act that the gvernr in 19 gd faith believes t be an act f terrrism (as defined in 20 I ); and 21 (B) in accrdance with the rules adted b the Indiana 22 emergenc medical services cmmissin r the disaster 23 emergenc declaratin f the gvernr. 24 (4) mmissined medical fficers r medical service fficers f 25 the armed frces f the United States, the United States Public 26 Health Service, and medical fficers f the United States 27 Deartment f Veterans Affairs in the discharge f their fficial 28 duties in Indiana. 29 (5) An individual wh is nt a licensee wh resides in anther 30 state r cuntr and is authrized t ractice medicine r 31 steathic medicine there, wh is called in fr cnsultatin b an 32 individual licensed t ractice medicine r steathic medicine 33 in Indiana. 34 (6) A ersn administering a dmestic r famil remed t a 35 member f the ersn's famil. 36 (7) A member f a church racticing the religius tenets f the 37 church if the member des nt make a medical diagnsis, 38 rescribe r administer drugs r medicines, erfrm surgical r 39 hsical eratins, r assume the title f r rfess t be a 40 hsician. 41 (8) A schl crratin and a schl emlee wh acts under 42 I (r I befre its reeal).

9 8 1 (9) A chirractr racticing the chirractr's rfessin under 2 I r t an emlee f a chirractr acting under the 3 directin and suervisin f the chirractr under I (10) A dental hgienist racticing the dental hgienist's rfessin 5 under I (11) A dentist racticing the dentist's rfessin under I (12) A hearing aid dealer racticing the hearing aid dealer's 8 rfessin under I (13) A nurse racticing the nurse's rfessin under I Hwever, a registered nurse ma administer anesthesia if the 11 registered nurse acts under the directin f and in the immediate 12 resence f a hsician and hlds a certificate f cmletin f a 13 curse in anesthesia arved b the American Assciatin f 14 Nurse Anesthetists r a curse arved b the bard. 15 (14) An tmetrist racticing the tmetrist's rfessin under 16 I (15) A harmacist racticing the harmacist's rfessin under 18 I (16) A hsical theraist racticing the hsical theraist's 20 rfessin under I (17) A diatrist racticing the diatrist's rfessin under 22 I (18) A schlgist racticing the schlgist's rfessin under 24 I (19) A seech-language athlgist r audilgist racticing the 26 athlgist's r audilgist's rfessin under I (20) An emlee f a hsician r gru f hsicians wh 28 erfrms an act, a dut, r a functin that is custmaril within 29 the secific area f ractice f the emling hsician r gru 30 f hsicians, if the act, dut, r functin is erfrmed under the 31 directin and suervisin f the emling hsician r a 32 hsician f the emling gru within whse area f ractice 33 the act, dut, r functin falls. An emlee ma nt make a 34 diagnsis r rescribe a treatment and must rert the results f 35 an examinatin f a atient cnducted b the emlee t the 36 emling hsician r the hsician f the emling gru 37 under whse suervisin the emlee is wrking. An emlee 38 ma nt administer medicatin withut the secific rder f the 39 emling hsician r a hsician f the emling gru. 40 Unless an emlee is licensed r registered t indeendentl 41 ractice in a rfessin described in subdivisins (9) thrugh 42 (18), nthing in this subsectin grants the emlee indeendent

