Bill > AB387

Introduced Session

Legislative Counsel's Digest: Existing law requires a midwife to perform certain duties relating to reporting 1 births and deaths and testing newborn babies for certain diseases. (NRS 440.100, 2 440.740, 442.008-442.110, 442.600-442.680) Sections 2-32of this bill provide for: 3 (1) the licensure of licensed certified professional midwives by the Division of 4 Public and Behavioral Health of the Department of Health and Human Services; 5 and (2) the regulation of licensed certified professional midwives by the Division 6 and the Board of Licensed Certified Professional Midwives created by section 167 of this bill. Sections 2-14, 45, 69and 73of this bill define certain terms related to 8 the practice of midwifery. Section 15of this bill exempts other providers of health 9 care from requirements governing the licensure and regulation of licensed certified 10 professional midwives. Section 15also authorizes an unlicensed person to engage 11 in the practice of midwifery if that person obtains from each client a statement 12 acknowledging that the person is not regulated by the State. Sections 36, 38, 3913 and 42-44of this bill similarly exempt licensed certified professional midwives and 14 student midwives from provisions governing certain other providers of health care. 15 Licensed certified professional midwives and student midwives would also be 16 exempt from provisions governing allopathic physicians. (NRS 630.047) 17 Section 16creates the Board of Licensed Certified Professional Midwives. 18 Sections 34, 55and 58-62of this bill make various changes to ensure that the 19 Board is treated similarly to other boards that regulate health-related professions. 20 Section 17of this bill prescribes certain requirements concerning the operations 21 and duties of the Board. Section 18of this bill requires the Board to adopt 22 regulations governing midwifery, including requirements governing: (1) programs 23 of training for licensed certified professional midwives; (2) qualifications for 24 licensure as a licensed certified professional midwife; (3) investigation of 25 misconduct and discipline; (4) management of a client who is at a moderate or high 26 risk of an adverse outcome; and (5) certain other aspects of the practice of 27 midwifery. 28 Sections 19, 20and 21of this bill prescribe the requirements for the issuance 29 of a license as a licensed certified professional midwife, a license by endorsement 30 as a licensed certified professional midwife and a permit as a student midwife, 31 respectively. Section 101of this bill revises the requirements for the issuance of a 32 license as a licensed certified professional midwife on January 1, 2024, and section 33 100of this bill removes a reference to a provision removed by section 101. Section 34 22of this bill: (1) authorizes a licensed certified professional midwife to utilize a 35 birth assistant to perform certain simple, routine medical tasks; and (2) prescribes 36 the required training for a birth assistant. 37 Existing federal law requires each state to adopt procedures to ensure that 38 applicants for certain licenses and certificates comply with child support 39 obligations. (42 U.S.C. 666) Sections 23and 29of this bill enact such procedures 40 as applicable to an applicant for a license as a licensed certified professional 41 midwife or a permit as a student midwife in order to comply with federal law. 42 Sections 102and 107of this bill remove a requirement that an application for a 43 license as a licensed certified professional midwife or a permit as a student midwife 44 include the social security number of the applicant on the date that those federal 45 requirements are repealed, while leaving in place the other requirements of sections 46 23and 29until 2 years after that date. Section 33of this bill makes a conforming 47 change to address applicants for licensure who do not have a social security 48 number. 49 Section 24of this bill prescribes the authorized activities of a student midwife 50 and requirements governing the supervision of a student midwife by a preceptor. 51 Section 25of this bill requires a licensed certified professional midwife to obtain 52 informed consent from each client before providing services. 53 Existing law authorizes only certain practitioners who are licensed in this State 54 and registered with the State Board of Pharmacy to prescribe drugs and devices. 55 (NRS 639.235, 639.23505) Sections 26, 40, 41and 76of this bill authorize a 56 licensed certified professional midwife to: (1) order, possess and administer certain 57 drugs, devices, chemicals and solutions; and (2) order certain devices and vaccines 58 for a client. Sections 22, 24and 77of this bill authorize a birth assistant or student 59 midwife to administer certain drugs, devices, chemicals and solutions under the 60 direct supervision of a licensed certified professional midwife. 61 Section 27of this bill imposes specific requirements concerning the 62 management of a client who is at a moderate or high risk of an adverse outcome, 63 and section 103of this bill removes some of those requirements on the effective 64 date of regulations adopted by the Board of Licensed Certified Professional 65 Midwives to replace those requirements. Section 105of this bill creates the 66 Transfer Guidelines Working Group to make recommendations to the Board for 67 regulations governing the transfer of such a client to a medical facility. Section 2768 also exempts: (1) a licensed certified professional midwife from liability resulting 69 from the informed refusal of such a client to consent to consultation, co-70 management with or referral to another provider of health care or transfer to a 71 medical facility or the inability of the licensed certified professional midwife to 72 arrange for such consultation or carry out such co-management, referral or transfer; 73 and (2) other providers of health care from liability for the actions or omissions of a 74 licensed certified professional midwife. 75 Section 28of this bill requires a licensed certified professional midwife to 76 annually report certain information concerning his or her practice to the Division. 77 Section 30of this bill: (1) requires the Division to maintain certain records of 78 proceedings relating to licensing, disciplinary actions and investigations; and (2) 79 declares certain records to be confidential and certain other records to be public. 