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HB1328
HOUSE OF REPRESENTATIVES
H.B. NO.
1328
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
relating
to midwives
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
PART I
����
SECTION 1.
�
The legislature finds that Act 32, Session
Laws of Hawaii 2019 (Act 32), created a licensure program to regulate non-nurse
midwives.
�
The intent of the program was
to provide the benefits of licensure while also "allow[ing] a woman to
choose where and with whom she gives birth."
�
The legislature noted in Act 32 that
"mothers and families seek out alternatives to hospital births and they
find significant value in community or home birth services."
�
The legislature also found that "these
services have been provided by individuals identifying themselves as
traditional or cultural practitioners, midwives, certified professional
midwives, lay midwives, direct entry midwives, birth keepers, or birth
attendants."
�
The licensure program
established by Act 32, enacted as chapter 457J, Hawaii Revised Statutes
(chapter 457J), has run for five years and will sunset on June 30, 2025.
����
Under chapter 457J, only certified
midwives and certified professional midwives are eligible for licensure.
�
However, Act 32 noted that "by the
end of the three-year period (2023), the legislature intends to enact statutes
that will incorporate all birth practitioners and allow them to practice to the
fullest extent under the law."
�
While significant efforts were made, this goal has not yet been
achieved.
�
A temporary exemption for
birth attendants other than certified midwives or certified professional midwives
expired in 2023, and no other routes have been implemented.
����
Since the enactment of chapter 457J,
forty midwives have been licensed, although currently, less than half of these
provide full-time midwifery care.
�
Of
these forty newly licensed midwives, approximately twenty-two per cent do not
currently reside in the State, none are Native Hawaiian, and ninety-seven per
cent are not originally from Hawaii.
�
In
2023, midwives other than certified nurse-midwives attended 1.9 per cent of all
births, reflecting a seventy-three per cent increase in the use of midwives.
�
At the same time, since chapter 457J took
effect, the number of home births that were unattended or attended by unknown
providers have increased by forty-two per cent.
����
The intent of this Act is to
continue licensure for certified midwives and certified professional midwives,
while fulfilling the legislature's original intent to allow all birth
practitioners to practice legally.
�
The
legislature finds that licensure for certified midwives and certified
professional midwives is beneficial only if the legislature also acknowledges locally
accessible pathways to these certifications and clarifies the full scope of
practice for certified midwives based on national standards.
����
The legislature recognizes that, for
many people, decisions about pregnancy and birth are informed by their personal
or community history and culture and are experiences of great social, cultural,
and spiritual significance.
�
For many
people, pregnancy and birth are not primarily medical events.
�
As such, there are a wide range of
traditional birth practitioners - for example, pale keiki, lola, and sanba - as
well as birth-related service providers like doulas, lactation consultants,
birth coaches, and others whose care and advice are important to the well-being
of birthing people and their families.
����
The legislature believes that the
midwife licensing program established by Act 32 was an important step toward
recognizing the practice of non-nurse midwifery; however, some changes are
still needed.
�
In its review of chapter
457J and its implications, the Hawaii home birth task force's final report
reflected unanimous agreement on the need for improved understanding of
out-of-hospital births, as well as relationship building.
�
The report also emphasized the need to allow
traditional midwives and other birth practitioners to continue to serve their
communities.
����
The legislature notes that the
implementation of chapter 457J provided valuable insight into the
complexity of community birth settings in Hawaii.
�
Some of the urgent needs identified in this
process include the following:
����
(1)
�
Safety
.
�
Research highlighted by the United
States Centers for Disease Control and Prevention and in the White House
Blueprint for Addressing the Maternal Health Crisis (June 2022) suggests that
legal access to culturally responsive care of the birthing person's choosing,
including traditional practices of that person's culture, is strongly corelated
with increased safety and well-being.
�
Removing barriers to this care is essential.
�
Home birth with either a licensed or traditional
midwife has been found to be safe, whereas illegality jeopardizes safety.
�
For example, if complications arise during a
home birth, effective communication during the hospital transport is important.
�
Stigma associated with the illegality of using
a chosen birth attendant may cause parents to delay transport or withhold
information, impeding communication between providers.
�
Safety is therefore best served by protecting
access to all types of birthing assistance.
����
(2)
�
Access to care.
�
There is a severe lack of overall access
to maternal health care in Hawaii, which must be considered in the context of
environment and culture.
�
Due to extreme
provider shortages and limited facilities, many pregnant people on neighbor
islands are forced to fly off-island in order to give birth, often with no
family or other support. Many pregnant and birthing people have no realistic
access to prenatal or postpartum care.
�
In response to this crisis, all three neighbor island counties (Hawaii,
Kauai, and Maui) passed resolutions in 2023 urging the legislature to "enact
a statute exempting birth attendants from state licensure requirements".
�
Native Hawaiians and other Pacific Islanders
have the highest rates of maternal mortality in the United States, according to
recent data from the United States Centers for Disease Control and Prevention.
�
These statistics have not been associated
with out‑of‑hospital births but are strongly correlated with a lack
of access to culturally competent care.
�
Access
is best served by keeping all care options legally accessible, while long-term
comprehensive solutions are developed.
����
(3)
�
Culture.
�
The need for genuine cultural care, as well
as for the revitalization of Indigenous traditions and self-determination has
been highlighted in data and scholarship produced within the last two
years.