10 9 1 ractitiner status r the authrit t erfrm atient services in 2 an indeendent ractice in a rfessin. 3 (21) A hsital licensed under I r I (22) A health care rganizatin whse members, sharehlders, r 5 artners are individuals, artnershis, crratins, facilities, r 6 institutins licensed r legall authrized b this state t rvide 7 health care r rfessinal services as: 8 (A) a hsician; 9 (B) a schiatric hsital; 10 () a hsital; 11 (D) a health maintenance rganizatin r limited service 12 health maintenance rganizatin; 13 (E) a health facilit; 14 (F) a dentist; 15 (G) a registered r licensed ractical nurse; 16 (H) a certified nurse midwife r a certified rfessinal 17 midwife; 18 (I) an tmetrist; 19 (J) a diatrist; 20 (K) a chirractr; 21 (L) a hsical theraist; r 22 (M) a schlgist. 23 (23) A hsician assistant racticing the hsician assistant 24 rfessin under I (24) A hsician rviding medical treatment under 26 I (25) An attendant wh rvides attendant care services (as 28 defined in I ). 29 (26) A ersnal services attendant rviding authrized attendant 30 care services under I (b) A ersn described in subsectin (a)(9) thrugh (a)(18) is nt 32 excluded frm the alicatin f this article if: 33 (1) the ersn erfrms an act that an Indiana statute des nt 34 authrize the ersn t erfrm; and 35 (2) the act qualifies in whle r in art as the ractice f medicine 36 r steathic medicine. 37 (c) An emlment r ther cntractual relatinshi between an 38 entit described in subsectin (a)(21) thrugh (a)(22) and a licensed 39 hsician des nt cnstitute the unlawful ractice f medicine under 40 this article if the entit des nt direct r cntrl indeendent medical 41 acts, decisins, r judgment f the licensed hsician. Hwever, if the 42 directin r cntrl is dne b the entit under I (r

11 10 1 I befre its reeal), the entit is excluded frm the 2 alicatin f this article as it relates t the unlawful ractice f 3 medicine r steathic medicine. 4 (d) This subsectin des nt al t a rescritin r drug rder fr 5 a legend drug that is filled r refilled in a harmac wned r erated 6 b a hsital licensed under I A hsician licensed in Indiana 7 wh ermits r authrizes a ersn t fill r refill a rescritin r drug 8 rder fr a legend drug excet as authrized in I thrugh 9 I is subject t discilinar actin under I A 10 ersn wh vilates this subsectin cmmits the unlawful ractice f 11 medicine under this chater. 12 (e) A ersn described in subsectin (a)(8) shall nt be authrized 13 t disense cntracetives r birth cntrl devices. 14 SETION 8. I , AS AMENDED BY P.L , 15 SETION 5, IS AMENDED TO READ AS FOLLOWS [EFFETIVE 16 JULY 1, 2009]: Sec. 2. (a) A ersn wh knwingl r intentinall 17 vilates this article b unlawfull racticing medicine r steathic 18 medicine cmmits a lass feln. 19 (b) A ersn wh ractices midwifer withut the license required 20 under this article cmmits a lass D feln. 21 (c) (b) A ersn wh knwingl r intentinall acts as a 22 hsician assistant withut the license required under I cmmits a lass D feln. 24 SETION 9. I IS AMENDED TO READ AS 25 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec. 1. As used in this 26 chater: 27 (a) "Bard" means the Indiana state bard f nursing. 28 (b) "Advanced ractice nurse" means: 29 (1) a nurse ractitiner; 30 (2) a certified nurse midwife; r 31 (3) a clinical nurse secialist; 32 wh is a registered nurse qualified t ractice nursing in a secialt 33 rle based un the additinal knwledge and skill gained thrugh a 34 frmal rganized rgram f stud and clinical exerience, r the 35 equivalent as determined b the bard, which des nt limit but 36 extends r exands the functin f the nurse which ma be initiated b 37 the client r rvider in settings that shall include hsital utatient 38 clinics and health maintenance rganizatins. 39 (c) "Human resnse" means thse signs, smtms, behavirs, and 40 rcesses that dente the individual's interactin with the envirnment. 41 SETION 10. I IS AMENDED TO READ AS 42 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec (a) An alicant