80 Section 57of this bill makes a conforming change to clarify that confidential 81 records of the Division are not public records. Section 31of this bill makes it a 82 misdemeanor for a person who does not hold a license as a licensed certified 83 professional midwife or a permit as a student midwife to: (1) engage in the practice 84 of midwifery without taking the actions required by section 15: or (2) represent that 85 he or she is licensed to engage in the practice of midwifery. Section 31also makes 86 it a misdemeanor for a student midwife to represent that he or she is qualified to 87 engage in the practice of midwifery without supervision. Section 32of this bill 88 authorizes the Division or the Attorney General to seek an injunction against any 89 person violating any provision of sections 2-32. 90 Existing law defines the term provider of health care as a person who 91 practices any of certain professions related to the provision of health care. (NRS 92 629.031) Existing law imposes certain requirements upon providers of health care, 93 including requirements for billing, standards for advertisements and criminal 94 penalties for acquiring certain debts. (NRS 629.071, 629.076, 629.078) Section 3595 of this bill includes licensed certified professional midwives in the definition of 96 provider of health care, thereby subjecting licensed certified professional 97 midwives to those requirements. Section 75of this bill makes a conforming change 98 to clarify that licensed certified professional midwives are providers of health care. 99 Section 37of this bill requires a licensed certified professional midwife to report 100 misconduct by a person licensed or certified by the State Board of Nursing to the 101 Executive Director of the Board. 102 Sections 48and 49of this bill provide that a licensed certified professional 103 midwife is not liable for civil damages resulting from providing emergency care or 104 gratuitous care to an indigent person under certain circumstances. Section 70of this 105 bill requires a licensed certified professional midwife who attends a birth that 106 occurs outside a hospital which is not also attended by a physician or advanced 107 practice registered nurse to prepare a birth certificate. Section 71of this bill 108 provides for the imposition of a fine upon a person who furnishes false information 109 to a licensed certified professional midwife for the purpose of making incorrect 110 certification of births or deaths. 111 Existing law provides that, in any civil action concerning any unwelcome or 112 nonconsensual sexual conduct, there is a rebuttable presumption that the sexual 113 conduct was unwelcome or nonconsensual if the alleged perpetrator was a person in 114 a position of authority over the alleged victim. (NRS 41.138) Section 47of this bill 115 provides that a licensed certified professional midwife, student midwife or birth 116 assistant is a person of authority for that purpose. 117 Sections 46, 50-54, 63, 64, 66-75and 78-99of this bill make revisions to treat 118 licensed certified professional midwives similarly to other providers of health care 119 in certain respects. Section 65of this bill requires Medicaid to cover the services of 120 a licensed certified professional midwife and provide reimbursement for such 121 services at comparable rates to other providers of health care who provide similar 122 services. Section 56of this bill makes a conforming change to indicate the 123 placement of section 65in the Nevada Revised Statutes. 124 SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Title 54 of NRS is hereby amended by adding 1 thereto a new chapter to consist of the provisions set forth as 2 sections 2to 32, inclusive, of this act. 3 Sec. 2. As used in this chapter, unless the context otherwise 4 requires, the words and terms defined in sections 2 to 14, 5 inclusive, of this act have the meanings ascribed to them in those 6 sections. 7 Sec. 3. Birth assistant means a person who performs 8 routine medical tasks and procedures under the direct supervision 9 of a licensed certified professional midwife. 10 Sec. 4. Board means the Board of Licensed Certified 11 Professional Midwives created by section 16 of this act. 12 Sec. 5. Certified nurse-midwife means a person who is: 13 1. Certified as a nurse-midwife by the American Midwifery 14 Certification Board, or its successor organization; and 15 2. Licensed as an advanced practice registered nurse 16 pursuant to NRS 632.237. 17 Sec. 6. Co-manage means a licensed certified professional 18 midwife jointly managing the care of a client with another 19 provider of health care. 20 Sec. 7. Consult means a client receiving an opinion 21 concerning the management of a particular condition or symptom 22 from an appropriate provider of health care at the direction of a 23 licensed certified professional midwife. 24 Sec. 8. Division means the Division of Public and 25 Behavioral Health of the Department of Health and Human 26 Services. 27 Sec. 9. Licensed certified professional midwife means a 1 person licensed as a licensed certified professional midwife 2 pursuant to section 19 or 20 of this act. 3 Sec. 10. Medical facility has the meaning ascribed to it in 4 NRS 449.0151. 5 Sec. 11. Practice of midwifery means the provision of 6 autonomous care to healthy clients who are at low risk of 7 developing complications before conception, while pregnant and 8 during the postpartum period and to newborn infants for up to 6 9 weeks after childbirth. The term includes, without limitation, co-10 management of the care of a client with a qualified provider of 11 health care. 12 Sec. 12. Provider of health care has the meaning ascribed 13 to it in NRS 629.031. 14 Sec. 13. Refer means a licensed certified professional 15 midwife arranging for another provider of health care to assume 16 primary responsibility for managing a condition or symptom. 17 Sec. 14. Student midwife means a person who holds a 18 permit as a student midwife issued pursuant to section 21 of this 19 act. 20 Sec. 15. 