Bill Text: MI HB4598 | 2015-2016 | 98th Legislature | Engrossed
Bill Title: Health occupations; health care professionals; midwives; provide for licensing and regulation. Amends 1978 PA 368 (MCL 333.1101 - 333.25211) by adding sec. 16326 & pt. 171.
Spectrum: Slight Partisan Bill (Republican 18-11)
Status: (Passed) 2016-12-31 - Assigned Pa 417'16 With Immediate Effect [HB4598 Detail]
Download: Michigan-2015-HB4598-Engrossed.html
HB-4598, As Passed Senate, December 14, 2016
SENATE SUBSTITUTE FOR
HOUSE BILL NO. 4598
A bill to amend 1978 PA 368, entitled
"Public health code,"
(MCL 333.1101 to 333.25211) by adding section 16326 and part 171.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 16326. (1) Fees for an individual who is licensed or
2 seeking licensure to engage in the practice of midwifery under part
3 171 are as follows:
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4 |
(a) Subject to subsection (2) and section |
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5 |
17116(4), application processing fee. ...... $ 450.00 |
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(b) License fee, per year....................... 200.00 |
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(c) Temporary license fee, per year............. 200.00 |
8 (2) After the department receives more than a total of
9 $23,000.00 in application processing fees from individuals who are
1 licensed or seeking licensure to engage in the practice of
2 midwifery under part 171, the application processing fee is reduced
3 to $75.00.
4 PART 171. MIDWIFERY
5 Sec. 17101. (1) As used in this part:
6 (a) "Appropriate health professional", for the purposes of
7 referral, consultation, or collaboration with a midwife under this
8 part, means any of the following:
9 (i) A physician.
10 (ii) A certified nurse midwife.
11 (iii) As identified in rules promulgated under section 17117,
12 another appropriate health professional licensed, registered, or
13 otherwise authorized to engage in a health profession under this
14 article.
15 (b) "Certified nurse midwife" means a registered professional
16 nurse under part 172 who has been granted a specialty certification
17 in the profession specialty field of nurse midwifery by the board
18 of nursing under section 17210.
19 (c) "Health care provider" means an individual who is licensed
20 or registered under this article.
21 (d) "Midwife" means an individual licensed under this part to
22 engage in the practice of midwifery.
23 (e) "Physician" means an individual licensed to engage in the
24 practice of medicine under part 170 or the practice of osteopathic
25 medicine and surgery under part 175.
26 (f) "Practice of midwifery", subject to subsection (2), means
27 providing maternity care that is consistent with a midwife's
1 training, education, and experience, to women and neonates during
2 the antepartum, intrapartum, and postpartum periods.
3 (2) For purposes of this part, practice of midwifery does not
4 include either of the following:
5 (a) The practice of medicine or osteopathic medicine and
6 surgery.
7 (b) The practice of nursing, including the practice of nursing
8 with a specialty certification in the profession specialty field of
9 nurse midwifery under part 172.
10 (3) In addition to the definitions of this part, article 1
11 contains general definitions and principles of construction
12 applicable to all articles in this code and part 161 contains
13 definitions applicable to this part.
14 Sec. 17103. Beginning on the effective date of rules
15 promulgated under section 17117, an individual shall not use the
16 titles "licensed midwife" or "l.m.", or similar words or initials
17 that indicate that the individual is licensed as a midwife, unless
18 the individual is licensed under this part.
19 Sec. 17105. (1) Beginning on the effective date of rules
20 promulgated under section 17117, an individual shall not engage in
21 the practice of midwifery unless licensed under this part or
22 otherwise authorized by this article.
23 (2) A midwife shall not perform an act, task, or function
24 within the practice of midwifery unless he or she is trained to
25 perform the act, task, or function and the performance of that act,
26 task, or function is consistent with the rules promulgated under
27 section 17117.
House Bill No. 4598 as amended December 14, 2016
1 (3) In addition to the exemptions from licensure under section
2 16171, subsection (1) does not prevent any of the following:
3 (a) An individual licensed, registered, or certified under any
4 other part or act from performing activities that are considered to
5 be within the practice of midwifery if those activities are within
6 the individual's scope of practice and if the individual does not
7 use the titles protected under section 17103.