12 11 1 wh desires t ractice certified nurse midwifer shall resent t the 2 bard the alicant's license as a registered nurse and a dilma earned 3 b the alicant frm a schl f midwifer arved r licensed b 4 the bard r licensing agenc fr midwives that is lcated in an state. 5 (b) The alicant shall submit t an examinatin in certified nurse 6 midwifer rescribed r administered b the bard. If the alicatin 7 and qualificatins are arved b the bard, the alicant is entitled 8 t receive a limited license that allws the alicant t ractice 9 midwifer as a certified nurse midwife. 10 (c) The bard shall adt rules under I : sectin 7 f this 11 chater: 12 (1) defining the sce f ractice fr midwifer; f a certified 13 nurse midwife; and 14 (2) fr imlementing this sectin. 15 SETION 11. I IS ADDED TO THE INDIANA ODE 16 AS A NEW ARTILE TO READ AS FOLLOWS [EFFETIVE JULY 17 1, 2009]: 18 ARTILE ERTIFIED PROFESSIONAL MIDWIVES 19 hater 1. Definitins 20 Sec. 1. The definitins in this chater al thrughut this 21 article. 22 Sec. 2. "Anteartum erid" means the erid that begins when 23 a wman becmes regnant and ends when the birthing erid 24 begins. 25 Sec. 3. "Bard" refers t the midwifer bard established b 26 I Sec. 4. (a) "ertified rfessinal midwife" r "PM" means an 28 individual wh has cmleted and assed the credentialing rcess 29 as administered b the Nrth American Registr f Midwives r a 30 successr rganizatin and met requirements established b the 31 bard. 32 (b) The term des nt include an f the fllwing: 33 (1) An individual engaged in the ractice f medicine under 34 I (2) A certified nurse midwife engaged in the ractice f 36 midwifer nl under I (3) An individual rviding emergenc medical services. 38 Sec. 5. "Health care rfessinal" means an f the fllwing: 39 (1) A hsician licensed under I (2) A dentist licensed under I (3) A chirractr licensed under I (4) A diatrist licensed under I

13 12 1 (5) An tmetrist licensed under I (6) A nurse licensed under I (7) A hsical theraist licensed under I r a hsical 4 theraist's assistant certified under I (8) A seech language athlgist r an audilgist licensed 6 under I (9) A seech language athlg aide r an audilg 8 assistant (as defined in I ). 9 (10) An: 10 (A) ccuatinal theraist; r 11 (B) ccuatinal thera assistant; 12 certified under I (11) A scial wrker licensed under I r a scial 14 wrk assistant. 15 (12) A harmacist licensed under I Sec. 6. "Intraartum erid" means the erid that begins 17 when a wman starts labr and ends when the wman gives birth. 18 Sec. 7. "Licensed certified rfessinal midwife" means an 19 individual wh is a certified rfessinal midwife and licensed 20 under this article. 21 Sec. 8. "Midwifer" means the acts f a ersn when the ersn, 22 fr cmensatin, advises, attends, r assists a wman during 23 regnanc, labr, natural childbirth, r the startum erid. 24 Sec. 9. "Pstartum erid" means the six (6) week erid after 25 a birth. 26 hater 2. Midwifer Bard 27 Sec. 1. The midwifer bard is established. 28 Sec. 2. (a) The bard cnsists f nine (9) members ainted b 29 the gvernr as fllws: 30 (1) Fur (4) members wh are licensed certified rfessinal 31 midwives. 32 (2) One (1) member wh: 33 (A) has an unlimited license t ractice medicine in 34 Indiana; and 35 (B) ractices as a famil ractitiner wh has exerience 36 in bstetrics, a ediatrician, r an bstetrician. 37 (3) One (1) member wh is an attrne licensed t ractice 38 law in Indiana. 39 (4) One (1) certified nurse midwife with exerience in the 40 ractice f hme births. 41 (5) Tw (2) members reresenting the ublic. 42 (b) A certified rfessinal midwife ainted t the bard