1. Except as otherwise provided in this section and 21 sections 22 and 27 of this act, the provisions of this chapter do not 22 apply to a person who holds a license, certificate or other 23 credential issued pursuant to chapters 630 to 641C, inclusive, of 24 NRS and is practicing within the scope of authority authorized by 25 that license, certificate or other credential. For the purposes of 26 this subsection, a certified nurse-midwife shall be deemed to be 27 practicing within the scope of authority authorized by his or her 28 license as an advanced practice registered nurse. 29 2. A person who is not licensed pursuant to this chapter and 30 engages in the practice of midwifery must: 31 (a) Obtain from each client of the person a statement in the 32 form prescribed by the Division signed by the person and the client 33 stating that: 34 (1) The person is not a licensed certified professional 35 midwife and has not had his or her credentials reviewed by any 36 governmental entity; and 37 (2) There is no state agency that oversees the services 38 provided by the person with which the client may file a complaint 39 concerning those services; and 40 (b) Maintain the statement in the records of the person for at 41 least 5 years after the person ceases providing services to the 42 client. 43 3. This chapter does not prohibit: 44 (a) Gratuitous services of a person in an emergency; or 45 (b) Gratuitous care by friends or by members of the family. 1 Sec. 16. 1. The Board of Licensed Certified Professional 2 Midwives is hereby created. 3 2. The Administrator of the Division shall appoint to the 4 Board: 5 (a) Four voting members who are licensed certified 6 professional midwives currently practicing in this State; 7 (b) One voting member who is a physician currently practicing 8 in the area of pediatrics in this State; 9 (c) One voting member who is a provider of health care, other 10 than a licensed certified professional midwife or a physician 11 practicing in the area of pediatrics, who is currently providing 12 neonatal care in this State; 13 (d) One voting member who is a representative of the general 14 public; and 15 (e) One nonvoting member to serve as a liaison with the 16 Division. 17 3. Each member of the Board must be a resident of this State. 18 4. The Administrator of the Division: 19 (a) May solicit nominations for appointment to the Board from 20 interested persons and entities. 21 (b) Shall give preference when appointing the members of the 22 Board to candidates who have experience collaborating with 23 licensed certified professional midwives or providing or utilizing 24 midwifery services outside of a hospital. 25 5. The Board shall adopt regulations prescribing the terms of 26 its members. Such terms must not exceed 4 years. The 27 Administrator of the Division may: 28 (a) Reappoint a member at the expiration of his or her term; or 29 (b) Terminate a member before the expiration of his or her 30 term for cause. 31 6. A vacancy on the Board must be filled in the same manner 32 as the initial appointment. 33 7. Except as otherwise provided in this subsection, members 34 of the Board serve without compensation. The State Board of 35 Health may, by regulation, provide for compensation of the 36 members of the Board. 37 Sec. 17. 1. A majority of the voting members of the Board 38 constitutes a quorum for the transaction of business, and a 39 majority of a quorum present at any meeting is sufficient for any 40 official action taken by the Board. 41 2. The Board shall: 42 (a) At its first meeting and annually thereafter, elect a Chair 43 from among its members; 44 (b) Meet regularly at the call of the Chair; and 45 (c) Recommend to the Legislature any statutory changes to 1 improve the practice of midwifery in this State. 2 3. To the extent practicable, any advice or recommendations 3 made by the Board concerning the practice of midwifery must be 4 guided by current, peer-reviewed scientific research. 5 Sec. 18. 1. The Board shall adopt any regulations 6 necessary or convenient for carrying out the provisions of this 7 chapter. Those regulations must include, without limitation: 8 (a) Requirements concerning the approval by the Division of 9 programs of training for licensed certified professional midwives 10 and birth assistants, including, without limitation, the required 11 training and instruction that must be provided by such a program 12 and the procedure for obtaining such approval. Those regulations 13 must require that a program for the training of licensed certified 14 professional midwives be accredited by the Midwifery Education 15 Accreditation Council, or its successor organization. 16 (b) Requirements governing the issuance and renewal of a 17 license as a licensed certified professional midwife, including, 18 without limitation: 19 (1) The educational qualifications that, except as otherwise 20 provided in section 19 of this act and in addition to the 21 qualifications prescribed by that section, are necessary to obtain a 22 license pursuant to that section. 23 (2) The period for which a license is valid. 24 (3) A requirement that an applicant for the renewal of a 25 license must have completed continuing education in cultural 26 humility or the elimination of racism or bias. 27 (c) The procedure for filing a complaint with the Division 28 concerning a licensed certified professional midwife or student 29 midwife. 30 (d) Grounds for the Division to impose disciplinary action 31 against a licensed certified professional midwife or student 32 midwife and the procedure by which the Division will impose such 33 disciplinary action. 34 (e) Requirements governing the reinstatement of a license that 35 has been revoked, including, without limitation, the procedure to 36 apply for reinstatement. 