8 (b) Subject to section 16215, an employee or other individual
9 who is assisting a midwife and who is under the midwife's
10 supervision from performing activities or functions that are
11 delegated by the midwife, that are nondiscretionary, that do not
12 require the exercise of professional judgment for their
13 performance, and that are within the midwife's authority to
14 perform.
15 (c) An individual from performing activities that are within
16 the practice of midwifery if those activities are performed under
17 the direct and immediate supervision of an appropriate health
18 professional while engaged in any of the following:
19 (i) Completing a portfolio evaluation process of the North
20 American Registry of Midwives or an organization that the board
21 determines is a successor organization.
22 (ii) Participating as a student attending a midwifery
23 education program that is accredited by the <<midwifery education and
24 accreditation council>> or another accrediting organization approved by
25 the board.
26 (d) Self-care by a patient or uncompensated care by a friend
27 or family member who does not represent or hold himself or herself
1 out to be a midwife.
2 (e) Services provided by a religious practitioner if that
3 religious practitioner does not hold himself or herself out to the
4 public as a midwife who is licensed to engage in the practice of
5 midwifery in this state and does not use any of the titles
6 protected under section 17103.
7 (f) Services provided by a member of a bona fide church or
8 religious denomination if all of the following are met:
9 (i) The services are provided to another member of that church
10 or denomination and that other member is an adherent of the
11 established tenets or teachings of that church or denomination and
12 relies on treatment by prayer or spiritual means only, in
13 accordance with the creed or tenets of that church or denomination.
14 (ii) The individual providing the services does not receive a
15 fee for those services. For purposes of this subparagraph, a
16 voluntary contribution is not considered a fee for the services
17 provided by that individual.
18 Sec. 17107. (1) At the inception of care, a midwife shall
19 establish a protocol for transfer of care to a physician or to a
20 hospital that is specific to that patient.
21 (2) For purposes of subsection (1), the board shall identify
22 or create a standard form, and recommend use of the standard form,
23 to collect information on a patient whose care is transferred,
24 either temporarily or permanently, to a hospital or a physician.
25 (3) The board shall promulgate rules that require a midwife to
26 report a patient's data to the MANA Statistical Registry maintained
27 by the Midwives Alliance of North America, or a similar registry
House Bill No. 4598 as amended December 14, 2016
1 maintained by a successor organization approved by the board,
2 unless the patient refuses to consent to the reporting of his or
3 her data.
4 Sec. 17109. A midwife shall obtain informed consent from a
5 patient at the inception of care and continuing throughout the
6 patient's care.
7 <<Sec. 17110. A health care provider who provides care to
8 a patient of a midwife who is licensed under this part is not
9 liable in a civil action for personal injury or death resulting
10 from an act or omission by the midwife, unless the professional
negligence or malpractice of the health care provider was a proximate
cause of the injury or death.>>
11 Sec. 17111. (1) A midwife shall not do any of the following:
12 (a) Except as provided in subsection (2), administer
13 prescription drugs or medications.
14 (b) Use vacuum extractors or forceps.
15 (c) Prescribe medications.
16 (d) Perform surgical procedures other than episiotomies or
17 repairs of perineal lacerations.
18 (e) Any other act, task, or function prohibited in rules
19 promulgated under this part.
20 (2) Beginning on the effective date of the rules promulgated
21 under subsection (3), a midwife who has appropriate pharmacology
22 training as established by rule by the board, and who holds a
23 standing prescription from a health care provider with prescriptive
24 authority, may administer any of the following in accordance with
25 the rules promulgated under subsection (3):
26 (a) Prophylactic vitamin K to a newborn, either orally or
27 through intramuscular injection.
House Bill No. 4598 as amended December 14, 2016
1 (b) Antihemorrhagic agents to a postpartum mother after the
2 birth of the baby.
3 (c) Local anesthetic for the repair of lacerations to a
4 mother.
5 (d) Oxygen to a mother or newborn.
6 (e) Prophylactic eye agent to a newborn.
7 (f) Prophylactic Rho(D) immunoglobulin to a mother.
8 (g) Agents for group B streptococcus prophylaxis, recommended
9 by the federal centers for disease control and prevention, to a
10 mother.
11 (h) Intravenous fluids, excluding blood products, to a mother.
12 (i) Any other drug or medication prescribed by a health care
13 provider with prescriptive authority that is consistent with the
14 scope of practice of midwifery and is authorized by the board by
15 rule.