14 13 1 under subsectin (a) after June 30, 2009, and befre Jul 1, 2012, 2 is nt required t be licensed under this article. Hwever, a 3 certified rfessinal midwife ainted t the bard after June 4 30, 2009, and befre Jul 1, 2012, under subsectin (a), must be a 5 certified rfessinal midwife. 6 Sec. 3. (a) The term f each bard member is fur (4) ears. 7 (b) A bard member ma be reainted fr nt mre than 8 three (3) cnsecutive terms. 9 (c) A bard member serves until the bard member's successr 10 is ainted. A vacanc ccurring in the membershi f the bard 11 fr an cause shall be filled b aintment b the gvernr fr the 12 unexired term. 13 (d) Bard members annuall shall select a chairersn and a 14 vice chairersn frm amng the bard's members. 15 Sec. 4. (a) The bard shall meet at least ne (1) time each ear 16 at the call f the chairersn. 17 (b) Fur (4) members f the bard cnstitute a qurum. 18 (c) The affirmative vte f fur (4) members f the bard is 19 required fr the bard t take actin. 20 Sec. 5. The health rfessins bureau shall rvide staff surt 21 fr the bard. 22 Sec. 6. The bard shall d the fllwing: 23 (1) Establish as a requirement fr licensure as a certified 24 rfessinal midwife the certified rfessinal midwife (PM) 25 credentials develed b the Nrth American Registr f 26 Midwives r a successr rganizatin. 27 (2) Establish fees fr the licensure f certified rfessinal 28 midwives. 29 (3) Establish annual cntinuing educatin requirements fr 30 license renewal. 31 (4) Devel a eer review rcedure, using as guidelines the 32 eer review rcedures established b: 33 (A) the Indiana Midwives Assciatin r a successr 34 rganizatin; and 35 (B) the Midwives Alliance f Nrth America r a successr 36 rganizatin. 37 (5) Prescribe infrmed cnsent frms and ther relevant 38 frms. 39 (6) Research the availabilit f liabilit insurance fr certified 40 rfessinal midwives and, if the bard determines that 41 liabilit insurance is sufficientl available, require the 42 urchase f liabilit insurance as a cnditin fr licensure.

15 14 1 (7) Establish cntinuing educatin requirements, including 2 stud in harmaclg. 3 (8) Adt rules under I that define the sce f 4 ractice fr certified rfessinal midwives. Rules adted 5 under this subdivisin must limit the ractice f certified 6 rfessinal midwives t nnhsital settings. 7 Sec. 7. The bard shall adt rules under I t 8 administer this article. 9 hater 3. ertified Prfessinal Midwifer Licensing 10 Sec. 1. (a) This sectin des nt al t an individual wh has 11 a limited license under I t ractice midwifer as a 12 certified nurse midwife and is racticing within the sce f that 13 license. 14 (b) After Jul 1, 2012, an individual ma nt ractice midwifer 15 unless: 16 (1) the individual is a licensed r certified health care 17 rfessinal (including a certified nurse midwife) acting 18 within the sce f the ersn's license r certificatin; r 19 (2) the individual has a certified rfessinal midwife license 20 under this article. 21 (c) T becme licensed as a certified rfessinal midwife, an 22 alicant must satisf the fllwing requirements: 23 (1) Be at least twent-ne (21) ears f age. 24 (2) Satisfactril cmlete educatinal and ractical 25 requirements f the PM credentialing rcess in accrdance 26 with the standards f the Nrth American Registr f 27 Midwives r a successr rganizatin. 28 (3) Acquire and dcument ractical exerience as utlined in 29 the PM credentialing rcess in accrdance with the 30 standards f the Nrth American Registr f Midwives r a 31 successr rganizatin. 32 (4) Obtain certificatin b the accredited assciatin in adult 33 cardiulmnar resuscitatin. 34 (5) mlete the rgram snsred b the American 35 Academ f Pediatrics in nenatal resuscitatin, excluding 36 endtracheal intubatin and the administratin f drugs. 37 (6) Prvide rf t the bard that the alicant has btained 38 the PM credential as administered b the Nrth American 39 Registr f Midwives r a successr rganizatin. 40 (7) Present additinal dcumentatin r certificatins 41 required b the bard. The bard ma adt standards that 42 require mre training than required b the Nrth American