37 (f) Regulations governing the ordering, usage and 38 administration of drugs, vaccines, chemicals, solutions and 39 devices pursuant to section 26 of this act. 40 (g) Regulations concerning the management by a licensed 41 certified professional midwife of a client who may have a 42 condition that puts the client at a moderate or high risk of an 43 adverse outcome for the client or the fetus or newborn infant of 44 the client. The regulations must, to the extent practicable, be 45 guided by current, peer-reviewed scientific research and must 1 include, without limitation: 2 (1) A list of conditions or symptoms associated with a risk 3 of serious permanent harm or death to a client or the fetus or 4 newborn infant of a client; 5 (2) A list of conditions or symptoms associated with a risk 6 of greater than minimal harm to a client or the fetus or newborn 7 infant of a client that do not pose a risk of serious permanent 8 harm or death; and 9 (3) Specific requirements for each condition or symptom 10 listed pursuant to subparagraphs (1) and (2) governing: 11 (I) The circumstances under which a licensed certified 12 professional midwife must arrange for the client to consult with 13 another provider of health care, co-manage the care of the client 14 with another provider of health care, refer primary responsibility 15 for the care of a client to another provider of health care or 16 transfer the care of the client to a medical facility, procedures for 17 such consultation, co-management, referral or transfer and 18 requirements to ensure that a provider of health care who is 19 consulted, with whom a client s condition or symptom is co-20 managed or to whom primary responsibility for the care of a client 21 is referred is appropriately qualified; and 22 (II) The information that must be included on the form 23 for providing informed refusal to consent to consultation, co-24 management, referral or transfer pursuant to section 27 of this act 25 and the management of a client who provides such informed 26 refusal to consent. 27 (h) Requirements governing the screening of clients in 28 accordance with chapter 442 of NRS and necessary measures for 29 the prevention of communicable diseases. 30 (i) Requirements concerning the records of treatment and 31 outcomes that must be kept by a licensed certified professional 32 midwife. 33 (j) Any other requirements necessary to optimize obstetrical 34 and neonatal outcomes for clients of licensed certified 35 professional midwives. 36 2. The Board may, by regulation, require an applicant for a 37 license as a licensed certified professional midwife, including, 38 without limitation, an applicant for a license by endorsement 39 pursuant to section 20 of this act, to submit to the Division a 40 complete set of his or her fingerprints and written permission 41 authorizing the Division to forward the fingerprints to the Central 42 Repository for Nevada Records of Criminal History for submission 43 to the Federal Bureau of Investigation for its report. 44 Sec. 19. 1. An applicant for a license as a licensed certified 1 professional midwife, other than a license by endorsement 2 pursuant to section 20 of this act, must submit to the Division an 3 application pursuant to this section in the form prescribed by the 4 Division. The application must be accompanied by a fee in the 5 amount prescribed by regulation of the State Board of Health 6 pursuant to NRS 439.150, which must not exceed $1,000. The 7 application must include, without limitation, proof that the 8 applicant: 9 (a) Is certified as a certified professional midwife by the North 10 American Registry of Midwives, or its successor organization; and 11 (b) Has completed any educational requirements prescribed by 12 the Board pursuant to section 18 of this act or holds a Midwifery 13 Bridge Certificate issued by the North American Registry of 14 Midwives, or its successor organization, and has completed the 15 Portfolio Evaluation Process prescribed by that organization. 16 2. A license as a licensed certified professional midwife may 17 be renewed upon submission to the Division of a renewal 18 application in the form prescribed by the Division. The renewal 19 application must: 20 (a) Be accompanied by a renewal fee in the amount prescribed 21 by regulation of the State Board of Health pursuant to NRS 22 439.150, which must not exceed $1,000; and 23 (b) Include any information required by the regulations 24 adopted by the Board pursuant to section 18 of this act. 25 Sec. 20. 1. The Division shall issue a license by 26 endorsement as a licensed certified professional midwife to an 27 applicant who meets the requirements set forth in this section. An 28 applicant may submit to the Division an application for such a 29 license if the applicant holds a corresponding valid and 30 unrestricted license as a licensed certified professional midwife in 31 the District of Columbia or any state or territory of the United 32 States. 33 2. An applicant for a license by endorsement pursuant to this 34 section must submit to the Division with his or her application: 35 (a) Proof satisfactory to the Board that the applicant: 36 (1) Satisfies the requirements of subsection 1; 37 (2) Has not been disciplined or investigated by the 38 corresponding regulatory authority of the District of Columbia or 39 any state or territory in which the applicant currently holds or has 40 held a license as a licensed certified professional midwife or any 41 other type of midwife; 42 (3) Has not been held civilly or criminally liable for 43 malpractice in the District of Columbia or any state or territory of 44 the United States; 45 (4) Is certified as a certified professional midwife by the 1 North American Registry of Midwives, or its successor 2 organization; and 3 (5) Holds a Midwifery Bridge Certificate issued by the 4 North American Registry of Midwives, or its successor 5 organization, and has completed the Portfolio Evaluation Process 6 prescribed by that organization or meets the educational 7 requirements prescribed by the Board pursuant to section 18 of 8 this act; 9 (b) An affidavit stating that the information contained in the 10 application and any accompanying material is true and correct; 11 (c) The fee prescribed by the State Board of Health pursuant 12 to NRS 439.150, which must not exceed $1,000; and 13 (d) Any other information required by the Division. 14 3. Not later than 15 business days after receiving an 15 application for a license by endorsement as a licensed certified 16 professional midwife pursuant to this section, the Division shall 17 provide written notice to the applicant of any additional 18 information required by the Division to consider the application. 19 Unless the Division denies the application for good cause, the 20 Division shall approve the application and issue a license by 21 endorsement as a licensed certified professional midwife to the 22 applicant not later than: 23 (a) Forty-five days after receiving the application; or 24 (b) If the Board requires the applicant to submit his or her 25 fingerprints pursuant to section 18 of this act, 10 days after the 26 Board receives a report on the applicant s background based on 27 the submission of the applicant s fingerprints, 28 whichever occurs later. 