�
While Act 32 states that
"practicing midwifery according to [the law] does not impede one's ability
to incorporate or provide cultural practices," the State's courts have
found that, in practice, the transmission of constitutionally protected customs
was impeded, and it emphasized the importance of protecting endangered Indigenous
traditions that might be lost.
�
The
emergence of a new generation of local birth-related practitioners carrying the
traditions of a diverse variety of cultures has also been identified as
important.
����
(4)
�
Licensing
equality.
�
In the entire United States,
there are only two schools for certified midwives accredited by the
Accreditation Commission for Midwifery Education and eight schools for
certified professional midwives accredited by the Midwifery Education
Accreditation Council.
�
None of these
schools are located in Hawaii.
�
Limiting
certification pathways to those that are prohibitively difficult for residents
of Hawaii to pursue displaces Hawaii practitioners and limits patients' access to
culturally informed, community-based care.
�
Balancing equities by assuring access to licensure for Hawaii residents
is important.
����
The Hawaii Regulatory Licensing
Reform Act, codified as chapter 26H, Hawaii Revised Statutes, requires the
State to regulate professions only "when the health, safety, or welfare of
the consumer may be jeopardized by the nature of the service".
�
The analysis must be based on "evidence
of abuses by providers of the service" and other actual evidence to
determine whether regulation is desirable.
�
Chapter 26H also requires that any professional regulations "not
unreasonably restrict entry into professions and vocations by all qualified
persons."
�
The law notes that
"the purpose of regulation shall be the protection of the public welfare
and not that of the regulated profession or vocation".
�
The law also requires regulations to be
eliminated "when the legislature determines that they have no further
benefits to consumers".
����
Based on this analysis, the
legislature finds that the regulation of certified midwives and certified
professional midwives, who utilize prescription drugs, modern instrumentations,
and techniques such as intravenous fluid administration, is reasonable and
beneficial to consumers; provided that additional pathways are recognized for
qualified local Hawaii practitioners to achieve licensure.
�
Regulation by the State of the birth
practices of traditional and non-clinical practitioners and extended or hanai
family members is not supported or required by the Hawaii Regulatory Licensing Reform
Act.
����
The legislature's intent is to allow
a person to choose where and with whom they give birth by ensuring the legality
of all practices used by any birthing person, while also building comprehensive
solutions that address the complexity of community needs and cultural
considerations in Hawaii.
����
Accordingly, the purpose of this Act
is to:
����
(1)
�
Provide for the continued
licensure of certified midwives and certified professional midwives by the
department of commerce and consumer affairs;
����
(2)
�
Identify the scope
of practice for a licensed midwife, including the ability to provide
independent midwifery services in hospitals, clinics, freestanding birthing
facilities, community birthing settings, and the home;
����
(3)
�
Clarify that the
services of licensed midwives are eligible for insurance reimbursement;
����
(4)
�
Prohibit persons
from identifying as certified midwives or certified professional midwives,
unless those persons are appropriately licensed; and
����
(5)
�
Temporarily re-establish
the home birth task force to provide additional recommendations on issues
related to home births.
PART II
����
SECTION
2
.
�
Section 26H-4,
Hawaii Revised Statutes, is amended to read as follows:
����
"
�26H-4
�
Repeal dates for newly
enacted professional and vocational regulatory programs.
�
[
(a)
]
�
Any professional or vocational regulatory program enacted after January
1, 1994, and listed in this section shall be repealed as specified in this
section.
�
The auditor shall perform an
evaluation of the program, pursuant to section 26H-5, before its repeal date.
����
[
(b)
�
Chapter 457J (midwives) shall be repealed on
June 30, 2025.
]"
����
SECTION 3.
�
Chapter 457J, Hawaii Revised Statutes, is
amended by adding a new part to be appropriately designated and to read as
follows:
"
Part
��
.
�
certified midwives and certified professional
midwives
����
�
457J-A
�
Definitions.
�
As used in this part, unless the context otherwise requires:
����
"Accredited
educational program in midwifery" means an academic and practical program
of midwifery accredited by the Accreditation Commission for Midwifery Education
for certified midwives or the Midwifery Education Accreditation Council for
certified professional midwives.
����
"American Midwifery
Certification Board means the national certifying body for certified midwives
and certified nurse‑midwives.
����
"American College of
Nurse-Midwives" means the professional association that represents
certified midwives and certified nurse-midwives in the United States.
����
"Certified
midwife" means a person who has graduated from a graduate-level accredited
educational program in midwifery, accredited by the Accreditation Commisssion
for Midwifery Education or its successor organization, and who holds a valid
certification from the American Midwifery Certification Board or its successor
organization.
����
"Certified
professional midwife" means a person who has obtained a midwifery
education by completing an accredited educational program in midwifery,
accredited by the Midwifery Education Accreditation Council, or by completing a
midwifery apprenticeship under a North American Registry of Midwives registered
preceptor and the portfolio evaluation process, successfully passing the North
American Registry of Midwives exam, and who holds a valid certification from
the North American Registry of Midwives or its successor organization.
����
"Collaborate" means a process in
which a practitioner cooperates and communicates with healthcare professionals
from different disciplines, based on the healthcare needs of the patient, each
providing distinct and complementary expertise to improve care.
����
"Department" means the
department of commerce and consumer affairs.