16 15 1 Registr f Midwives. 2 Sec. 2. (a) The bard shall set u frmal educatin requirements 3 in additin t thse required in sectin 1. The requirements must 4 include curse material n: 5 (1) emergenc life surt rcedures; 6 (2) identificatin f high risk births fr mthers; 7 (3) identificatin f tential cmlicatins during labr; and 8 (4) ther material the bard secifies. 9 (b)the bard ma require an ral interview with the alicant 10 t assess the alicant's fitness t ractice midwifer. 11 Sec. 3. The bard shall grant a license t ractice certified 12 rfessinal midwifer t an alicant wh satisfies the 13 requirements f sectins 1 and 2 f this chater. 14 Sec. 4. (a) A license issued under this chater exires three (3) 15 ears after the date f issuance. Failure t renew a license n r 16 befre the exiratin date makes the license invalid withut an 17 actin b the bard. 18 (b) The rcedures and fees fr renewal are set b the bard. 19 (c) T be eligible fr the renewal f a license issued under this 20 chater, an individual must meet cntinuing educatin 21 requirements set b the bard. 22 Sec. 5. The bard: 23 (1) shall adt rules under I t set the fees fr 24 issuance f a license under this article; and 25 (2) ma adt rules under I t set ther fees the 26 bard cnsiders necessar t administer this article. 27 Sec. 6. After Jul 1, 2012, nl an individual wh is licensed 28 under this article ma use the title "certified rfessinal 29 midwife". 30 Sec. 7. The bard ma den, susend, r revke a license issued 31 under this article t an individual wh des an f the fllwing: 32 (1) Uses alchl r drugs t a degree that imairs the 33 individual's ractice f midwifer. 34 (2) Engages in unrfessinal cnduct as defined b the 35 bard's rules. 36 (3) mmits an act r makes an missin cnstituting grss 37 negligence arising frm the ractice f midwifer. 38 (4) Obtains a certified rfessinal midwife license thrugh 39 fraud. 40 (5) Vilates this article r a rule adted under this article b 41 the bard. 42 Sec. 8. The bard shall rvide ntice and a hearing under

17 16 1 I t an individual licensed under this article befre the 2 bard ma den, susend, r revke the individual's license under 3 sectin 7 f this chater. 4 Sec. 9. The bard ma imse a civil enalt f nt mre than 5 five hundred dllars ($500) n an individual licensed under this 6 article wh cmmits an act r makes an missin described in 7 sectin 7 f this chater. 8 Sec. 10. The bard ma issue a license t an individual wh is 9 licensed as a midwife in anther state with requirements that the 10 bard determines are at least equal t the licensing requirements 11 f this article. 12 Sec. 11. (a) This sectin des nt al t an individual wh has 13 a limited license under I t ractice midwifer as a 14 certified nurse midwife. 15 (b) After Jul 1, 2012, an individual wh knwingl r 16 intentinall ractices midwifer withut a license required under 17 this article cmmits a lass B misdemeanr. 18 hater 4. Infrmed nsent fr the Practice f ertified 19 Prfessinal Midwifer 20 Sec. 1. All the fllwing must ccur befre a certified 21 rfessinal midwife ma accet a client fr midwifer care: 22 (1) The certified rfessinal midwife must rvide the 23 tential client with an infrmed disclsure f ractice frm 24 rescribed b the bard under sectin 3 f this chater. 25 (2) The tential client must sign and date the frm. 26 (3) The certified rfessinal midwife must sign and date the 27 frm. 28 (4) If the tential client refuses a rcedure r treatment 29 required b law, the tential client must s indicate n a 30 searate rcedure r treatment frm. 31 (5) The certified rfessinal midwife must have an 32 emergenc lan fr the care f the client if an emergenc 33 arises. 34 (6) The certified rfessinal midwife must make an effrt t 35 have a written agreement with a hsician t rvide fr 36 backu care fr the client. The backu hsician shuld be 37 lcated in an area clse t where the deliver will ccur. The 38 bard shall set standards fr determining: 39 (A) the te f effrt sufficient t have a written agreement 40 with a hsician t rvide fr backu care fr the client; 41 and 42 (B) the gegrahic area clse enugh t the lanned

