Official Summary Text
HB2251 - 572R - Senate Fact Sheet
Assigned to
RAGE��������������������������������������������������������������������������������������������� AS
PASSED BY COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh
Legislature, Second Regular Session
AMENDED
FACT SHEET FOR
H.B. 2251
midwives; medication administration; advisory committee
Purpose
Outlines prescription administration authority and disclosure and
reporting requirements for licensed midwives. Establishes the Arizona Midwifery
Advisory Committee (Advisory Committee) in the Department of Health Services
(DHS).
Background
DHS licenses and regulates midwives in Arizona. The DHS Director must, by
rule: 1) define and describe, consistent with statute, the duties and limits of
the practice of midwifery; 2) adopt standards with respect to the practice of
midwifery designed to safeguard the health and safety of the mother and child;
3) establish criteria for granting, denying, suspending and revoking a license
in order to protect the health and safety of the mother and child; and
4) describe and define reasonable and necessary minimum qualification for
midwives (
A.R.S. Title 36,
Chapter 6, Article 7
).
����������� A
person applying for midwife licensure must: 1) disclose whether the applicant
has ever been convicted of a felony or a misdemeanor in Arizona or another
state or jurisdiction;
2) demonstrate that the applicant is at least 21 years of age; 3) document
completion of training in adult basic cardiopulmonary resuscitation through a
course recognized by the American Heart Association and neonatal resuscitation
through a course recognized by the American Academy of Pediatrics or American
Heart Association; 4) document a high school diploma, a high school equivalency
diploma, an associate degree or a higher degree; and 5) document certification
by the North American Registry of Midwives as a Certified Professional Midwife
(
A.A.C.
R9-16-102
).
A midwife must not administer drugs or medications except: 1) Rh
immunoglobulin to an unsensitized Rh negative client under a physician�s
written orders; or 2) vitamin K under a physician's written order to a newborn.
In an emergency, a midwife may also administer: 1) oxygen at up to eight liters
per minute via mask for the client and five liters per minute for the newborn
via neonatal mask; 2) local anesthetic for suturing of episiotomy or tearing of
the perineum to stop active bleeding, contingent upon consultation with a
physician or certified nurse midwife or physician�s written orders; and 3) pitocin
intramuscularly at a maximum dose of 20 units, in
10-unit dosages each, 30 minutes apart, to a client for the control of
postpartum hemorrhage, contingent upon physician or certified nurse midwife
consultation and written orders by a physician, and arrangements for immediate
transport of the client to a hospital (A.A.C.
R9-16-108
and
R9-16-113
).
There is no anticipated fiscal impact to the state General Fund
associated with this legislation.
Provisions
Prescription
Dispensing and Administration Authority
1.
Allows a licensed midwife who, in addition to the requirements for
initial licensure, has proof of completion of a pharmacology course of at least
eight continuing education units from a midwifery education accreditation,
council-accredited institution or a regionally accredited institution to
dispense and administer the following medications, therapies and devices with
the following limitations:
a)
antibiotics
related to Group B Streptococcus Prophylaxis consistent with the U.S. Centers
for Disease Control and Prevention guidelines or other current evidence-based
guidelines;
b)
the
following antihemorrhagic medications for preventing and treating postpartum
hemorrhage as defined by the American College of Obstetricians and
Gynecologists:
i.
oxytocin for preventing uterine atony during or immediately following
the third stage of labor according to current evidence-based standards of care;
ii.
methylergonovine;
iii.
carboprost tromethamine;
iv.
misoprostol; and
v.
tranexamic acid;
c)
prophylactic
ophthalmic medications for newborn eye care;
d)
intravenous
fluids for the following:
i.
medication administration;
ii.
routine fluid administration; and
iii.