����
"Director" means the
director of commerce and consumer affairs.
����
"Expedited partner
therapy" means the clinical practice of treating the sexual partner of a
client diagnosed with a sexually transmitted infection by relaying
prescriptions or providing medications for the client to take to their partner,
without the prescribing healthcare provider first examining the partner.
����
"Legend
drug" means a drug required by state law or pharmaceutical regulations to only
be dispensed based on a prescription.
����
"Licensed
midwife" means a person licensed under this chapter.
����
"Midwife preceptor" means
a licensed midwife, licensed maternal health professional, or preceptor
registered with a school accredited by the Midwifery Education Accreditation
Council, who participates in the clinical education of persons who are:
����
(1)
�
Enrolled in a
school accredited by the Accreditation Commission for Midwifery Education;
����
(2)
�
Enrolled in a
midwifery education program offered by the Midwifery Education Accreditation
Council; or
����
(3)
�
Working directly
under a midwife preceptor registered with the North American Registry of
Midwives to acquire certification through the portfolio evaluation process.
����
"Midwifery" means the
independent provision of care consistent with a midwife's training, education,
and experience.
����
"Midwifery bridge
certificate" means a certificate issued by the North American Registry of
Midwives to a certified professional midwife who obtains certification through
the portfolio evaluation process, upon the certified professional midwife's
completion of at least fifty hours of additional accredited education in
specific subjects, as required by the North American Registry of Midwives.
�
The bridge certificate demonstrates a blended
training pathway of both apprenticeship and accredited education.
����
"Midwifery Education
Accreditation Council" means the independent, non-profit organization
recognized by the United States Department of Education as the accrediting
agency of direct-entry midwifery institutions and programs.
����
"National
Association of Certified Professional Midwives" means the professional
association that represents certified professional midwives.
����
"North American Registry of
Midwives" means the national certifying body for certified professional
midwives.
����
"Portfolio evaluation
process" is an apprenticeship-model educational process that includes the
verification of the applicant's knowledge and skills by a qualified North
American Registry of Midwives preceptor.
�
Completion of this process qualifies an applicant to sit for the North
American Registry of Midwives written examination.
����
"Practice of certified midwifery"
means midwifery as practiced by a certified midwife and encompasses the
independent provision of care during pregnancy, childbirth, and the postpartum
period and care related to sexual and reproductive health, gynecology, family
planning, and preconception.
�
A certified
midwife may also provide primary care for a person from adolescence throughout
the person's lifespan, as well as for a healthy newborn or infant during the newborn
or infant's first twenty‑eight days of life.
����
"Practice of certified
professional midwifery" means midwifery as practiced by a certified
professional midwife and encompasses the independent provision of care during
pregnancy, childbirth, and the postpartum period and care related to sexual and
reproductive health, gynecology, family planning, and preconception.
�
A certified professional midwife may also
provide primary care for a healthy newborn or infant during the newborn or
infant's first twelve weeks of life.
����
"Student midwife" means a
person who is:
����
(1)
�
Enrolled in a
school accredited by the Accreditation Commission for Midwifery Education;
����
(2)
�
Enrolled in a
midwifery education program offered by the Midwifery Education Accreditation
Council; or
����
(3)
�
Working directly
under a midwife preceptor registered with the North American Registry of
Midwives to acquire certification through the portfolio evaluation process.
����
"Traditional birth
attendant" means a person who is not licensed under this part but who uses
traditional skills and techniques to assist with the birthing process.
����
"Unlicensed assistive
person" means a person who is not licensed to practice certified midwifery
or certified professional midwifery but who can competently perform tasks
delegated by a licensed midwife.
����
�
457J-B
�
Midwives licensing program.
�
(a)
�
To obtain a license under this part, the applicant shall provide:
����
(1)
�
An application for
licensure;
����
(2)
�
The required fees;
and
����
(3)
�
Proof of current,
unencumbered certification as a:
���������
(A)
�
Certified midwife;
or
���������
(B)
�
Certified
professional midwife.
����
(b)
�
To obtain a license to practice as a certified midwife pursuant to this part,
in addition to meeting the requirements in subsection (a), the applicant shall
establish to the satisfaction of the department that the person:
����
(1)
�
Holds a valid
graduate degree in midwifery from a program accredited by the Accreditation
Commission for Midwifery Education, or its successor;
����
(2)
�
Has successfully
passed the certification exam administered by the American Midwifery Certification
Board, or its successor; and
����
(3)
�
Is at least
twenty-one years of age by the date the licensure application is submitted.
����
(c)
�
To obtain a license to practice as a certified professional midwife
under this part, in addition to meeting the requirements in subsection (a), the
applicant shall provide:
����
(1)
�
Proof that the
person has successfully completed midwifery education and training by:
���������
(A)
�
Becoming certified
through an educational program that is accredited by the Midwifery Education Accreditation
Council and passing the certification exam administered by the North American
Registry of Midwives or its successor;
���������
(B)
�
Becoming certified
by completing the portfolio evaluation process, obtaining a midwifery bridge
certificate from the North American Registry of Midwives, and passing the
certification exam administered by the North American Registry of Midwives, or
its successor; or
���������
(C)
�
Maintaining a
current license in a state that does not require accredited education and
obtaining a midwifery bridge certificate issued by the North American Registry
of Midwives;
����
(2)
�
If applicable,
evidence of any licenses currently or previously held in other jurisdictions, including
proof of the status of the license and documentation of any disciplinary
proceedings pending or taken by the jurisdiction;
����
(3)
�
Information
regarding any criminal conviction that has not been annulled or expunged; and
����
(4)
�
Any other
information the department may require to investigate the applicant's
qualifications for licensure.