18 17 1 lcatin f the deliver t make the backu hsician a 2 reasnable chice t rvide backu care. 3 The bard shall, in ceratin with the medical licensing 4 bard r rfessinal rganizatins f hsicians, devel a 5 list f hsicians willing t rvide backu care and make the 6 list available t certified rfessinal midwives. 7 Sec. 2. A certified rfessinal midwife ma nt erfrm n a 8 client a secific rcedure r treatment that is nt described n the 9 infrmed disclsure f ractice frm described in sectin 1 f this 10 chater until bth f the fllwing ccur: 11 (1) The secific rcedure r treatment is disclsed t the 12 client in writing n a frm that is searate frm the infrmed 13 disclsure f ractice frm. 14 (2) The client agrees t the rcedure r treatment b signing 15 the rcedure r treatment frm. 16 Sec. 3. (a) The bard shall rescribe the written frm fr the 17 infrmed disclsure f ractice. 18 (b) The infrmed disclsure f ractice frm must be in writing 19 and must cntain the fllwing infrmatin: 20 (1) A descritin f the certified rfessinal midwife's 21 educatin and training in midwifer, including cmletin f 22 cntinuing educatin curses and articiatin in the eer 23 review rcess. 24 (2) The certified rfessinal midwife's exerience level in the 25 field f midwifer. 26 (3) The certified rfessinal midwife's hilsh f 27 ractice. 28 (4) Anteartum, intraartum, and startum cnditins 29 requiring cnsultatin, transfer f care, and transrt t a 30 hsital. 31 (5) The emergenc medical backu lan, including the 32 emergenc lan and the agreement with a hsician fr 33 backu care required under sectin 1 f this chater. 34 (6) The services t be rvided t the client b the certified 35 rfessinal midwife. 36 (7) The certified rfessinal midwife's current licensure 37 status and ertinent legal ramificatins. 38 (8) A detailed exlanatin f treatments and rcedures. 39 (9) A detailed descritin f the risks and exected benefits f 40 midwifer care. 41 (10) The availabilit f a grievance rcess in a case in which 42 a client is dissatisfied with the erfrmance f the certified

19 18 1 rfessinal midwife. 2 (11) A statement that under I a health care 3 rvider (as defined in I r I befre 4 its reeal) ma nt be held jintl r severall liable fr the 5 acts r missins f a: 6 (A) certified rfessinal midwife; r 7 (B) licensed hsician wh has entered int a cllabrative 8 agreement under I with a certified rfessinal 9 midwife, fr the acts r missins f the licensed hsician 10 while the hsician assists r cllabrates with the certified 11 rfessinal midwife t erfrm midwifer. 12 Sec. 4. A certified rfessinal midwife ma nt disclse 13 infrmatin btained frm a client during a rfessinal 14 cnsultatin excet under the fllwing cnditins: 15 (1) The client r the client's ersnal reresentative r 16 guardian rvides written cnsent. 17 (2) The infrmatin cncerns the cmmissin f a crime r 18 the threat f imminent danger. 19 (3) The client: 20 (A) is a minr and is the victim f a crime; 21 (B) brings a cause f actin against the midwife; 22 () waives the cnfidentialit rivilege; r 23 (D) is seeking emergenc care. 24 (4) An ther cnditin allwed b law. 25 Sec. 5. (a) A certified rfessinal midwife shall rvide an 26 annual rert t the bard regarding each birth that the certified 27 rfessinal midwife assists. A rert must summarize the 28 fllwing n a frm rescribed b the bard: 29 (1) Vital statistics. 30 (2) Sce f care. 31 (3) Transrt infrmatin. 32 (4) Phsician referral. 33 (b) A certified rfessinal midwife ma nt reveal the identit 34 f the clients referred t in a rert under subsectin (a). 35 Sec. 6. (a) Excet as rvided in subsectin (b), a certified 36 rfessinal midwife ma nt rescribe, disense, r administer 37 rescritin drugs. 38 (b) A certified rfessinal midwife ma administer: 39 (1) vitamin K, either rall r thrugh intramuscular 40 injectin; 41 (2) startum antihemrrhagic drugs in emergenc 42 situatins;