treating hypovolemic shock while awaiting emergency medical service;
e)
vitamin
K prophylaxis for newborns;
f)
rho
immune globulin;
g)
topical,
intramuscular or subcutaneous local anesthetics for postpartum repair of first
and second degree tears, lacerations or episiotomies, excluding any Schedule I
controlled substance;
h)
oxygen
and compressed air for fetal or maternal distress and infant resuscitation;
i)
epinephrine
for neonatal resuscitation consistent with the neonatal resuscitation program
guidelines and to treat maternal allergic reactions;
j)
glucose
gel administered orally for neonatal hypoglycemia;
k)
vitamins
and minerals for correcting electrolyte imbalances, including B vitamins,
calcium, magnesium, dietary supplements, homeopathic remedies, plant substances
that are not designated as prescription drugs or controlled substances and
over-the-counter medications;
l)
resuscitation
supplies and equipment according to the current neonatal resuscitation program
algorithm;
m)
medical supplies and
equipment needed to administer authorized medications; and
n)
electronic
breast pumps, glucose monitors, compression stockings and pregnancy support
belts or devices.
2.
Prohibits a licensed midwife from using the antihemorrhagic medications
to induce or augment labor.
3.
Requires the licensed midwife to initiate a transfer of care if an
antihemorrhagic medication is administered for managing hemorrhage.
4.
States
that a pharmacist who dispenses prescription medications in compliance with
statute to a licensed midwife is not liable for any adverse reaction that is
caused by the licensed midwife's method of use.
5.
Allows
a licensed midwife to lawfully obtain, transport, administer and possess
adequate quantities of authorized medications and the equipment normally
required to administer those medications.
6.
Requires the licensed midwife to:
a)
store
the authorized medications as directed by the manufacturer; and
b)
record in the patient's chart each use of medication and the
medication's lot number and expiration date.
7.
Prohibits
a licensed midwife from administering a medication to any person after the
listed expiration date.
Advisory Committee
8.
Establishes the Advisory Committee in DHS to:
a)
assist
in examining applicants for a midwifery license, if requested;
b)
collaborate
with and assist the DHS Director in disciplinary matters, if requested; and
c)
perform any other required duties.
9.
Requires the DHS Director to appoint the members of the Advisory
Committee, which must be composed of no more than 11 of the following members:
a)
at
least five licensed midwives;
b)
two licensed
certified nurse midwives; and
c)
two physicians who are licensed to practice allopathic, naturopathic or
osteopathic medicine, one of whom is board-certified in obstetrics and one of
whom is board-certified in pediatrics.
10.
Requires the DHS Director to
solicit physician applications from state medical societies and associations
for the two physician members of the Advisory Committee.
11.
�States that the Advisory
Committee members are not eligible for compensation or reimbursement of
expenses.
12.
Requires the Advisory
Committee to meet at least four times each year, once per quarter.
13.
Requires the Advisory
Committee to conduct a review of sentinel events occurring during the course of
prenatal, intrapartum or postpartum care provided by licensed midwives in
Arizona.
14.
Allows the Advisory
Committee to convene emergency meetings when a case or sentinel event requires
timely review or action to protect the public health and safety.
15.
Requires
the Advisory Committee, following the review of a sentinel event, to make
recommendations to DHS regarding whether the care provided was:
a)
consistent
with community standards;
b)
consistent
with community standards but outside the scope of practice; or
c)
outside
of community standards and requiring corrective action.
16.
Allows
the Advisory Committee, for care determined to be outside of community standards
or the scope of practice, to recommend one or more of the following to DHS:
a)
additional
continuing education requirements;
b)
mentoring
or supervised practice;
c)
administrative
civil penalties;
d)
restriction
or suspension of a license; or
e)
revocation
of a license.
17.
Requires
the Advisory Committee to review midwife care disclosure reports submitted in
accordance with statute.
18.
Allows
the Advisory Committee to recommend modifications to the disclosure reporting
requirements to DHS to support quality improvement and patient safety.
Disclosure and
Reporting Requirements
19.
Requires each licensed
midwife, at the initiation of care, to disclose to each patient whether the
licensed midwife maintains professional liability insurance.
20.
Requires the disclosure to
be included in the informed consent document and acknowledged by the patient's
signature.
21.