����
�
457J-C
�
Powers and duties of the director.
�
In addition to any other powers and
duties authorized by law, the director:
����
(1)
�
Shall grant
permission to a person to use the title "licensed midwife" pursuant
to this part and any rules adopted pursuant to this part;
����
(2)
�
Shall adopt,
amend, or repeal rules pursuant to chapter 91 to carry out the purposes of this
part;
����
(3)
�
Shall administer,
coordinate, and enforce this part and any rules adopted pursuant to this part;
����
(4)
�
Shall discipline a
licensee for any cause described by this part and any violation of the rules
adopted pursuant to this part;
����
(5)
�
May refuse to
license a person for failure to meet the licensing requirements or for any
cause that would be grounds for disciplining a licensee; and
����
(6)
�
Shall appoint an
advisory committee pursuant to section 457J-D to assist with the implementation
of this part and any rules adopted pursuant to this part.
����
�
457J-D
�
Midwives licensing advisory committee.
�
(a)
�
The director shall establish a
midwives
licensing advisory committee
to assist with the implementation of this part.
�
The following members shall be selected by
the director and invited to participate:
����
(1)
�
Three certified
professional midwives;
����
(2)
�
One member who is,
in order of preference:
���������
(A)
�
A certified
midwife;
���������
(B)
�
A certified nurse
midwife who works in the community birth setting; or
���������
(C)
�
A certified
professional midwife;
����
(3)
�
Two members of the
public, at least one of whom has used home birth services;
����
(4)
�
One traditional
birth attendant; and
����
(5)
�
Two active
practitioners of Native Hawaiian customary practices related to pregnancy,
birth, and infancy.
����
(b)
�
The committee shall elect a chairperson from among its members.
����
(c)
�
The members of the advisory committee shall serve without compensation
but shall be reimbursed for expenses, including travel expenses, necessary for
the performance of their duties.
����
�
457J-E
�
Scope of practice; licensed midwives; licensed
certified midwives; licensed certified professional midwives.
�
(a)
�
Except
as provided in section 457J-J, no midwife may practice without a current and
valid certification and license.
����
(b)
�
Unless authorized to practice as a licensed midwife under this part, no
person shall use or imply that they are a "licensed midwife," use any
similar title or description of the person's services, or in any way represent
that the person practices midwifery as a licensed midwife.
����
(c)
�
Each licensed midwife shall at all times practice within the scope of applicable
nationally established standards, including standards delineated by:
����
(1)
�
The American
College of Nurse-Midwives, or its successor, for a licensed certified midwife;
and
����
(2)
�
The North American
Registry of Midwives, for a licensed certified professional midwife.
����
(d)
�
The department shall adopt rules, pursuant to chapter 91, clarifying
the scope of practice for a licensed midwife; provided that the rules are
consistent with applicable national standards pursuant to subsection (c).
����
(e)
�
Notwithstanding any law to the contrary, a licensed midwife may:
����
(1)
�
Authorize, order,
and interpret medical laboratory and diagnostic tests, perform ultrasound
screenings, and obtain equipment and supplies necessary for the safe practice
of midwifery;
����
(2)
�
Provide
comprehensive initial and ongoing assessment, diagnosis, and treatment;
����
(3)
�
Conduct physical
examinations;
����
(4)
�
Promote
individualized wellness education and counseling for purposes of health
promotion, disease prevention, risk assessment, and disease management;
����
(5)
�
Collaborate with
individuals and families in diverse settings, including ambulatory care
clinics, private offices, community and public health systems, hospitals, birth
centers, homes, and via telehealth and other forms of remote care;
����
(6)
�
Order medical
devices, including durable medical equipment;
����
(7)
�
Provide evidence-based,
client-centered care in collaboration with the client, including, as indicated,
providing referrals to other providers and services;
����
(8)
�
Adopt ethical
standards in support of individual rights and self-determination in the context
of family, community, and a system of healthcare;
����
(9)
�
Document client
charts to facilitate interprofessional communication and provide clients with a
means to access the client's healthcare records; and
���
(10)
�
Participate in
quality management practices, such as peer review, continuing education, and
data analysis to improve the practice of midwifery.
����
(f)
�
Notwithstanding any law to the contrary, a licensed certified midwife
may, in addition to practicing within the scope of subsection (e):
����
(1)
�
Obtain
prescriptive authority to independently prescribe medications, including
controlled substances, medications for the treatment of a substance use
disorder, and medications for expedited partner therapy;
����
(2)
�
Admit, manage, and
discharge patients to or from a hospital or freestanding birthing facility;
����
(3)
�
Assist in surgery;
provided that this paragraph shall apply only to certified nurse midwives; and
����
(4)
�
Order home health
services.
