TWENTY-NINTH LEGISLATURE, 2017
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO THE LICENSURE OF MIDWIVES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that the nature of the maternity and prenatal services provided by midwives could potentially endanger the health and safety of women and newborns under a midwife's care if the profession is not adequately regulated. Public health and safety concerns substantially outweigh any negative effects arising from regulation, including the resulting restrictions on individuals entering the profession of midwifery and any increase in the cost of midwifery services caused by regulation of the profession. The legislature further finds that the auditor, in its sunrise analysis on the regulation of certified professional midwives, applied the criteria for licensure in the Hawaii regulatory licensing reform act. The auditor recommended that the profession of midwifery be regulated and its practitioners be licensed.
The legislature also finds that there are two national pathways to certification for midwives. The American Midwifery Certification Board is the certifying agency for certified nurse midwives and certified midwives. The North American Registry of Midwives is the certifying agency for certified professional midwives. The legislature notes that the intent of this measure is to establish regulations for certified midwives and certified professional midwives, based on standards and best practices adopted by the United States Midwifery Education, Regulation, and Association coalition. The legislature also notes that certified nurse midwives are already otherwise regulated by the state board of nursing and are not intended to be covered by this measure. Native Hawaiian healers engaged in traditional Native Hawaiian healing practices, recognized as such by any council convened by Papa Ola Lokahi, are also not intended to be regulated by this measure, although the legislature notes that traditional Native Hawaiian healers are encouraged to participate in the licensing pathway, if they so choose.
The purpose of this Act is to establish mandatory licensing for certified midwives and certified professional midwives in Hawaii.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
§ -1 Definitions. As used in this chapter:
"Accreditation Commission for Midwifery Education" means the organization established in 1982 and recognized by the United States Department of Education as an accrediting agency for midwifery education programs, whose graduates are eligible for certification as certified midwives.
"American Midwifery Certification Board" means the national certifying body for certified midwife candidates who have received their graduate level education in programs accredited by the Accreditation Commission for Midwifery Education.
"Board" means the state board of midwifery established under section -3.
"Certified midwife" means a midwife who has been certified by the American Midwifery Certification Board.
"Certified professional midwife" means a midwife who has been certified by the North American Registry of Midwives.
"Licensed certified midwife" means a certified midwife who holds a current license issued by the board pursuant to this chapter to engage in the practice of midwifery in Hawaii.
"Licensed certified professional midwife" means a certified professional midwife who holds a current license issued by the board pursuant to this chapter to engage in the practice of midwifery in Hawaii.
"Midwifery Education Accreditation Council" means the organization established in 1991 and recognized by the United States Department of Education as an accrediting agency for midwifery education programs and institutions, whose graduates are eligible for certification as certified professional midwives.
"Practice of midwifery" means providing well-woman and maternity care for individuals and their newborns during the antepartum, intrapartum, and postpartum periods.
"United States Midwifery Education, Regulation, and Association Coalition" means the national coalition comprised of representatives of national midwifery associations, credentialing bodies, and education accreditation agencies, including:
(1) Accreditation Commission for Midwifery Education;
(2) American College of Nurse-Midwives;
(3) American Midwifery Certification Board;
(4) Midwives Alliance of North America;
(5) Midwifery Education Accreditation Council;
(6) National Association of Certified Professional Midwives; and
(7) North American Registry of Midwives.
§ -2 Powers and duties. In addition to any other powers and duties authorized by law, the board shall:
(1) Receive applications for licensure;
(2) Determine the qualifications of persons applying for licensure;
(3) Grant licenses to qualified applicants;
(4) Establish procedures to renew, suspend, revoke, and reinstate licenses;
(5) Establish and collect fees for the examination of applicants for licensure and license renewal;
(6) Establish the minimum educational and continuing educational requirements for licensure;
(7) Investigate complaints against licensed certified midwives and licensed certified professional midwives;
(8) Undertake, when appropriate, disciplinary hearings; and
(9) Subject to chapter 91, adopt, amend, or repeal rules, as necessary to effectuate this chapter.
§ -3 Board of midwifery; establishment, appointment, membership. (a) There is established the board of midwifery within the department of commerce and consumer affairs for administrative purposes.
(b) The board shall consist of seven members as follows:
(1) One certified nurse midwife regulated by the state board of nursing who shall be in current and active practice of midwifery in the State for the duration of appointment and who shall have actively practiced as a certified nurse midwife in the State for at least three years immediately preceding the appointment;
(2) Two licensed certified midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as licensed certified midwives in the State for at least three years immediately preceding their appointment; provided that the two certified midwives initially appointed under this paragraph shall be licensed pursuant to this chapter by January 1, 2021;
(3) Two licensed certified professional midwives who shall be in current and active practice of midwifery in the State for the duration of their appointment and who shall have actively practiced as licensed certified professional midwives in the State for at least three years immediately preceding their appointment; provided that the two certified professional midwives initially appointed under this paragraph shall be licensed pursuant to this chapter by January 1, 2021;
(4) One traditional Native Hawaiian healer engaged in traditional practices of prenatal, maternal, and childcare, as recognized by a kupuna council convened pursuant to section 453-2(c); and
(5) One public member.
(c) The board shall select its own chairperson from among its members.
(d) The term of office for members of the board shall be four years. No member shall be appointed to more than two consecutive terms or serve more than eight consecutive years.
(e) The governor may appoint and fill each vacancy on the board pursuant to section 26-34.