Requires
each licensed midwife, by January 31 of each year, to file a report with DHS,
in a format prescribed by DHS, the following information, not including any
individually identifiable health information of a patient, for the preceding
calendar year:
a)
the
number of women for whom the licensed midwife provided care;
b)
the
number of deliveries the licensed midwife attended as primary midwife;
c)
the
number, reason for and outcome of each transfer or transport of a patient in
the antepartum, intrapartum or immediate postpartum periods;
d)
the
number of perinatal deaths, including both:
i.
maternal deaths occurring during pregnancy and through the first month
of postpartum; and
ii.
neonatal deaths occurring through the first month of life;
e)
the
number and outcome of breech births and vaginal births after cesarean;
f)
the
number of births that occurred more than 25 miles from a hospital that provides
obstetrics services;
g)
the
number of fetal deaths after 20 weeks' gestation; and
h)
the licensed midwife's full name, license number and county.
22.
States
that each perinatal death reported in the annual reports to DHS must include
the cause of death, if known, and a description of the circumstances
surrounding the death.
23.
Requires
a licensed midwife to additionally report to DHS:
a)
a
perinatal mortality within 72 hours after the death; and
b)
a sentinel event within 14 days after the event.
24.
Allows the information
reported to DHS by a licensed midwife to be inspected, copied, obtained or
provided to the Advisory Committee for research and evidence.
25.
Requires the annual report
to DHS to replace the report required by each licensed midwife following
termination of care for each patient.
26.
Requires the data that is
collected in the annual reports to DHS, by September 1 of each year, to be:
a)
shared with the Speaker of the House of Representatives, the President
of the Senate and the Governor; and
b)
posted
on DHS's public website.
Miscellaneous
27.
Clarifies
that the DHS Director must adopt rules to describe and define reasonable and
necessary minimum qualifications for licensed midwives.
28.
Defines
individually
identifiable health information
as having the same meaning prescribed in
the federal Health Insurance Portability and Accountability Act privacy
standards.
29.
Defines
licensed midwife
as a midwife licensed in accordance with statute.
30.
Defines
sentinel event
as
an unexpected, serious patient safety incident resulting in death, permanent
harm or a significant risk of harm.
31.
Includes,
in the definition of
sentinel event,
both of the following:
a)
maternal
sentinel events, including:
i.
maternal deaths during the pregnancy through 30 days postpartum;
ii.
maternal intensive care unit admission in the first 120 hours postpartum;
iii.
uterine rupture;
iv.
postpartum hemorrhage requiring a blood transfusion; and
v.
shoulder dystocia with brachial plexus injury; and
b)
neonatal
sentinel events, including:
i.
neonatal deaths in the first 30 days of life;
ii.
neonatal intensive care unit admission within 120 hours after birth, not
including observation-only admissions or admissions for congenital anomalies;
iii.
a birth weight of less than 2,500 grams;
iv.
an Apgar score of less than seven at five minutes; and
v.
respiratory distress requiring prolonged ventilation.
32.
Designates
this legislation as the
Jordan and Mack Terry Act
.
33.
Makes
technical and conforming changes.
34.
Becomes
effective on the general effective date.
Amendments Adopted by
Committee
1.
Removes the requirement for the DHS Director to consider the most recent
midwifery job analysis issued by the North American Registry of Midwives when
adopting or amending rules related to the midwifery scope of practice.
2.
Removes the authorization for a licensed midwife to administer other
prescription medications as prescribed by a licensed physician, a registered
nurse practitioner or a licensed physician assistant.
3.
Specifies, for the two physician Advisory Committee members, that one be
board-certified in obstetrics and one be board-certified in pediatrics.
4.
Removes the requirement for the Advisory Committee to make
recommendations to the DHS Director when adopting or amending rules relating to
the midwifery scope of practice.
5.
Specifies that the Advisory Committee, following the review of a
sentinel event, must make recommendations to DHS regarding whether the care
provided was consistent with community standards but outside the scope of
practice, rather than outside the scope of practice as defined by DHS in rule.
6.