����
(g)
�
Notwithstanding any law to the contrary, a licensed certified
professional midwife may, in addition to practicing within the scope of
subsection (e):
����
(1)
�
Obtain limited
prescriptive authority to obtain, administer, and independently prescribe
medications and therapies for the prevention and treatment of outpatient
conditions that do not constitute a significant deviation from normal midwifery
care during pregnancy or the postpartum period, based on current evidence and
practice, including medication for expedited partner therapy;
����
(2)
�
Prescribe other
medications and devices that are used within the safe practice of certified
professional midwifery;
����
(3)
�
Admit, manage, and
discharge patients to and from a birthing facility or birthing home in the
community setting; and
����
(4)
�
Obtain medical
devices, durable medical equipment, and any supplies necessary for the safe
practice of certified professional midwifery.
����
�457J-F
�
Delegation of tasks.
�
(a)
�
A licensed midwife may delegate to any licensed, certified, registered,
or unlicensed assistive person, any tasks within the licensed midwife's scope
of practice; provided that the authority to select medications shall not be
delegated unless the delegate is independently authorized by law to select
medications.
����
(b)
�
No delegated task shall require the delegate to exercise the judgment
required of a licensed midwife.
����
(c)
�
Before delegating any task, the licensed midwife shall make a
determination that, in the licensed midwife's professional judgement, the
delegated task can be safely and properly performed by the delegate and that
the delegation is in accordance with the patient's safety and welfare.
����
(d)
�
The delegating licensed midwife shall be solely responsible for
determining the degree of supervision the delegate requires, with consideration
given to:
����
(1)
�
The stability of
the patient's condition;
����
(2)
�
The delegate's
training and abilities; and
����
(3)
�
The nature of the
task being delegated.
����
(e)
�
The employer of a licensed midwife may establish policies, procedures,
protocols, or standards of care that limit or prohibit the delegation of
certain tasks by the licensed midwife, or the delegation of tasks in certain
circumstances.
����
(f)
�
The department shall adopt rules pursuant to chapter 91 as
necessary to implement this section, including:
����
(1)
�
Standards for
assessing the proficiency of a delegate to perform certain tasks; and
����
(2)
�
Accountability
standards for a licensed midwife who delegates tasks.
����
�457J-G
�
Prescriptive authority; certified midwives.
�
(a)
�
The department may authorize a certified midwife to prescribe certain
controlled substances or prescription drugs; provided that the certified
midwife:
����
(1)
�
Is in good
standing, without disciplinary sanctions;
����
(2)
�
Has fulfilled the
requirements of this part; and
����
(3)
�
Has fulfilled any
requirements established by the department pursuant to this part.
����
(b)
�
Any prescriptive authority granted to a certified midwife shall be limited
to the midwife's scope of practice and for patients appropriate to the scope of
practice.
����
(c)
�
A certified midwife to whom the department has granted the authority to
prescribe prescription drugs and controlled substances may advise the certified
midwife's patients of the option to have the symptom or purpose for which a
prescription is being issued included on the prescription order.
����
(d)
�
A certified midwife having prescriptive authority shall maintain
national certification, as required by section 457J-B, unless the department
grants an exception.
����
(e)
�
Each certified midwife granted prescriptive authority by the department
shall be assigned a specific identifier, which shall be made available to the
Hawaii medical board and the state board of pharmacy.
�
The department shall establish a mechanism to
ensure that the prescriptive authority of a certified midwife may be readily
verified using this specific identifier.
����
(f)
�
The prescriptive authority granted to a certified midwife may be limited
or withdrawn, and the certified midwife may be subject to further disciplinary
action, if the certified midwife prescribes outside the certified midwife's
scope of practice, for patients other than those appropriate to the certified
midwife's scope of practice, or for other than therapeutic purposes.
����
(g)
�
Nothing in this section shall be construed to require a certified
midwife to obtain prescriptive authority to order anesthesia care.
����
(h)
�
No certified midwife shall accept any direct or indirect benefit from a
pharmaceutical manufacturer or pharmaceutical representative for prescribing a
specific medication to a patient.
�
For
purposes of this section, a direct or indirect benefit does not include a
benefit offered to a certified midwife, regardless of whether a specified
medication is prescribed.
����
(i)
�
A pharmacist who dispenses drugs and devices to a certified midwife as
authorized by this section and in conformity with chapter 461 shall not be
liable for any adverse reactions caused by the midwife's administration of
legend drugs and devices.
����
�457J-H
�
Limited prescriptive authority; certified professional midwives.
�
(a)
�
The department may
authorize a certified professional midwife to prescribe certain legend drugs
and devices provided that the certified professional midwife:
����
(1)
�
Is in good
standing, without disciplinary sanctions;
����
(2)
�
Has fulfilled the
requirements of this part; and
����
(3)
�
Has fulfilled any
requirements established by the department pursuant to this part.
����
(b)
�
Any prescriptive authority granted to a certified professional midwife
shall be limited to the midwife's scope of practice and for patients appropriate
to the scope of practice.
����
(c)
�
A certified professional midwife to whom the department has granted limited
prescriptive authority to prescribe legend drugs and devices may advise the
certified professional midwife's patients of the option to have the symptom or
purpose for which a prescription is being issued included on the prescription
order.
����
(d)
�
A certified professional midwife having limited prescriptive authority
shall maintain national certification, as required by section 457J-B, unless
the department grants an exception.
����
(e)
�
Each certified professional midwife granted limited prescriptive
authority by the department shall be assigned a specific identifier, which
shall be made available to the Hawaii medical board and the state board of
pharmacy. The department shall establish a mechanism to ensure that the limited
prescriptive authority of a certified professional midwife may be readily
verified using this specific identifier.