20 19 1 (3) lcal anesthetics; 2 (4) xgen; 3 (5) Rhgam; 4 (6) rhlactic ee agents; and 5 (7) rhlactic antibitics fr Gru B Stre (als knwn as 6 Beta Stre). 7 In defining the sce f ractice fr certified rfessinal midwives 8 under I (8), the bard ma adt rules secifing the 9 circumstances under which a certified rfessinal midwife ma 10 administer the substances listed in this subsectin. 11 hater 5. llabrative Plans f Treatment 12 Sec. 1. A certified rfessinal midwife ma rvide services t 13 an at-risk client (as defined in standards established b the bard) 14 under this article during the client's anteartum, intraartum, and 15 startum erids if the certified rfessinal midwife has 16 entered int a cllabrative lan f treatment with a hsician 17 licensed under I Sec. 2. A cllabrative lan f treatment under sectin 1 f this 19 chater must include the fllwing: 20 (1) Prvisins stating the circumstances that wuld require 21 cnsultatin r referral. 22 (2) Prvisins stating the circumstances that wuld require 23 transfer f resnsibilit fr the rimar care f the client. 24 (3) Prvisins stating the services t be rvided b the 25 certified rfessinal midwife and the licensed hsician. 26 hater 6. Right t ertified Prfessinal Midwifer Services 27 Sec. 1. Excet as therwise rvided b law, an individual is 28 entitled t: 29 (1) give birth in the resence f; and 30 (2) receive assistance during the birth rcess frm; 31 a certified rfessinal midwife. 32 SETION 12. I IS ADDED TO THE INDIANA 33 ODE AS A NEW SETION TO READ AS FOLLOWS 34 [EFFETIVE JULY 1, 2009]: Sec "ertified nurse midwife", 35 fr urses f I 34-18, has the meaning set frth in 36 I SETION 13. I IS ADDED TO THE INDIANA 38 ODE AS A NEW SETION TO READ AS FOLLOWS 39 [EFFETIVE JULY 1, 2009]: Sec "ertified nurse midwife" 40 means a registered nurse wh hlds a limited license t ractice 41 midwifer under I SETION 14. I IS AMENDED TO READ AS

21 20 1 FOLLOWS [EFFETIVE JULY 1, 2009]: Sec. 14. "Health care 2 rvider" means an f the fllwing: 3 (1) An individual, a artnershi, a limited liabilit cman, a 4 crratin, a rfessinal crratin, a facilit, r an institutin 5 licensed r legall authrized b this state t rvide health care 6 r rfessinal services as a hsician, a schiatric hsital, a 7 hsital, a health facilit, an emergenc ambulance service 8 (I ), a dentist, a registered r licensed ractical 9 nurse, a hsician assistant, a certified nurse midwife, a 10 certified rfessinal midwife, an tmetrist, a diatrist, a 11 chirractr, a hsical theraist, a resiratr care ractitiner, 12 an ccuatinal theraist, a schlgist, a aramedic, an 13 emergenc medical technician-intermediate, an emergenc 14 medical technician-basic advanced, r an emergenc medical 15 technician, r a ersn wh is an fficer, emlee, r agent f 16 the individual, artnershi, crratin, rfessinal crratin, 17 facilit, r institutin acting in the curse and sce f the 18 ersn's emlment. 19 (2) A cllege, universit, r junir cllege that rvides health 20 care t a student, facult member, r emlee, and the gverning 21 bard r a ersn wh is an fficer, emlee, r agent f the 22 cllege, universit, r junir cllege acting in the curse and 23 sce f the ersn's emlment. 24 (3) A bld bank, cmmunit mental health center, cmmunit 25 mental retardatin center, cmmunit health center, r migrant 26 health center. 27 (4) A hme health agenc (as defined in I ). 28 (5) A health maintenance rganizatin (as defined in 29 I ). 30 (6) A health care rganizatin whse members, sharehlders, r 31 artners are health care rviders under subdivisin (1). 32 (7) A crratin, limited liabilit cman, artnershi, r 33 rfessinal crratin nt therwise qualified under this sectin 34 that: 35 (A) as ne (1) f its functins, rvides health care; 36 (B) is rganized r registered under state law; and 37 () is determined t be eligible fr cverage as a health care 38 rvider under this article fr its health care functin. 39 verage fr a health care rvider qualified under this 40 subdivisin is limited t its health care functins and des nt 41 extend t ther causes f actin. 42 SETION 15. THE FOLLOWING ARE REPEALED [EFFETIVE