Specifies that the Advisory Committee, for care determined to be outside
community standards or the scope of practice, rather than only outside
community standards, may recommend one or more prescribed disciplinary actions
to DHS.
7.
Adds
the following to the annual report to DHS required for each licensed midwife:
a)
maternal deaths occurring during pregnancy and through the first month
postpartum; and
b)
neonatal
deaths occurring through the first month of life.
8.
States that each perinatal death reported in the annual reports to DHS must
include the cause of death, if known, and a description of the circumstances
surrounding the death.
9.
Requires the data that is collected in the annual reports to DHS, by
September 1 of each year, to be:
a)
shared with the Speaker of the House of Representatives, the President
of the Senate and the Governor; and
b)
posted
on DHS's public website.
10.
Modifies
the definition of
sentinel event
.
House Action
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Senate
Action
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Prepared by Senate Research
March 27, 2026
JT/ci
Current Bill Text
Read the full stored bill text
HB2251 - 572R - H Ver
House Engrossed
midwives; medication
administration; advisory committee
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HOUSE BILL 2251
AN
ACT
Amending sections 36-751 and 36-755,
Arizona Revised Statutes; amending title 36, chapter 6, article 7, Arizona
Revised Statutes, by adding sections 36-761, 36-762 and 36-763;
relating to midwifery.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section 1. Section 36-751, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-751.
Definitions
In this article, unless the context otherwise requires:
1. "Department" means the department of
health services.
2. "Director" means the director of the
department
of health services
.
3. "Licensed midwife" means
a midwife who is licensed pursuant to this article.
3.
4.
"Midwife"
means a person who delivers a baby or provides health care related to
pregnancy, labor, delivery and postpartum care of the mother and her infant.
END_STATUTE
Sec. 2. Section 36-755, Arizona Revised
Statutes, is amended to read:
START_STATUTE
36-755.
Powers and duties of the director
A. The director may adopt rules necessary for the
proper administration and enforcement of this article.
B. The director shall, by rule:
1. Define and describe, consistent with this article
and the laws of this state, the duties and limits of the practice of midwifery.
2. Adopt standards with respect to the practice of
midwifery designed to safeguard the health and safety of the mother and child.
3. Establish the criteria for granting, denying,
suspending and revoking a license in order to protect the health and safety of
the mother and child.
4. Describe and define reasonable and necessary
minimum qualifications for
licensed
midwives, including:
(a) The ability to read and write.
(b) Knowledge of the fundamentals of hygiene.
(c) The ability to recognize abnormal or potentially
abnormal conditions during pregnancy, labor and delivery and following birth.
(d) Knowledge of the laws of this state concerning
reporting of births, prenatal blood tests and newborn screening and of the
rules pertaining to midwifery.
(e) Education requirements.
(f) Age requirements.
C. The director shall consider the
most recent midwifery job analysis issued by the North American registry of
midwives when adopting or amending rules relating to the midwifery scope of
practice.
END_STATUTE
Sec. 3. Title
36, chapter 6, article 7, Arizona Revised Statutes, is amended by adding
sections 36-761, 36-762 and 36-763, to read:
START_STATUTE
36-761.
Prescription drugs; dispensing and administration authority;
storage; documentation
A. A
licensed midwife who
, in addition to the requirements for
initial licensure, has proof of completion of a pharmacology course of at least
eight continuing education units from a midwifery education accreditation
council-accredited institution or a regionally accredited institution may
dispense and administer the following medications, therapies and devices with
the following limitations:
1. Antibiotics related to Group B
streptococcus prophylaxis consistent with the United States centers for disease
control and prevention guidelines
or other current
evidence-based guidelines.
2. The following antihemorrhagic
medications for preventing and treating postpartum hemorrhage as defined by the
American college of obstetricians and gynecologists:
(
a
) Oxytocin
for preventing uterine atony during or immediately following the third
stage of labor according to current evidence-based standards of care.
(
b
) Methylergonovine.
(
c
) Carboprost
tromethamine.
(
d
) Misoprostol.
(
e
) Tranexamic
acid.