29 Sec. 21. 1. An applicant for a permit as a student midwife 30 must submit to the Division an application in the form prescribed 31 by the Division. The application must be accompanied by a fee of 32 $100 and must include, without limitation: 33 (a) A copy of an agreement with at least one preceptor to 34 supervise the applicant and proof that each preceptor meets the 35 requirements of section 24 of this act; and 36 (b) Proof that the applicant is enrolled in a program of 37 training for licensed certified professional midwives approved by 38 the Division. 39 2. A permit as a student midwife is valid for 2 years after the 40 date of issuance and may be renewed upon submission to the 41 Division of: 42 (a) A renewal application in the form prescribed by the 43 Division; and 44 (b) A renewal fee of $100. 45 3. Upon approving an application for the issuance or renewal 1 of a permit as a student midwife, the Division shall provide to the 2 applicant a written copy of the provisions of section 24 of this act 3 and any regulations adopted pursuant to section 18 of this act that 4 apply to student midwives. 5 Sec. 22. 1. A licensed certified professional midwife may 6 utilize a birth assistant to perform the tasks and procedures 7 authorized by subsection 3. Except as otherwise provided in 8 subsection 2, a birth assistant, including, without limitation, a 9 provider of health care serving as a birth assistant, must: 10 (a) Be at least 18 years of age; 11 (b) Have completed the training for birth assistants approved 12 by the Division; 13 (c) Have completed training in cultural humility or the 14 elimination of racism or bias; 15 (d) Hold current certification in the techniques of 16 administering neonatal resuscitation issued by an instructor 17 certified by the American Academy of Pediatrics, or its successor 18 organization; and 19 (e) Hold current certification in the techniques of 20 administering cardiopulmonary resuscitation. 21 2. A birth assistant who is a licensed certified professional 22 midwife is not required to possess the qualifications set forth in 23 subsection 1. 24 3. A birth assistant may perform routine clinical tasks and 25 procedures under the direct supervision of a licensed certified 26 professional midwife who is present on the premises and able to 27 intervene if necessary. Such tasks include, without limitation: 28 (a) Administering medications, including, without limitation 29 and to the extent applicable, any medication described in 30 subsection 2 of section 26 of this act, intradermally, 31 subcutaneously and intramuscularly and performing skin tests; 32 (b) Providing medication, including, without limitation and to 33 the extent applicable, any medication described in subsection 2 of 34 section 26 of this act, to a patient to self-administer orally, 35 sublingually, topically or rectally; 36 (c) Administering oxygen; 37 (d) Assisting in the care of a newborn infant immediately after 38 birth; 39 (e) Placing a device used for auscultation of fetal heart tones; 40 (f) Assisting a client with activities of daily living and assisting 41 the client in moving between the bed and bathroom; 42 (g) Performing cardiopulmonary or neonatal resuscitation; 43 and 44 (h) Checking vital signs. 45 4. A birth assistant shall not assess clinical information or 1 make clinical decisions. 2 Sec. 23. 1. In addition to any other requirements set forth 3 in this chapter: 4 (a) An applicant for the issuance of a license as a licensed 5 certified professional midwife or a permit as a student midwife in 6 this State shall include the social security number of the applicant 7 in the application submitted to the Division. 8 (b) An applicant for the issuance of a license as a licensed 9 certified professional midwife or a permit as a student midwife in 10 this State shall submit to the Division of Public and Behavioral 11 Health of the Department of Health and Human Services the 12 statement prescribed by the Division of Welfare and Supportive 13 Services of the Department of Health and Human Services 14 pursuant to NRS 425.520. The statement must be completed and 15 signed by the applicant. 16 2. The Division of Public and Behavioral Health of the 17 Department of Health and Human Services shall include the 18 statement required pursuant to subsection 1 in: 19 (a) The application or any other forms that must be submitted 20 for the issuance or renewal of the license or permit; or 21 (b) A separate form prescribed by the Division. 22 3. A license as a licensed certified professional midwife or a 23 permit as a student midwife may not be issued or renewed by the 24 Division if the applicant: 25 (a) Fails to submit the statement required pursuant to 26 subsection 1; or 27 (b) Indicates on the statement submitted pursuant to 28 subsection 1 that the applicant is subject to a court order for the 29 support of a child and is not in compliance with the order or a 30 plan approved by the district attorney or other public agency 31 enforcing the order for the repayment of the amount owed 32 pursuant to the order. 33 4. If an applicant indicates on the statement submitted 34 pursuant to subsection 1 that the applicant is subject to a court 35 order for the support of a child and is not in compliance with the 36 order or a plan approved by the district attorney or other public 37 agency enforcing the order for the repayment of the amount owed 38 pursuant to the order, the Division shall advise the applicant to 39 contact the district attorney or other public agency enforcing the 40 order to determine the actions that the applicant may take to 41 satisfy the arrearage. 42 Sec. 24. 1. A student midwife may engage in the practice of 43 midwifery, including, without limitation, by using or administering 44 any drug, vaccine, device, chemical or solution described in 45 subsection 1, 2 or 3 of section 26 of this act, under the direct 1 supervision of a preceptor who is present on the premises and able 2 to intervene if necessary. The preceptor is responsible for each 3 client to whom the student midwife provides midwifery services. 