§ -4 Scope of practice; standards. (a) The board shall establish scope of practice standards for the practice of midwifery by licensed certified midwives and licensed certified professional midwives. The scope of practice standards shall be based on the definition and scope of practice established by the United States Midwifery Education, Regulation, and Association coalition for certified midwives and certified professional midwives.
(b) The standards adopted by the board shall include requirements for educational standards, ethical conduct, client protection, disclosures, immunity from vicarious liability, and recordkeeping.
§ -5 License; qualifications. (a) No person shall engage in the practice of midwifery in this State unless the person holds a current license issued by the board pursuant to this chapter. A license shall be granted to an applicant who files a board-approved application for licensure, pays the required application fees, and provides evidence to the board of the following:
(1) Documentation of completion of an educational program or pathway as follows:
(A) For certified midwives, documentation of graduation from a midwifery educational program accredited by the Accreditation Commission for Midwifery Education; or
(B) For certified professional midwives, documentation of completion of an educational program or pathway accredited by the Midwifery Education Accreditation Council;
(2) Documentation of certification from the appropriate national certifying agency:
(A) For certified midwives, documentation of certification by the American Midwifery Certification Board; or
(B) For certified professional midwives, documentation of credentialing by the North American Registry of Midwives; and
(3) Successful completion of continuing education requirements established by the board.
(b) All licenses for certified midwives issued pursuant to this chapter shall be valid for five years from the date of issuance.
(c) All licenses for certified professional midwives issued pursuant to this chapter shall be valid for three years from the date of issuance.
§ -6 Fees; penalties. (a) Each applicant shall pay a licensing fee of $ upon application for a new or renewal license. Fees collected pursuant to this section shall be deposited into the compliance resolution fund established pursuant to section 26-9(o).
(b) Any fine imposed by the board after a hearing conducted pursuant to this chapter shall be no less than $100 and no more than $1,000 for a first violation. A second or subsequent violation of this chapter shall be referred to the department of the attorney general for criminal prosecution. Any person who pleads guilty to or is found guilty of a second or subsequent violation of this chapter shall be guilty of a misdemeanor.
§ -7 Hearings. (a) Unless otherwise provided by law, in every case in which the board refuses to issue, renew, restore, or reinstate a license under this chapter, or proposes to take disciplinary action or other licensing sanctions against a licensee, the board shall conduct an administrative proceeding in accordance with chapter 91.
(b) In all proceedings before it, the board shall have the same powers respecting administering oaths, compelling the attendance of witnesses and the production of documentary evidence, and examining witnesses as are possessed by circuit courts. In case of disobedience by any person of any order of the board, or of any subpoena issued by the board, or the refusal of any witness to testify to any matter regarding which the witness may be questioned lawfully, any circuit judge, on application by the board, shall compel obedience as in the case of disobedience of the requirements of a subpoena issued by a circuit court, or a refusal to testify therein.
§ -8 Exemptions. (a) This chapter shall not apply to the following:
(1) Student midwives in training under the direct supervision of licensed certified midwives;
(2) Certified nurse midwives regulated by the board of nursing pursuant to chapter 457;
(3) A person administering care to a spouse, parent, sibling, child, or other family member, including hanai family;
(4) A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received;
(5) A person performing a service within the person's authorized scope of practice of a profession that is licensed, certified, or registered under other laws of this State; and
(6) Traditional Native Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and child care, as recognized by a council convened pursuant to section 453-2(c).
(b) Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii. Nothing in this chapter shall prevent a Native Hawaiian healer from pursuing licensure under this chapter.
(c) Except as otherwise provided in this section, after December 31, 2020, no person shall practice midwifery in the State or hold themselves out as a certified midwife or certified professional midwife without being licensed pursuant to this chapter."
SECTION 3. (a) The department of commerce and consumer affairs shall convene a working group of interested stakeholders, including representatives from various midwifery organizations, different midwifery backgrounds, Papa Ola Lokahi, and the American Congress of Obstetricians and Gynecologists, before the midwifery licensing goes into effect pursuant to section 4 of this Act.
(b) The group shall consider matters related to the following issues or concerns:
(1) Informed consent;
(2) Peer review as part of the re-credentialing process;
(3) A transport plan;
(4) Whether an additional person, apart from family members, needs to be present during a home birth;
(5) Whether the Midwifery Bridge Certificate, issued by the North American Registry of Midwives, is sufficient for licensure as a certified professional midwife or if recipients of this certificate should be viewed as students or trainees and have a different licensure status; and
(6) The potential for a path for licensure for lay midwives who are neither certified midwives or certified professional midwives.
(c) The working group shall submit a report to the legislature, no later than twenty days prior to the regular session of 2018, on the findings and recommendations of the working group.
SECTION 4. (a) The board of midwifery established pursuant to section 2 of this Act shall establish the midwifery licensing program by July 1, 2019; provided that licenses for certified midwives and certified professional midwives shall be issued by the board beginning July 1, 2020.
(b) The board of midwifery shall submit a report to the legislature, no later than twenty days prior to the regular session of 2019, regarding the status of the licensing program established pursuant to this Act.
SECTION 5. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of this Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 6. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
SECTION 7. This Act shall take effect on July 1, 2050.
Licensure; Midwives; Board of Midwifery; Certified Midwives; Certified Professional Midwives
Establishes the board of midwifery to regulate the practice of midwifery by certified midwives and certified professional midwives. Requires licensing of certified midwives and certified professional midwives to commence beginning on July 1, 2020. Requires the department of commerce and consumer affairs to convene a working group of interested stakeholders and submit a report to the legislature. Effective July 1, 2050. (SD2)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.