����
(f)
�
The limited prescriptive authority granted to a certified professional midwife
may be limited or withdrawn, and the certified professional midwife may be
subject to further disciplinary action, if the certified professional midwife
prescribes outside the certified professional midwife's scope of practice, for
patients other than those appropriate to the certified professional midwife's
scope of practice, or for other than therapeutic purposes.
����
(g)
�
No certified professional midwife shall accept any direct or indirect
benefit from a pharmaceutical manufacturer or pharmaceutical representative for
prescribing a specific medication to a patient.
�
For purposes of this section, a direct or indirect benefit does not
include a benefit offered to a certified professional midwife, regardless of
whether a specified medication is prescribed.
����
(h)
�
A pharmacist who dispenses drugs and devices to a certified professional
midwife as authorized by this section and in conformity with chapter 461 shall
not be liable for any adverse reactions caused by the certified professional midwife's
administration of legend drugs and devices.
����
(i)
�
A
certified professional midwife candidate seeking limited prescriptive authority
shall complete additional study and training requirements as prescribed by the
department, in collaboration with the
midwives licensing advisory
committee
.
�
The department shall adopt rules pursuant to
chapter 91 providing requirements for:
����
(1)
�
The number of additional obstetrical
pharmacology training hours consistent with the training hours required for
other, similar prescribers; and
����
(2)
�
Additional training consistent with guidelines
commensurate with other professions providing family planning and treating
common prenatal and postpartum conditions and any other relevant sources.
����
(j)
�
A certified professional midwife seeking a
licensing extension to include medical devices and implants shall complete the
requirements listed in subsection (i) and additional training requirements as
prescribed by the department
in
collaboration with the
midwives licensing advisory committee
.
�
The department shall adopt rules pursuant to chapter 91 providing
requirements for:
����
(1)
�
The minimum number of completed procedures
under supervision;
����
(2)
�
Completed trainings as required by the device
manufacturers or an equivalent; and
����
(3)
�
Additional training consistent with guidelines
commensurate with other professions providing family planning and treating
common prenatal and postpartum conditions, and any other relevant sources.
����
�457J-I
�
License required.
�
(a)
�
Beginning July 1, 2025, except as provided in this part, no person in
the State shall use the title "licensed midwife," or the abbreviation
"L.M.," or any other words, letters, abbreviations, or insignia
indicating or implying that the person is a licensed midwife, unless the person
holds a valid license issued pursuant to this part.
����
(b)
�
No person shall use the title "certified midwife" or
"certified professional midwife" without a valid certification.
����
(c)
�
Nothing in this section shall preclude a person holding a national
midwife certification from identifying as a person holding this certification;
provided that the person shall not profess to be licensed to practice midwifery
in Hawaii unless the person is licensed in accordance with this part.
����
�457J-J
�
Exemptions.
�
This part does
not require a midwifery license if the person is a:
����
(1)
�
Certified nurse-midwife
holding a valid license under chapter 457;
����
(2)
�
Student midwife;
����
(3)
�
Member of a
profession that overlaps with the practice of midwifery who is licensed and
performing work within the scope of the person's position and duties;
����
(4)
�
Person providing
limited perinatal support services that are not subject to state licensing
requirements, including childbirth education, lactation support, or doula care;
����
(5)
�
Person rendering
emergency aid;
����
(6)
�
Person
administering care to the person's immediate or extended family, including
hanai family;
����
(7)
�
Person engaged in traditional Native Hawaiian
healing practices of prenatal, maternal, or child care.
�
Nothing in this part shall prohibit, limit,
or otherwise adversely impact any traditional Native Hawaiian customary
practice related to pregnancy, birth, or infancy, pursuant to the Constitution
of the State of Hawaii;
����
(8)
�
Person engaged in
birth-related practices in connection or accordance with the tenets and practices
of any ethnic culture; provided that the person shall not claim to practice as
a certified midwife, certified professional midwife, or licensed midwife unless
licensed pursuant to this part;
����
(9)
�
Person engaged in
birth-related practices related to healing by prayer or spiritual means in connection
or accordance with the tenets and practices of any well‑recognized church
or religious denomination; provided that the person shall not claim to practice
as a certified midwife, certified professional midwife, or licensed midwife
unless licensed pursuant to this part; or
���
(10)
�
Person acting as a
traditional birth attendant who:
���������
(A)
�
Does not use
legend drugs or devices, the use of which requires a license under the laws of
the State;
���������
(B)
�
Does not advertise
themselves as a licensed midwife;
���������
(C)
�
Discloses to the client
verbally and in writing at the time that care is first initiated:
�������������
(i)
�
That the person
does not possess a professional license issued by the State to provide health
or maternity care to women or infants;
������������
(ii)
�
The person's
education and training;
�����������
(iii)
�
That person's
education and training qualifications have not been reviewed by the State;
������������
(iv)
�
That the person is
not authorized to acquire, carry, administer or direct others to administer
legend drugs;
�������������
(v)
�
The details of any
judgement, award, disciplinary sanction, order, or other determination by a
licensing or regulatory authority, territory of the United States, state, or
any other jurisdiction, that adjudges or finds that the person has committed
misconduct or is criminally or civilly liable for conduct relating to midwifery;
and
������������
(vi)
�
A plan for
transporting the client to the nearest hospital if a problem arises during the
patient's care; and
���������
(D)
�
Maintains a copy
of the written disclosure required by subparagraph (C) for at least ten years
and makes the form available for inspection by the department upon request.