16 (3) The department, in consultation with the board, shall
17 promulgate rules concerning the administration of prescription
18 drugs or medications described in subsection (2) by midwives.
19 Sec. 17112. (1) Beginning on the effective date of, and
20 subject to, the rules described in section 17117, and if necessary
21 to the practice of midwifery and consistent with the scope of
22 practice of midwifery, a midwife may directly obtain supplies and
23 devices, order and obtain screening tests including ultrasound
24 tests, and receive verbal and written reports of the results of
25 those tests.
26 <<(2) The department shall promulgate rules that include
27 standards for the delineation of findings that preclude a woman or
House Bill No. 4598 as amended December 14, 2016
1 a newborn from being classified as having a normal pregnancy,
2 labor, delivery, postpartum period, or newborn period. In
3 promulgating the rules described in this subsection, the department
4 shall consider any data, views, questions, and arguments submitted
5 by the Michigan board of licensed midwifery, the Michigan board of
medicine, and the Michigan board of osteopathic medicine and surgery.
6 (3) The finding described in subsection (2) shall form the
7 basis for any requirements or restrictions imposed by the board on
8 the practice of midwifery when providing care to women or newborns
9 whose condition is classified as outside of normal.
10 Sec. 17113. (1) The Michigan board of licensed midwifery is
11 created in the department. The board consists of the following 12
12 members, each of whom must meet the requirements of part 161:
13 (a) Seven midwives.
14 <<(b) One certified nurse midwife.
15 >>
16 (c) One physician who is board certified as an obstetrician-
17 gynecologist.
18 (d) One physician who is board certified as a pediatrician.
19 (e) Two members of the general public, 1 of whom is a consumer
20 of midwifery care.
21 (2) Except as otherwise provided in this article, the term of
22 office of a member of the board is 4 years and expires on December
23 31 of the year in which the term expires. For members first
24 appointed under this section, 5 members shall serve for 2 years, 4
25 members shall serve for 3 years, and 3 members shall serve for 4
26 years.
27 Sec. 17115. (1) If the department receives a complete
House Bill No. 4598 as amended December 14, 2016
1 application and payment of the fee prescribed in section 16326, the
2 board shall grant a license under this part to the applicant if the
3 applicant meets all of the following:
4 (a) Except as provided in subsection (2), he or she has
5 completed an educational program or pathway accredited by the
6 <<midwifery education and accreditation council>> or another accrediting
7 organization approved by the board.
8 (b) He or she holds the credential of certified professional
9 midwife from the North American Registry of Midwives or holds an
10 equivalent credential from another midwifery credentialing program
11 that is approved by the board under section 16148 and accredited by
12 <<national commission for certifying agencies>> or another
13 accrediting organization approved by the board.
14 (c) He or she successfully passes an examination approved by
15 the department, in consultation with the board. If the education
16 program described in subdivision (a) includes an examination that
17 meets the requirements of section 16178(1), the board may accept
18 passing of that examination as meeting the requirements of this
19 subdivision.
20 (2) An applicant who holds the credential described in
21 subsection (1)(b) before January 1, 2020, and has not completed the
22 educational program or pathway described in subsection (1)(a),
23 meets the requirement of subsection (1)(a) if he or she provides
24 evidence that he or she holds a midwifery bridge certificate
25 awarded by the North American Registry of Midwives, or an
26 equivalent credential from another midwifery credentialing program
27 that is approved by the board under section 16148 and accredited by
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1 the <<national commission for certifying agencies>> or another
2 accrediting organization approved by the board.
3 Sec. 17116. (1) If the department receives a completed
4 application and an application fee and temporary license fee
5 described in section 16326, the board shall grant a nonrenewable
6 temporary license under this part to an individual who holds a
7 credential of certified professional midwife from a midwifery
8 education program that does not meet the requirements of section
9 17115(1)(a). An individual who holds a temporary license under this
10 section must hold a midwifery bridge certificate awarded by the
11 North American Registry of Midwives, or an equivalent credential
12 approved by the board, to qualify for a license when his or her
13 temporary license expires.
14 (2) The term of a temporary license under this section is 24
15 months.
16 (3) An applicant who is granted a temporary license under this
17 section is subject to all other requirements of this part and rules
18 promulgated under this part, and the department may automatically
19 void the temporary license if the applicant fails to comply with
20 those requirements.
