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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 1234
Introduced by Hansen, 16; Spivey, 13.
Read first time January 21, 2026
Committee: Health and Human Services
A BILL FOR AN ACT relating to public health and welfare; to adopt the1
Freestanding Birth Center Act; and to authorize insurance coverage.2
Be it enacted by the people of the State of Nebraska,3
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Section 1. The State of Nebraska adopts the Freestanding Birth1
Center Act in the form substantially as follows: 2
I. PURPOSE AND SCOPE 3
A. Freestanding birth centers, as defined in Section II, provide4
health care services within a home-like environment, which is different5
from and outside of the hospital setting, while promoting safety and6
quality care for patients and their newborn infants.7
B. Birth centers shall be licensed by the state Licensing Agency.8
The Licensing Agency shall adopt these standards for governing the9
licensure and regulation of such birth centers. 10
C. Birth centers shall be licensed to provide services of labor,11
birth, and early postpartum and newborn care to patients experiencing12
low-risk pregnancies, as defined in Section II, and their newborns.13
Nothing in the Freestanding Birth Center Act shall restrict the scope of14
practice of the Licensed Provider to perform other outpatient services in15
space that is shared with or adjacent to the birth center and which may16
be regulated under other facility licensure, the Licensed Provider's17
professional license, or both. 18
D. Birth centers are low-volume facilities limited to low-risk19
perinatal care, and do not employ the use of regional or general20
anesthesia. Birth centers shall not be restricted by any Certificate of21
Need laws regulating hospitals and ambulatory surgical centers.22
E. Admission to a birth center for labor and delivery shall be23
limited to low-risk, uncomplicated pregnancies, with anticipated24
spontaneous vaginal delivery, which, as determined by history of prenatal25
care and ongoing assessment of risk criteria, indicates the likelihood of26
an uncomplicated birth. 27
F. No person, entity, or facility shall represent itself as a "birth28
center" or use the term "birth center" as its title, in its advertising,29
publications, or other form of communication, unless licensed as a birth30
center in accordance with the provisions herein. 31
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G. A birth center shall employ a clinical director who is a1
certified nurse midwife. 2
II. DEFINITIONS 3
A. The terms defined in this section shall have the following4
meanings, unless the context clearly indicates otherwise:5
B. Applicant: Any person, entity, or organization which qualifies6
and submits an application seeking licensure to own, establish, and7
operate a birth center under the Freestanding Birth Center Act.8
C. CABC: Commission for the Accreditation of Birth Centers. An9
accrediting organization dedicated exclusively to the quality and safety10
of the operation and services of birth centers, regardless of state11
regulations, ownership, primary care provider, location, or population12
served. 13
D. Change of ownership: A change in the majority or controlling14
interest in an established birth center to another person, entity, or15
organization. 16
E. Freestanding Birth Center: A facility licensed for the primary17
purpose of providing midwifery care, low-risk deliveries, and newborn18
care immediately after delivery, for a stay of generally less than19
twenty-four hours. A freestanding birth center may be a location for20
additional services in shared or adjacent spaces, including outpatient21
gynecologic care, primary care, and education and support services within22
each Licensed Provider's scope of practice. This term does not include a23
hospital, ambulatory surgical center, or the residence of the patient24
giving birth. The terms "freestanding birth center," "birth center," and25
"center" may be used interchangeably in the Freestanding Birth Center26
Act, and shall have the same meaning defined in this section.27
F. License: The certification issued to an applicant indicating that28
the birth center meets the requirements for licensure outlined herein.29
Licenses must be renewed on an annual basis. 30
G. Licensed Provider: An individual licensed or certified in this31
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state to provide specific health care related services within a defined1
scope of practice by the licensing rules and licensing body. For the2
purposes of the Freestanding Birth Center Act, licensed providers may3
include, but are not limited to: Certified nurse midwives, certified4
midwives, or licensed midwives. The term provider may be used5
interchangeably, and shall have the same meaning defined in this Section.6
H. Licensed Maternity Care Provider: A Licensed Provider whose7
professional scope of practice includes preconception, prenatal, labor,8
birth, and postpartum care and early care of the newborn and who may be9
the primary attendant during the perinatal period.10
I. Licensee: The person, entity, or organization granted a license11
to operate the birth center. 12
J. Licensing Agency: The Department of Health and Human Services, or13
its equivalent, within this state. 14
K. Low-risk pregnancy: An uncomplicated prenatal course and the15
anticipation of an uncomplicated labor and birth, which is determined by16
ongoing assessment of risk criteria. 17
L. Midwifery: The provision of perinatal care by a midwife to a18
patient, along with care of the newborn, support of the family unit, and19
ongoing gynecologic health and wellness care, in accordance with the20
professional scope and standards of practice of the profession's21
certifying or licensing body. 22