����
�457J-K
�
Fees.
�
(a)
�
Each applicant shall pay a licensing fee upon application for an initial
license or for the renewal of a license.
�
Any fees collected pursuant to this section, or by rule adopted under
this section, shall be nonrefundable.
����
(b)
�
Pursuant to section 26-9(l), the director may establish fees to restore
a license, penalty fees, and any other fees required for the administration of
this part.
����
(c)
�
All fees collected pursuant to this part shall be deposited into the
compliance resolution fund established pursuant to section 26-9(o).
����
(d)
�
Fees assessed pursuant to this part shall be used to defray costs
incurred by the department in implementing this part.
����
(e)
�
The director may assess fees as provided in this part and section 26-9
and, notwithstanding any other law to the contrary, may change the amount of
the fees at any time without regard to chapter 91 if the director:
����
(1)
�
Holds at least one
public hearing to discuss the fee change and to receive testimony on the issue;
and
����
(2)
�
Provides public
notice at least thirty days prior to the date of the public hearing.
����
�457J-L
�
Issuance of a license.
�
The director may issue a license to
any person who meets all licensure requirements and pays the appropriate fees.
����
�457J-M
�
Renewal of a license.
�
(a)
�
Each license issued under this part shall be renewed every three years on
or before June 30.
�
Failure to renew a
license shall result in a forfeiture of the license.
����
(b)
�
A license that has been forfeited may be restored within one year of the
expiration date upon payment of renewal and penalty fees.
�
Failure to restore a forfeited license within
one year of the date of its expiration shall result in the automatic
termination of the license.
����
(c)
�
Re-licensure after termination shall require the person to apply as a
new applicant and to again satisfy all licensing requirements that are in place
at the time of the new application.
����
�457J-N
�
Grounds for refusal to grant, renew,
reinstate, or restore a license or to revoke, suspend, deny, or place
conditions on a license.
�
In addition to any other conditions
provided by law, the director may refuse to grant, renew, reinstate, or restore
a license, or may deny, revoke, suspend, or place conditions on a license if
the applicant or licensee:
����
(1)
�
Fails to meet or
maintain the conditions and requirements necessary to qualify for the granting
of a license;
����
(2)
�
Fails to notify
the department in writing within thirty days of the change in status if a
licensee's certification as a certified midwife or certified professional
midwife is no longer current or is encumbered;
����
(3)
�
Engages in false,
fraudulent, or deceptive advertising, or makes untruthful or improbable
statements;
����
(4)
�
Is addicted to,
dependent on, or a habitual user of a narcotic, barbiturate, amphetamine,
hallucinogen, opium, cocaine, or other drugs or drug derivatives of a similar
nature;
����
(5)
�
Practices as a
licensed midwife while impaired by alcohol, drugs, a physical disability, or
mental instability;
����
(6)
�
Procures a license
through fraud, misrepresentation, or deceit;
����
(7)
�
Engages in
professional misconduct as defined by the licensing program in accordance with
its own rules, demonstrates gross negligence, or is manifestly incapable in the
practice of midwifery;
����
(8)
�
Fails to maintain
a record or history of competency, trustworthiness, fair dealing, or financial
integrity;
����
(9)
�
Engages in conduct
or practices contrary to recognized standards of ethics for the practice of
midwifery;
���
(10)
�
Violates any
condition or limitation upon which a conditional license was issued;
���
(11)
�
Engages in
business under a past or present license issued pursuant to this part in a
negligent manner that causes injury to one or more members of the public;
���
(12)
�
Fails to comply,
observe, or adhere to any law in such a manner that the director deems the
applicant or licensee to be an unfit or improper person to hold a license;
���
(13)
�
Is subject to a
revocation, suspension, or other disciplinary action by a territory of the
United States, or by another state or federal agency, based on any reason
provided by this state's licensing laws, including this part;
���
(14)
�
Has been
convicted, whether by nolo contendre or otherwise, of a penal offense
substantially related to the qualifications, functions, or duties of a licensed
midwife;
���
(15)
�
Fails to notify
the department in writing within thirty days of any disciplinary decision
issued against the applicant or licensee in another jurisdiction;
���
(16)
�
Violates this part,
any other applicable licensing laws, or any rule or order of the director; or
���
(17)
�
Uses or removes
without authorization any controlled substances or drugs, or diverts or attempts
to divert controlled substances or drugs for unauthorized use.
����
�457J-O
�
Reimbursement for licensed midwives.
�
Any health benefit plan or health insurance reimbursement, including
the medicaid program, shall provide coverage for services rendered by a
licensed midwife if the services rendered are within the scope of practice for
a certified midwife or certified professional midwife, without regard to the location
where the services were provided.
����
�457J-P
�
Penalties.
��
Any person who violates this part or rules adopted pursuant to this part
shall be subject to a fine of not more than $1,000 for each separate offense.
����
�
457J-Q
�
Annual reporting requirement.