22 21 1 JULY 1, 2009]: I ; I SETION 16. [EFFETIVE JULY 1, 2009] (a) As used in this 3 SETION, "bard" refers t the midwifer bard established b 4 I , as added b this act. 5 (b) Ntwithstanding I , as added b this act, the 6 gvernr shall aint the initial members f the bard befre 7 Setember 1, 2009, fr terms exiring as fllws: 8 (1) Tw (2) members ainted under I (1), as 9 added b this act, ne (1) member ainted under 10 I (2), as added b this act, and ne (1) member 11 ainted under I (5), as added b this act, fr a 12 term exiring August 31, (2) One (1) member ainted under I (1), as 14 added b this act, ne (1) member ainted under 15 I (3), as added b this act, and ne (1) member 16 ainted under I (5), as added b this act, fr a 17 term exiring August 31, (3) One (1) member ainted under I (1), as 19 added b this act, and ne (1) member ainted under 20 I (4), as added b this act, fr a term exiring 21 August 31, (c) This SETION exires Setember 1, SETION 17. [EFFETIVE JULY 1, 2009] (a) As used in this 24 SETION, "ffice" refers t the ffice f Medicaid lic and 25 lanning established b I (b) The ffice shall rvide Medicaid reimbursement t a 27 certified rfessinal midwife wh hlds a license under 28 I , as added b this act, fr services rendered b the 29 certified rfessinal midwife that the certified rfessinal 30 midwife is authrized t erfrm under the law. 31 (c) Befre Jul 1, 2013, the ffice shall seek a waiver frm the 32 United States Deartment f Health and Human Services t allw 33 Medicaid reimbursement fr a certified rfessinal midwife wh 34 hlds a license under I , as added b this act, fr services 35 rendered b the certified rfessinal midwife that the certified 36 rfessinal midwife is authrized t erfrm under the law. 37 (d) Ntwithstanding subsectin (b), the ffice ma nt rvide 38 Medicaid reimbursement fr services rvided b a certified 39 rfessinal midwife, as described in subsectin (c), until: 40 (1) the waiver described in subsectin (c) is arved; r 41 (2) a waiver is nt required under federal law. 42 (e) Nt later than five (5) das after receiving ntice f arval

23 22 1 f the waiver requested under subsectin (c), the ffice shall file an 2 affidavit with the gvernr's ffice and the budget cmmittee 3 attesting t the fact that the waiver has been arved. 4 (f) The ffice shall imlement subsectin (b) nt later than 5 ninet (90) das after the gvernr's ffice and the budget 6 cmmittee receive the affidavit described in subsectin (e). 7 (g) This SETION exires Jul 1, SETION 18. [EFFETIVE JULY 1, 2009] (a) Nt later than Jul 9 1, 2010, the midwifer bard established b I , as 10 added b this act, with the assistance f the deartment f 11 insurance, shall adt rules under I t allw a certified 12 rfessinal midwife wh hlds a license under I , as 13 added b this act, t receive reimbursement frm an insurance 14 cman r a third art ar fr services rendered b the 15 certified rfessinal midwife that the certified rfessinal 16 midwife is authrized t erfrm under the law. 17 (b) This SETION exires Jul 1, SETION 19. [EFFETIVE JULY 1, 2009] (a) A registered nurse 19 wh hlds a limited license t ractice midwifer under 20 I (frmerl referred t as a "midwife" befre the 21 reeal f I b this act) shall, beginning Jul 1, 2009, be 22 knwn as a "certified nurse midwife", as rvided in 23 I , as added b this act. 24 (b) This SETION exires December 31, 2012.