4 2. A preceptor must be a person engaged in the practice of 5 midwifery who is approved by the North American Registry of 6 Midwives, or its successor organization, to serve as a preceptor. 7 3. A preceptor shall: 8 (a) Provide to each client in the form prescribed by the 9 Division notice that a student midwife may be involved in the care 10 of the client; 11 (b) Explain the scope of the activities that the student midwife 12 may perform under the supervision of the preceptor; and 13 (c) Review and evaluate all care provided by a student midwife 14 under his or her supervision and attend every encounter between 15 the student midwife and a client. 16 4. Not later than 10 days after the preceptor of a student 17 midwife ceases to serve as his or her preceptor, the student 18 midwife shall notify the Division. If the student midwife has no 19 additional preceptor, the student midwife must cease engaging in 20 the practice of midwifery until he or she submits to the Division a 21 written agreement with a new preceptor who meets the 22 requirements of this section. 23 Sec. 25. Upon accepting a client, a licensed certified 24 professional midwife shall obtain from the client informed written 25 consent regarding the care to be provided by the licensed certified 26 professional midwife. Informed written consent requires that the 27 licensed certified professional midwife provide to the client: 28 1. A description of the educational background and 29 credentials of the licensed certified professional midwife; 30 2. A description of the practice of midwifery as set forth in 31 section 11 of this act and the limitations on the practice of a 32 licensed certified professional midwife; 33 3. Instructions for obtaining a copy of the provisions of 34 sections 2 to 32, inclusive, of this act and the regulations adopted 35 pursuant to section 18 of this act; 36 4. Instructions for filing a complaint with the Division in 37 accordance with the regulations adopted pursuant to section 18 of 38 this act; 39 5. A description of the actions that the licensed certified 40 professional midwife will take in an emergency, including, without 41 limitation, the conditions under which the licensed certified 42 professional midwife will recommend the transfer of the client to a 43 medical facility and the procedure that the licensed certified 44 professional midwife will follow when making such a transfer; 45 6. A description of the procedures that will be used during the 1 birth in the client s chosen setting, the risks and benefits of birth 2 in that setting and the conditions that may arise during delivery; 3 7. A disclosure of whether the licensed certified professional 4 midwife holds liability insurance and, if so, the amount for which 5 the licensed certified professional midwife is insured; 6 8. A summary of the provisions of section 27 of this act and 7 the regulations adopted pursuant to section 18 of this act 8 governing consultation, co-management, referral and transfer and 9 a description of the procedures established by the licensed certified 10 professional midwife for consultation, co-management, referral 11 and transfer; and 12 9. Any other information required by regulation of the Board. 13 Sec. 26. 1. A licensed certified professional midwife may 14 use the following devices: 15 (a) Dopplers, syringes, needles, phlebotomy equipment, 16 sutures, urinary catheters, intravenous equipment, amnihooks, 17 airway suction devices, electronic fetal monitors, 18 tocodynamometer monitors, equipment for administering oxygen, 19 glucose monitoring systems and testing strips, neonatal and adult 20 oximetry equipment, centrifuges and equipment for conducting 21 screenings of hearing ability; 22 (b) Equipment for administering nitrous oxide, including, 23 without limitation, scavenging systems; 24 (c) Neonatal and adult resuscitation equipment, including, 25 without limitation, airway devices; and 26 (d) Any other device authorized by regulation of the Board. 27 2. A licensed certified professional midwife may possess and 28 administer: 29 (a) Oxytocin, misoprostol, methylergonovine, tranexamic acid, 30 lidocaine, penicillin, ampicillin, cefazolin, clindamycin, 31 epinephrine, diphenhydramine, ondansetron, phylloquinone, 32 erythromycin ointment and nitrous oxide; 33 (b) Influenza vaccine, hepatitis B vaccine and diphtheria, 34 tetanus and pertussis vaccine; 35 (c) Rho (D) immune globulin and hepatitis B immune 36 globulin; and 37 (d) Any other drugs or vaccines authorized by regulation of the 38 Board. 39 3. A licensed certified professional midwife may possess and 40 administer: 41 (a) Oxygen, lactated Ringers solution, 5 percent dextrose in 42 lactated Ringers solution, 0.9 percent sodium chloride solution 43 and sterile water; and 44 (b) Any other chemicals or solutions authorized by regulation 1 of the Board. 2 4. A licensed certified professional midwife may order for a 3 client: 4 (a) Breast pumps, compression stockings and belts, maternity 5 belts, diaphragms, cervical caps, glucometers, glucose testing 6 strips, iron supplements and prenatal vitamins; and 7 (b) Any vaccine described in paragraph (b) of subsection 2. 8 Sec. 27. 1. Except as otherwise provided in subsections 4 9 and 5, a licensed certified professional midwife must recommend 10 and, with the consent of the client, arrange for consultation or co-11 management with or referral to a qualified provider of health care 12 or transfer to an appropriate medical facility if the licensed 13 certified professional midwife determines that any of the following 14 conditions or symptoms exist: 15 (a) Complete placenta previa; 16 (b) Partial placenta previa after the 27th week of gestation; 17 (c) Infection with the human immunodeficiency virus; 18 (d) Cardiovascular disease; 19 (e) Severe mental illness that may cause the client to cause 20 harm to themselves or others; 21 (f) Pre-eclampsia or eclampsia; 22 (g) Fetal growth restriction, oligohydramnios or moderate or 23 severe polyhydramnios in the pregnancy; 24 (h) Potentially serious anatomic fetal abnormalities; 25 (i) Diabetes that requires insulin or other medication for 26 management; 27 (j) Gestational age of greater than 43 weeks; or 28 (k) Any other condition or symptom which, in the judgment of 29 the licensed certified professional midwife, could threaten the life 30 of the client or the fetus or newborn infant of the client. 