A licensed midwife may not use the
antihemorrhagic medications specified in this paragraph to induce or augment
labor. �The licensed midwife shall initiate a transfer of care if an
antihemorrhagic medication
is administered for managing
hemorrhage.
3. prophylactic ophthalmic
medications for newborn eye care.
4. Intravenous fluids for the
following:
(
a
) medication
administration.
(
b
)
Routine fluid administration.
(
c
) treating
hypovolemic shock while awaiting emergency medical service.
5. Vitamin K prophylaxis for
newborns.
6. Rho immune globulin.
7. Topical, intramuscular or
subcutaneous local anesthetics for postpartum repair of
first
and second degree tears, lacerations or episiotomies. This PARAGRAPH does not
include any schedule i controlled substance.
8. Oxygen and Compressed air for
fetal or maternal distress and infant resuscitation.
9. Epinephrine for neonatal
resuscitation consistent with the neonatal resuscitation program guidelines and
to treat maternal allergic reactions.
10. Glucose gel administered orally
for neonatal hypoglycemia.
11.
Vitamins
and minerals for correcting electrolyte imbalances, including B vitamins,
calcium, magnesium, Dietary supplements, homeopathic remedies, plant substances
that are not designated as prescription drugs or controlled substances, and over-the-counter
medications.
12. Resuscitation supplies and
equipment according to the current neonatal resuscitation program algorithm.
13. Medical supplies and equipment
needed to administer the medications prescribed in this subsection.
14. Electronic breast pumps, Glucose
monitors, compression stockings and pregnancy support belts or devices.
B. A licensed midwife may administer
other prescription medications as prescribed by a physician who is licensed
pursuant to title 32, chapter 13, 14 or 17, a registered nurse practitioner who
is licensed pursuant to title 32, chapter 15 or a physician assistant who is
licensed pursuant to title 32, chapter 25. A pharmacist who dispenses
prescription medications prescribed pursuant to this subsection to a licensed
midwife is not liable for any adverse reaction that is caused by the licensed midwife's
method of use.
C. A licensed midwife may lawfully
obtain, transport, administer and possess adequate quantities of the
medications prescribed in subsection A of this section and the equipment
normally required to administer those medications. The licensed midwife shall:
1. Store the medications prescribed
in subsection A of this section as directed by the manufacturer. a licensed
midwife may not administer a medication to any person after the listed
expiration date.
2. Record in the patient's chart each
use of medication and the medication's lot number and expiration date.
END_STATUTE
START_STATUTE
36-762.
Arizona midwifery advisory committee; membership; duties; scope
of practice; modification; sentinel events; definition
A. The Arizona midwifery advisory
committee is established in the department to assist in examining applicants
for a midwifery license, if requested, to collaborate with and assist the
director in disciplinary matters, if requested, and to perform any other duties
prescribed in this article.
b. The director shall appoint the
members of the advisory committee, which shall be composed of not more than
eleven of the following members:
1. At least
five
licensed midwives.
2. Two certified nurse midwives who
are licensed pursuant to title 32, chapter 15.
3. Two physicians who are licensed
pursuant to title 32, chapter 13, 14 or 17 and who are board certified in
obstetrics, pediatrics or family medicine.
The director
shall solicit physician applications from state medical societies and
associations.
4. One consumer of midwifery care.
c. Advisory committee members are not
eligible for compensation or reimbursement of expenses.
d. The advisory committee shall meet
at least four times each year, once per quarter.
e. The advisory committee shall make
recommendations to the director when adopting or amending rules relating to the
midwifery scope of practice.
f. a licensed midwife who is
interested in modifying the midwifery scope of practice must submit a report to
the advisory committee that contains at least the following:
1. A description of the issue and why
an addition to the midwifery scope of practice is necessary, including the
extent to which consumers need and will benefit from a licensed midwife's
ability to provide this additional health care service.
2. The available evidence-based
research that demonstrates that licensed midwives are competent to perform the
proposed health care service.
