SB 370: RELATING TO MIDWIVES.

THE SENATE	S.B. NO.	370
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 (2022), 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 exemptions have been implemented.

     Since the enactment of chapter 457J, more than 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 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 creates 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 made available 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:

     "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.

     "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.

     "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 and by meeting other requirements for certification by the North American Registry of Midwives.

     "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.

     "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 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 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 and by meeting other requirements for certification by the North American Registry of Midwives.

     "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;

          (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)  May grant permission to a person to use the title "licensed midwife" pursuant to this part and any rules adopted pursuant to this part;

     (2)  May 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;

     (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-9, 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 midwife shall at all times practice within the scope of applicable nationally established standards, including standards deliniated 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 may 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)  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, 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 limited 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.

     §457-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  Limited 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 controlled substances or prescription drugs; 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 the authority to prescribe prescription drugs and controlled substances 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 prescriptive authority shall maintain national certification, as required by section 457J-B, unless the department grants an exception.

     (e)  Each certified professional 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 professional midwife may be readily verified using this specific identifier.

     (f)  The 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 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.

     §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.

     (d)  Nothing in this part shall be construed to prohibit traditional Native Hawaiian healing practices related to prenatal, maternal, or child care.  Nothing in this part shall be construed to limit, alter, or otherwise adversely impact any traditional Native Hawaiian practices related to pregnancy or birth that are protected by the Constitution of the State of Hawaii.

     (e)  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 parinatal 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 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;

     (8)  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;

     (9)  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 patient 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 patient 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-J  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-K  Issuance of a license.  The director may issue a license to any person who meets all licensure requirements and pays the appropriate fees.

     §457J-L  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-M 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-N  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-O  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, in addition to any disciplinary actions taken by the director.

     §457J-P  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 midwifery without a license;

     (7)  The total number of complaints filed in the previous year against traditional birthing 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;

     (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;

          (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:

Establishes 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.