M. Owner: An individual, a partnership, an association, a23
corporation, or a combination thereof, that has a majority and24
controlling interest in the birth center. 25
N. Patient: An individual and the individual's fetus or newborn26
accepted to receive care and services provided by the birth center during27
wellness care, pregnancy, labor, childbirth, and recovery.28
O. Policies and Procedures: A written document which describes all29
policies and procedures to be followed at the birth center, including,30
but not limited to, administrative, clinical, and personnel procedures,31
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which is to be maintained at the licensed premises, in either electronic1
or hard copy format, and accessible by all members of the birth center2
workforce. 3
P. Standards: Minimum requirements under the Freestanding Birth4
Center Act. 5
III. LICENSING PROCEDURES 6
A. Licensure Fees 7
1. The schedule of fees for a birth center license is as follows:8
(a) Initial licensure fee is two hundred fifty dollars.9
(b) Renewal licensure fee is two hundred fifty dollars.10
(c) Change of ownership license fee is two hundred fifty dollars.11
2. An application for licensure is not considered complete until the12
applicant pays the licensing fee. The fee shall accompany the application13
form. 14
3. License fees paid by an applicant are nonrefundable.15
B. Initial Licensure Process 16
1. No person, entity, or organization shall establish, conduct,17
operate, or maintain a birth center without a license. The license shall18
be issued only to the applicant named in the application, and only for19
the premises listed in the application for licensure.20
2. An application for initial licensure and the required licensing21
fee shall be submitted to the Licensing Agency on the form provided by22
the Licensing Agency. 23
3. Licenses are not transferable or assignable.24
C. Issuance of Licenses 25
1. Applicants in substantial compliance with the Freestanding Birth26
Center Act shall receive a certificate from the Licensing Agency naming27
the applicant and birth center as a licensee under the act.28
2. The license shall expire annually at midnight on the anniversary29
of licensure. 30
3. The license shall be conspicuously posted in the birth center.31
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D. Renewal Licensure Process 1
1. In order to renew its license, a birth center shall submit to the2
Licensing Agency a renewal application, on the form provided by the3
Licensing Agency, along with a renewal fee, at least thirty days prior to4
the license expiration date. 5
2. If a birth center fails to renew its license prior to the date of6
expiration, but submits the renewal form and fee within sixty days7
thereafter, the birth center may renew late by paying, in addition to the8
renewal fee, a late penalty of fifty dollars per month for each month or9
fraction of a month that renewal is late. 10
3. In the event that a birth center fails to renew its license11
within the sixty-day grace period following the license expiration date,12
the birth center must reapply for a new license by submitting the13
following: 14
(a) A completed initial application for licensure; and15
(b) The initial license fee. 16
E. Change of Ownership Process 17
1. The birth center shall make reasonable efforts to notify the18
Licensing Agency a minimum of thirty days prior to the change in19
ownership of a majority or controlling interest. 20
2. A change of ownership application and fee must be received by the21
Licensing Agency before the license may be issued.22
3. A change of ownership is considered effective when the name of23
the licensee reflected on the license certificate is changed by the24
Licensing Agency to reflect the name of the applicant applying for the25
change of ownership. 26
F. Suspension, Revocation, Refusal to Renew 27
1. The Licensing Agency may deny, suspend, revoke, or refuse to28
renew a license if the birth center substantially violates a requirement29
of the Freestanding Birth Center Act. 30
2. If the Licensing Agency proposes to deny, suspend, revoke, or31
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refuse to renew a license, the Licensing Agency shall send a notice of1
the proposed action to the birth center at least sixty days ahead of the2
action's effective date. The notice to deny, suspend, revoke, or refuse3
to renew a license shall state the alleged facts or conduct to warrant4
the proposed action, shall provide an opportunity for the birth center to5
demonstrate or achieve compliance, and shall state that the birth center6
has an opportunity for a hearing before the proposed action is final.7
3. The request for a hearing must be submitted to the Licensing8
Agency in writing, within twenty-one days of the date of the notice of9
proposed action. The Licensing Agency will provide an opportunity for a10
fair hearing upon a center's timely request. 11
4. If the birth center does not request a hearing, the center is12
deemed to have waived the opportunity for a hearing and the proposed13
action shall take effect. 14
G. Standards for Licensure 15
1. In order to be eligible for licensure, a birth center must be16
currently accredited by the Commission for the Accreditation of Birth17
Centers (CABC), or in the process of obtaining accreditation within six18
months of the date of the application for licensure.19
2. If the birth center loses its accreditation, the birth center20
must immediately notify the Licensing Agency. 21
3. The birth center shall clearly define written risk criteria or22
factors which, when present, would preclude the patient from being23
considered a low-risk patient, and, therefore, ineligible for a birth24
center birth. 25
4. Upon request, the birth center shall provide the Licensing Agency26
with any material submitted by the birth center to the CABC as part of27