31 2. Except as otherwise provided in subsections 4 and 5, a 32 licensed certified professional midwife must recommend and, with 33 the consent of the client, arrange for consultation or co-34 management with or referral to a qualified provider of health care 35 if the licensed certified professional midwife determines that any 36 of the following conditions or symptoms exist: 37 (a) Prior cesarean section or other surgery resulting in a 38 uterine scar; 39 (b) Multifetal gestation; or 40 (c) Non-cephalic presentation after 36 weeks of gestation. 41 3. A licensed certified professional midwife who recommends 42 to a client consultation, co-management, referral or transfer shall 43 document in the record of the client: 44 (a) The contents of the recommendation; 45 (b) The condition or symptom for which the recommendation 1 was made; 2 (c) Whether the client consented to the consultation, co-3 management, referral or transfer; and 4 (d) If the client provides consent, the name, profession and 5 specialty of the provider of health care with whom the licensed 6 certified professional midwife consulted or co-managed or to 7 whom the client was referred or the medical facility to which the 8 client was transferred. 9 4. A client may provide informed refusal to consent to 10 consultation, co-management, referral or transfer in writing on a 11 form prescribed by the Division. If a client provides informed 12 refusal to consent to: 13 (a) Consultation, co-management, referral or transfer after the 14 licensed certified professional midwife has determined that a 15 condition or symptom described in subsection 1 exists, the licensed 16 certified professional midwife must attempt to locate a qualified 17 provider of health care for which the client consents to 18 consultation, co-management or referral or an appropriate 19 medical facility for which the client consents to transfer. If the 20 licensed certified professional midwife is unable to locate such a 21 provider of health care who is willing to consult, co-manage or 22 accept the referral or such a medical facility which is willing to 23 accept the transfer, the licensed certified professional midwife is 24 not liable for any damages resulting from the failure to consult, 25 co-manage, refer or transfer. If the condition or symptom 26 threatens the life or health of the client or the fetus or the 27 newborn infant of the client during labor or delivery, the licensed 28 certified professional midwife must call 911 and provide care until 29 relieved by a qualified provider of health care. 30 (b) Consultation, co-management or referral after the licensed 31 certified professional midwife has determined that a condition or 32 symptom described in subsection 2 exists, the licensed certified 33 professional midwife: 34 (1) May continue to serve as the primary provider of health 35 care for the client until the client provides such consent; and 36 (2) Is not liable for any damages resulting from the failure 37 to consult, co-manage or refer. 38 5. If, after determining that a condition or symptom described 39 in: 40 (a) Subsection 1 exists and making a reasonable effort to 41 arrange for consultation with, co-management of the condition or 42 symptom with or referral of the client to a qualified provider of 43 health care or the transfer of the client to an appropriate medical 44 facility, a licensed certified professional midwife is unable to 45 locate a qualified provider of health care who is willing to consult, 1 co-manage or accept the referral or an appropriate medical 2 facility willing to accept the transfer, the licensed certified 3 professional midwife shall be deemed to be in compliance with the 4 requirements of this section and is not liable for any damages 5 resulting from the inability of the licensed certified professional 6 midwife to consult, co-manage, refer or transfer. If the condition 7 or symptom threatens the life or health of the client or the fetus or 8 newborn infant of the client during labor or delivery, the licensed 9 certified professional midwife must call 911 and provide care until 10 relieved by a qualified provider of health care. 11 (b) Subsection 2 exists and making a reasonable effort to 12 arrange for consultation with, co-management of the condition or 13 symptom with or referral of the client to a qualified provider of 14 health care, a licensed certified professional midwife is unable to 15 locate a qualified provider of health care who is willing to consult, 16 co-manage or accept the referral, the licensed certified 17 professional midwife shall be deemed to be in compliance with the 18 requirements of this section and is not liable for any damages 19 resulting from the inability of the licensed certified professional 20 midwife to arrange for consultation, co-manage or refer. 21 6. A provider of health care who is not a licensed certified 22 professional midwife is not liable for any damages resulting from 23 any act or omission of a licensed certified professional midwife 24 and is not required to adhere to any standards of care governing 25 the practice of midwifery. Such a provider of health care is only 26 liable for the damages resulting from his or her own acts or 27 omissions in accordance with the standards of care governing his 28 or her profession. 29 Sec. 28. 1. On or before January 31 of each year, a 30 licensed certified professional midwife shall submit to the Division 31 a report that includes, for the immediately preceding calendar 32 year: 33 (a) The total number of clients who, when accepted by the 34 licensed certified professional midwife as clients, intended to 35 deliver their babies outside of a hospital; 36 (b) The number of live births attended by the licensed certified 37 professional midwife outside of a hospital; 38 (c) The number of cases of fetal demise, deaths of newborns 39 and maternal deaths attended by the licensed certified professional 40 midwife; 41 (d) The number of clients transferred to a medical facility 42 during the antepartum, intrapartum or immediate postpartum 43 periods and the reason for and outcome of each such transfer; 44 (e) A brief description of any complications resulting in 1 maternal or infant morbidity or mortality; 2 (f) The planned location and actual location of each delivery; 3 and 4 (g) Any other information required by regulation of the Board. 