3. The extent to which a change in
the midwifery scope of practice may harm the public, including the extent to
which a change in the scope of practice will restrict entry into the practice
of midwifery.
g. If a majority of a quorum of the
advisory committee members votes to approve a change in the midwifery scope of
practice pursuant to subsection f of this section, the advisory committee shall
provide the director with its recommendations for a possible rule change.
H. The advisory committee shall
conduct a review of sentinel events occurring during the course of prenatal,
intrapartum or postpartum care provided by licensed midwives in this state.
I. The advisory committee may convene
emergency meetings when a case or sentinel event requires timely review or
action to protect the public health and safety.
J. Following the review of a sentinel
event, the advisory committee shall make recommendations to the department
regarding whether the care provided was:
1. Consistent with community
standards.
2. Consistent with community
standards but outside the scope of practice as defined by the department in
rule.
3. Outside of community standards and
requiring corrective action.
K. For care determined to be outside
of community standards under subsection J of this section, the advisory
committee may recommend one or more of the following to the department:
1. Additional continuing education
requirements.
2. Mentoring or supervised practice.
3. Administrative civil penalties.
4. Restriction or suspension of a
license.
5. Revocation of a license.
L. The advisory committee shall
review midwife reports submitted pursuant to section 36-763 and may
recommend modifications to reporting requirements to the department to support
quality improvement and patient safety.
M. For the purposes of this section,
"sentinel event":
1. Means an unexpected, serious
patient safety incident resulting in death, permanent harm or a significant
risk of harm.
2. includes both:
(
a
) Maternal
sentinel events, including:
(
i
) Maternal
death.
(
ii
) Maternal
intensive care unit admission.
(
iii
) Uterine rupture.
(
iv
) Postpartum
hemorrhage requiring a blood transfusion.
(
v
) Shoulder
dystocia with brachial plexus injury.
(
b
) Neonatal
sentinel events, including:
(
i
) Neonatal
intensive care unit admission within seventy-two hours after birth, not including
observation-only admissions or admissions for congenital anomalies.
(
ii
) A birth
weight of less than two thousand five hundred grams.
(
iii
) An apgar
score of less than seven at five minutes.
(
iv
) Respiratory
distress requiring prolonged ventilation.
END_STATUTE
START_STATUTE
36-763.
Disclosure;
reporting requirements; definitions
A. At the initiation of care, eAch
licensed midwife shall disclose to each patient whether the licensed midwife
maintains professional liability insurance. This disclosure shall be included
in the informed consent document and acknowledged by the patient's signature.
B. on or before January 31 each year,
Each licensed midwife shall file a report with the department, in a format
prescribed by the department, the following information, not including any
individually identifiable health information of a patient, for the preceding
calendar year:
1. The number of women for whom the
licensed midwife provided care.
2. The number of deliveries the
licensed midwife
attended as primary midwife.
3. The number, reason for and outcome
of each transfer or transport of a patient in the antepartum, intrapartum or
immediate postpartum periods.
4. The number of perinatal deaths,
including the cause of death and a description of the circumstance.
5. The number and outcome of breech
births and vaginal births after cesarean.
6. The number of births that occurred
more than twenty-five miles from a hospital that provides obstetrics
services.
7. The number of fetal deaths after
twenty weeks' gestation.
8. The licensed midwife's full name,
license number and county.
C. In addition to the reporting
required in subsection B of this section, a licensed midwife shall report to
the department:
1. A perinatal mortality within
seventy-two hours after the death.
2. A sentinel event within fourteen
days after the event.
D. The information reported to the
department pursuant to
subsections B
and C of this SECTION may be inspected, copied, obtained or provided
to the advisory committee for research and evidence.
E. The report required by subsection
B of this section replaces the report required by each licensed midwife
following the termination of care for each patient.
F. For the purposes of this section
:
1. "Individually identifiable health
information" has the same meaning prescribed in section 36-3801.
2. "Sentinel event" has the
same meaning prescribed in section 36-762.
END_STATUTE
Sec. 4.
Short title
This act may be cited as the
"Jordan and Mack Terry Act".