the accreditation process, including the accreditation application, self-28
evaluation report, accreditation decision letter from the CABC, and any29
reports from the CABC following a site visit. 30
H. Limitations on Scope of Services 31
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1. The following limitations apply to the services performed at the1
birth center: 2
(a) The use of general or regional anesthesia, including epidurals,3
is prohibited. 4
(b) Notwithstanding paragraph (a), local anesthesia, systemic5
analgesia, nitrous oxide, and other forms of pain relief may be6
administered at the birth center if it is performed within the provider's7
scope of practice, and as determined by the birth center's policies and8
procedures. 9
(c) Labor shall not be induced, stimulated, or augmented with10
pharmacologic agents during the first or second stages of labor or before11
labor. 12
(d) Surgical services must be limited to those normally performed13
during an uncomplicated birth, including episiotomy and repair. No14
operative obstetrics or cesarean sections shall be performed.15
(e) The use of vacuum extractors, vaginal forceps, or continuous16
electronic fetal monitoring is prohibited. 17
(f) The risk factors that preclude a patient from delivering at the18
birth center shall be consistent with national standards within the CABC19
and other risk factors contrary to the birth center's established risk20
criteria. 21
IV. PATIENT RIGHTS AND RESPONSIBILITIES 22
A. The birth center shall support and respect the rights of the23
patients and their families, however they define their families. These24
rights shall be posted in the center or otherwise made available to25
patients. 26
B. Patient rights shall include, but are not limited to, the right27
to: 28
1. Be treated with dignity, courtesy, and respect.29
2. Receive equal treatment, regardless of race, gender, gender30
identity, religion, ethnic background, sexual orientation, education,31
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social class, physical or mental disability, economic status, or source1
of payment. 2
3. Be assured of confidentiality. 3
4. Be informed of the benefits, risks, and eligibility requirements4
for a birth center birth. 5
5. Participate in decisions relating to the management of their6
care. 7
6. Give written informed consent prior to receiving services or8
care. 9
7. Be informed of the process by which a patient may raise a10
grievance against the birth center or one of the birth center's11
providers. 12
8. Refuse treatment, at any time, even after treatment has begun.13
9. Be informed of the center's plan for provision of emergency and14
nonemergency care in the event complications arise.15
10. Access a licensed maternity care provider twenty-four hours per16
day, seven days per week, in accordance with birth center policies and17
procedures. 18
11. Receive a statement of fees for all charges made by the birth19
center. 20
C. The birth center may develop a plan for patient responsibilities21
as it relates to the patient's participation in the patient's own plan of22
care. If any patient responsibilities are developed by the birth center,23
then the birth center shall notify patients of their responsibilities24
alongside the notification of patient rights. 25
V. HEALTH RECORDS 26
A. The birth center shall maintain a health record for every27
patient, in accordance with acceptable professional standards, for the28
purposes of continuity and evaluation of care. 29
B. The birth center shall develop, implement, and enforce written30
policies and procedures for the maintenance of patient health records, to31
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ensure that care and services provided to the patient are documented and1
organized in a way to easily facilitate the accessibility of information.2
C. Policies and procedures shall include, but are not limited to,3
the following: 4
1. A process to ensure that records will be updated accurately,5
appropriately, and in a timely manner. 6
2. A plan to allow for the complete record to be provided in the7
event of an emergent or nonemergent transfer of care.8
3. A process for disclosing the record only in accordance with9
federal HIPAA/HITECH and state privacy laws. 10
4. A process to ensure the confidentiality of patient records,11
including the prevention of loss, accidental destruction, or the12
unauthorized use and disclosure of the record or its contents.13
5. A plan to allow for patient access to the patient's own record.14
6. A plan to allow for the retention of the record in accordance15
with federal and state law. 16
VI. REPORTING 17
A. The birth center shall have a mechanism for data collection to18
assess efficacy and outcomes. 19
B. A certificate of birth shall be filed for each birth occurring at20
the birth center, in accordance with the requirements mandated by the21
local Office of Vital Statistics, in the county where the birth center is22
located. 23
VII. CLOSURE OF THE CENTER 24
A. In the event of a permanent closure of a birth center, the birth25
center shall make good faith efforts to develop a plan for continuity of26
care for patients, and shall notify the Licensing Agency in writing27
within thirty calendar days of the center ceasing operations.28
B. The birth center shall return the original license certificate to29
the Licensing Agency along with the written notification of closure.30
Sec. 2. An individual or group policy of accident or health31
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insurance that provides newborn care or maternity benefits, not limited1
to complications of pregnancy, may provide coverage for maternity2
services rendered by a Licensed Provider or birth center under the3
Freestanding Birth Center Act. 4
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