5 2. Not later than 30 days after attending a maternal or 6 newborn infant death, a licensed certified professional midwife 7 shall report the death to the Division and the Board. 8 Sec. 29. 1. If the Division receives a copy of a court order 9 issued pursuant to NRS 425.540 that provides for the suspension 10 of all professional, occupational and recreational licenses, 11 certificates and permits issued to a person who is the holder of a 12 license or permit issued pursuant to this chapter, the Division 13 shall deem the license or permit issued to that person to be 14 suspended at the end of the 30th day after the date on which the 15 court order was issued unless the Division receives a letter issued 16 to the holder of the license by the district attorney or other public 17 agency pursuant to NRS 425.550 stating that the holder of the 18 license has complied with the subpoena or warrant or has satisfied 19 the arrearage pursuant to NRS 425.560. 20 2. The Division shall reinstate a license or permit issued 21 pursuant to this chapter that has been suspended by a district 22 court pursuant to NRS 425.540 if: 23 (a) The Division receives a letter issued by the district attorney 24 or other public agency pursuant to NRS 425.550 to the person 25 whose license or permit was suspended stating that the person 26 whose license or permit was suspended has complied with the 27 subpoena or warrant or has satisfied the arrearage pursuant to 28 NRS 425.560; and 29 (b) The person whose license or permit was suspended pays the 30 appropriate fee required pursuant to this chapter. 31 Sec. 30. 1. The Division shall keep a record of its 32 proceedings relating to licensing, disciplinary actions and 33 investigations. Except as otherwise provided in this chapter, the 34 record must be open to public inspection at all reasonable times. 35 2. Except as otherwise provided in this section and NRS 36 239.0115, a complaint filed with the Division, all documents and 37 other information filed with the complaint and all documents and 38 other information compiled as a result of an investigation 39 conducted to determine whether to initiate disciplinary action 40 against a person are confidential and privileged, unless the person 41 submits a written statement to the Division requesting that such 42 documents and information be made public records. 43 3. A complaint or other document filed by the Division to 44 initiate disciplinary action, any written opinion rendered by the 45 Division and all documents and information considered by the 1 Division when determining whether to impose discipline are public 2 records. 3 4. An order that imposes discipline and the findings of fact 4 and conclusions of law supporting that order are public records. 5 5. The provisions of this section do not prohibit the Division 6 from communicating or cooperating with or providing any 7 documents or other information to any other licensing board or 8 any other agency that is investigating a person, including, without 9 limitation, a law enforcement agency. 10 Sec. 31. 1. A person who is not licensed as a licensed 11 certified professional midwife or does not hold a permit as a 12 student midwife or a person whose license as a licensed certified 13 professional midwife or permit as a student midwife has been 14 suspended or revoked by the Division shall not: 15 (a) Engage in the practice of midwifery without complying 16 with the requirements of subsection 2 of section 15 of this act; 17 (b) Use in connection with his or her name the words 18 licensed certified professional midwife, certified professional 19 midwife, licensed midwife or student midwife or any other 20 letters, words or insignia indicating or implying that he or she is 21 licensed or holds a permit to engage in the practice of midwifery, 22 or in any other way, orally, or in writing or print, or by sign, 23 directly or by implication, represent himself or herself as licensed 24 or holding a permit engage in the practice of midwifery in this 25 State; or 26 (c) List or cause to have listed in any directory, including, 27 without limitation, a telephone directory, his or her name or the 28 name of his or her company under the heading licensed certified 29 professional midwife, certified professional midwife, licensed 30 midwife or any other term that indicates or implies that he or she 31 is licensed or holds a permit to engage in the practice of midwifery 32 in this State. 33 2. A student midwife shall not use in connection with his or 34 her name the words licensed certified professional midwife, 35 certified professional midwife, licensed midwife or any other 36 letters, words or insignia indicating or implying that he or she is 37 licensed to engage in the practice of midwifery without 38 supervision, or in any other way, orally, or in writing or print, or 39 by sign, directly or by implication, represent himself or herself as 40 licensed to engage in the practice of midwifery without supervision 41 in this State. 42 3. A person or entity shall not operate a program of training 43 for licensed certified professional midwives or birth assistants or 44 advertise or otherwise represent that the person or entity is 45 authorized to operate such a program unless the person or entity 1 has been approved to offer such a program by the Division. 2 4. A person who violates any provision of this section is guilty 3 of a misdemeanor. 4 Sec. 32. 1. The Division or the Attorney General may 5 maintain in any court of competent jurisdiction a suit to enjoin 6 any person from violating a provision of this chapter or any 7 regulations adopted pursuant thereto. 8 2. Such an injunction: 9 (a) May be issued without proof of actual damage sustained by 10 any person as a preventive or punitive measure. 11 (b) Does not relieve any person or business entity from any 12 other legal action. 13

AI Summary

Committee Categories

Maggie Carlton (D)*,  Michelle Gorelow (D)*,  Daniele Monroe-Moreno (D)*,  Sarah Peters (D)*,  Shondra Summers-Armstrong (D)*,  Natha Anderson (D),  Shannon Bilbray-Axelrod (D),  Tracy Brown-May (D),  Bea Duran (D),  Jason Frierson (D),  Cecelia González (D),  Rochelle Nguyen (D),  Selena Torres-Fossett (D), 

(No further action taken.) (on 06/03/2021)

Official Document