�
No later than twenty days before the
convening of each regular session, the department of commerce and consumer
affairs shall submit to the legislature a report that shall include:
����
(1)
�
The total number
of midwives currently licensed in the State;
����
(2)
�
The number of
certified midwives newly licensed in the previous year;
����
(3)
�
The number of
licensed certified professional midwives who, in the previous year, passed the
exam administered by the North American Registry of Midwives after completing
an educational pathway accredited by the Midwifery Education Accreditation
Council;
����
(4)
�
The number of licensed
certified professional midwives who, in the previous year, passed the exam
administered by the North American Registry of Midwives after completing the
portfolio evaluation pathway;
����
(5)
�
The total number
of complaints filed in the previous year against midwives licensed in the
State;
����
(6)
�
The total number
of complaints filed in the previous year against persons who engaged in certified
midwifery and certified professional midwifery without a license;
����
(7)
�
The total number
of complaints filed in the previous year against traditional birth attendants
who failed to comply with statutory requirements;
����
(8)
�
The status and
resolution of each complaint filed in the previous year; and
����
(9)
�
Any recommendations
for proposed legislation."
PART III
����
SECTION 4.
�
(a)
�
There
is established a home birth task force, within the department of health for
administrative purposes.
����
(b)
�
Notwithstanding subsection (d), the task force shall comprise no more
than seventeen members, including:
����
(1)
�
The director of
commerce and consumer affairs, or the director's designee;
����
(2)
�
The director of
health, or the director's designee;
����
(3)
�
A representative
from the med-QUEST division of the department of human services; and
����
(4)
�
The following
members, who shall be selected by the director of commerce and consumer affairs
and invited to participate:
���������
(A)
�
An active
practitioner of Native Hawaiian customary practices related to pregnancy,
birth, and infancy;
���������
(B)
�
A representative
from the Hawaii section of the American College of Obstetricians and
Gynecologists, or another physician who is licensed in Hawaii;
���������
(C)
�
A representative
from emergency medical services;
���������
(D)
�
A representative
from the Hawaii Hospital Association;
���������
(E)
�
A representative
from the Hawaii affiliate of the American College of Nurse-Midwives, or another
certified midwife or certified nurse midwife who is licensed in Hawaii;
���������
(F)
�
A representative
from the Hawaii chapter of the National Association of Certified Professional
Midwives; and
���������
(G)
�
Eight members
recommended by the Hawaii Home Birth Collective who represent the following
stakeholder groups:
�������������
(i)
�
Certified
midwives;
������������
(ii)
�
Certified
professional midwives;
�����������
(iii)
�
Home birth elders;
������������
(iv)
�
Traditional or
cultural birthing attendants; and
�������������
(v)
�
Members of the
public who have used home birth services.
����
(c)
�
The task force shall elect a chairperson from among its members.
����
(d)
�
The task force may recommend additional members having appropriate
expertise, to be approved by the chairperson.
����
(e)
�
The task force shall include representation from all counties.
����
(f)
�
The task force shall discuss matters relating to home births and shall
make recommendations to improve the coordination of care and sharing of
information across the maternal health system.
�
Issues discussed by the task force shall include:
����
(1)
�
The education and
training of birth practitioners;
����
(2)
�
Public health
education and information regarding home birth practices;
����
(3)
�
Data and
information regarding home births and maternal and infant health;
����
(4)
�
Issues arising
when transport is needed from home births to hospital care; and
����
(5)
�
Proposed actions
to improve public health and safety in relation to home births.
����
(g)
�
The members of the task force shall serve without compensation but shall
be reimbursed for expenses, including travel expenses, necessary for the
performance of their duties.
����
(h)
�
No member of the task force shall be made
subject to section 84-17, Hawaii Revised Statutes, solely based on the member's
participation on the task force.
����
(i)
�
The department of health shall provide any administrative or clerical
support required by the task force.
����
(j)
�
The home birth task force shall submit a report of its findings and
recommendations, including any proposed legislation, to the legislature no
later than twenty days prior to the convening of the regular session of
2026.
����
(k)
�
The home birth task force shall dissolve on June 30, 2026.
PART IV
����
SECTION 5.
�
Chapter 457J, Hawaii Revised Statutes, is
amended by designating sections 457J-1 to 457J-13 as part I, entitled "Midwives".
����
SECTION 6.
�
Part I of Chapter 457J, Hawaii Revised
Statutes, is repealed.
PART V
����
SECTION 7.
�
In codifying the new sections added by
section 3 of this Act, the revisor of statutes shall substitute appropriate
section numbers for the letters used in designating the new sections in this
Act.
����
SECTION 8.
�
This Act does not affect rights and duties
that matured, penalties that were incurred, and proceedings that were begun
before its effective date.
����
SECTION 9.
�
Statutory material to be repealed is
bracketed and stricken.
�
New statutory
material is underscored.
����
SECTION 10.
�
This Act shall take effect upon its approval;
provided that section 2 shall take effect on June 29, 2025.
INTRODUCED BY:
_____________________________
Report Title:
DCCA;
Licensed Midwives; Licensed Certified Midwives; Licensed Certified Professional
Midwives; Task Force; Reports
Description:
Continues
a licensing scheme for licensed certified midwives and licensed certified
professional midwives, to be overseen by the Department of Commerce and
Consumer Affairs.
�
Re‑establishes the
home birth task force to provide recommendations on issues related to home
births.
�
Dissolves the task force on
6/30/2026.
�
Requires reports to the
Legislature.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.