21 (4) An individual who paid an application fee under section
22 16326 in connection with an application for a temporary license
23 under this section is not required to pay an application fee in
24 connection with an application for an initial license under this
25 part if the department receives the application within 60 days
26 after the expiration of the temporary license.
27 Sec. 17117. (1) Within 24 months after the effective date of
1 this part, the department, in consultation with the board, shall
2 promulgate rules to do all of the following:
3 (a) Establish and implement the licensure program for the
4 practice of midwifery under this part.
5 (b) Require the completion of continuing education for the
6 practice of midwifery as a condition for license renewal. However,
7 the rule shall allow the board to accept proof of a current
8 credential under section 17115(1)(b) as meeting the requirements of
9 this subdivision.
10 (c) Describe and regulate, limit, or prohibit the performance
11 of acts, tasks, or functions by midwives. The department shall
12 include rules that recognize and incorporate the requirements under
13 section 17107 regarding the referral to and consultation with
14 appropriate health professionals and ensure that those rules
15 conform to national standards for the practice of midwifery as
16 defined in section 17101.
17 (d) For purposes of section 17109, establish the process by
18 which informed consent is obtained and ensure that the process
19 conforms to national standards for the practice of midwifery as
20 defined in section 17101. The process established for obtaining
21 informed consent shall include at least all of the following:
22 (i) A requirement that at the inception of care for a client,
23 the midwife must provide a copy of the rules promulgated by the
24 department under this section.
25 (ii) A requirement that at the inception of care for a client,
26 the midwife must orally and in writing disclose whether the midwife
27 has malpractice liability insurance coverage and, if so, the policy
House Bill No. 4598 as amended December 14, 2016
1 limitations of that coverage.
<<(e) For purposes of establishing protocols for transfer of care
under section 17107, establish the duties a midwife must perform if an
emergency transfer to a hospital is necessary. Rules promulgated under
this subdivision shall conform to nationally recognized guidelines on
safe transfers.>>
2 (2) In addition to the authority to promulgate rules under
3 section 16145 and subject to this section and section 16175, the
4 department, in consultation with the board, may promulgate rules to
5 supplement the requirements for licensure under this part,
6 including the adoption of updated standards applicable to the
7 practice of midwifery established by the North American Registry of
8 Midwives or an organization that the board determines is a
9 successor organization.
10 Sec. 17119. (1) The board may grant a license under this part
11 to an individual who is licensed as a midwife in another state at
12 the time of application if the applicant provides evidence
13 satisfactory to the board and the department that all of the
14 following are met:
15 (a) Subject to subsection (2), the applicant meets the
16 requirements described in section 17115(1) and (2).
17 (b) There are no pending disciplinary proceedings against the
18 applicant before a similar licensing agency of this or any other
19 state or country.
20 (c) If sanctions have been imposed against the applicant by a
21 similar licensing agency of this or any other state or country
22 based upon grounds that are substantially similar to those under
23 this article, as determined by the board, the sanctions are not in
24 force at the time of the application.
25 (2) If an applicant is licensed as a midwife in a state that
26 does not require completion of an educational program or pathway
27 equivalent to section 17115(1)(a) for licensure, the department may
1 determine that the applicant has met the requirements of subsection
2 (1)(a) if he or she meets all of the following:
3 (a) The requirements of this part and rules promulgated under
4 this part for licensure, except section 17115(1)(a).
5 (b) The requirements of section 17115(2), regardless of the
6 date he or she obtained the credential of certified professional
7 midwife described in section 17115(1)(b).
8 (3) The board may make an independent inquiry to determine
9 whether an applicant meets the requirements described in subsection
10 (1)(b) and (c).
11 Sec. 17121. (1) Except as provided in subsection (2) and
12 section 17116, the department shall determine the term of initial
13 or renewal licenses granted under this part.
14 (2) Until the application processing fee for a license under
15 this part is reduced to $75.00 under section 16326, the term of an
16 initial license under part 171 is 1 year. This subsection does not
17 limit the department's authority under this section to establish a
18 renewal cycle for licenses under this part regardless of the amount
19 of the application fee under section 16326.
20 Sec. 17123. This part does not require new or additional third
21 party reimbursement or mandated worker's compensation benefits for
22 services rendered by an individual licensed under this part.
23 Enacting section 1. This amendatory act takes effect 90 days
24 after the date it is enacted into law.
