PRINTER'S NO. 1754
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1262
Session of
2024
INTRODUCED BY BROWN, BAKER, VOGEL, BREWSTER, COSTA, FONTANA,
J. WARD, SCHWANK, CAPPELLETTI, HAYWOOD, SAVAL AND COMITTA,
JUNE 24, 2024
REFERRED TO CONSUMER PROTECTION AND PROFESSIONAL LICENSURE,
JUNE 24, 2024
AN ACT
Amending the act of December 20, 1985 (P.L.457, No.112),
entitled "An act relating to the right to practice medicine
and surgery and the right to practice medically related acts;
reestablishing the State Board of Medical Education and
Licensure as the State Board of Medicine and providing for
its composition, powers and duties; providing for the
issuance of licenses and certificates and the suspension and
revocation of licenses and certificates; provided penalties;
and making repeals," further providing for definitions, for
midwifery and for nurse-midwife license; and providing for
certified midwife license.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The definitions of "medical training facility"
and "midwife or nurse-midwife" in section 2 of the act of
December 20, 1985 (P.L.457, No.112), known as the Medical
Practice Act of 1985, are amended to read:
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
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"Medical training facility." A medical college, hospital or
other institution which provides courses in the art and science
of medicine and surgery and related subjects for the purpose of
enabling a matriculant to qualify for a license to practice
medicine and surgery, graduate medical training, [midwife]
nurse-midwife certificate or physician assistant license.
* * *
"Midwife [or nurse-midwife]." An individual who is licensed
as a [midwife] nurse-midwife under section 35 or a certified
midwife under section 35.1 by the board.
* * *
Section 2. Section 12(b) of the act is amended to read:
Section 12. Midwifery.
* * *
(b) Use of title.--A [midwife may ] nurse-midwife and a
certified midwife may also use the title midwife[, nurse-
midwife] or an appropriate abbreviation of [those titles] the
title.
* * *
Section 3. Section 35(c) and (d) of the act are amended and
the section is amended by adding subsections to read:
Section 35. Nurse-midwife license.
* * *
(c) Authorization.--
(1) A nurse-midwife is authorized to practice midwifery
[pursuant to a collaborative agreement with a physician and
regulations promulgated by the board.] under the following
conditions:
(i) A nurse-midwife who is not an employee of a
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public or private health system, hospital, licensed birth
center or part of an interdisciplinary group practice in
which at least one physician practices in the specialty
area of the care the nurse-midwife will provide, shall
practice pursuant to a collaborative agreement with a
physician or physician interdisciplinary group practice
in accordance with the regulations promulgated by the
board.
(ii) A nurse-midwife who is an employee of a public
or private health system, hospital, licensed birth center
or part of an interdisciplinary group practice in which
at least one physician practices in the specialty area of
the care the nurse-midwife will provide, shall obtain and
maintain clinical staff privileges at the public or
private health system, hospital, licensed birth center
and shall adhere to the established internal mechanisms
at the facility of the public or private health system,
hospital, licensed birth center for quality improvement,
consultation, collaboration or referral in accordance
with the nurse-midwife's clinical practice privileges and
the facility's policies and procedures as approved by the
Department of Health.
(2) A nurse-midwife who possesses a master's degree or
its substantial equivalent and national certification may
prescribe, dispense, order and administer drugs, including
legend drugs and Schedule II through Schedule V controlled
substances, as defined in the act of April 14, 1972 (P.L.233,
No.64), known as The Controlled Substance, Drug, Device and
Cosmetic Act, provided that the nurse-midwife demonstrates to
the board that:
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(i) The nurse-midwife has successfully completed at
least 45 hours of coursework specific to advanced
pharmacology at a level above that required by a
professional nursing education program.
(ii) As a condition of biennial license renewal by
the board, a nurse-midwife shall complete the continuing
education requirement as required by the act of May 22,
1951 (P.L.317, No.69), known as The Professional Nursing
Law. In case of a nurse-midwife who has prescriptive
authority under this act, the continuing education
required by The Professional Nursing Law shall include at
least 16 hours in pharmacology in that two-year period.
[(iii) The nurse-midwife acts in accordance with a
collaborative agreement with a physician which shall at a
minimum identify the categories of drugs from which the
nurse-midwife may prescribe or dispense and the drugs
which require referral, consultation or comanagement.]
(iv) The nurse-midwife acts in accordance with the
following restrictions:
(A) A nurse-midwife shall not prescribe,
dispense, order or administer a controlled substance
except for a woman's acute pain[.], for a woman's
medication-assisted treatment for opioid use disorder
or for primary gynecologic health conditions.
(B) In the case of a Schedule II controlled
substance for acute pain, the dose shall be limited
to 72 hours and shall not be extended except with the
approval of the collaborating physician.
(C) In the case of a Schedule III or IV
controlled substance, the prescription shall be
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limited to 30 days and shall only be refilled with
the approval of [the] a collaborating physician.
[(B) A nurse-midwife shall prescribe, dispense,
order or administer psychotropic drugs only after
consulting with the collaborating physician.]
(D) A nurse-midwife when working with a
physician or physician group prescribing medication
treatment for opioid use disorder may prescribe,
dispense, order and administer United States Food and
Drug Administration-approved prescription drugs,
including buprenorphine, methadone and naltrexone,
for medication-assisted treatment for opioid use
disorders consistent with Federal laws and
regulations.
(3) A nurse-midwife may, [in accordance with a
collaborative agreement with a physician and] consistent with
the nurse-midwife's academic educational preparation and
national certification, prescribe, dispense, order and
administer:
(i) Medical devices.
(ii) Immunizing agents.
(iii) Laboratory tests.
(iv) Therapeutic, diagnostic and preventative
measures.
[(d) Collaborative agreements.--The physician with whom a
nurse-midwife has a collaborative agreement shall have hospital
clinical privileges in the specialty area of the care for which
the physician is providing collaborative services.]
(e) Consultation, collaboration or referral.--
(1) A nurse-midwife who is an employee of a public or
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private health system, hospital, licensed birth center or
part of an interdisciplinary group practice in which at least
one physician practices in the specialty area of the care the
nurse-midwife will provide, shall identify deviations from
normal and appropriate interventions, including the
management of complications and emergencies utilizing
consultation, collaboration or referral to or with a
physician as indicated by the health status of a patient. A
consultation between a nurse-midwife and a physician shall
not alone establish a physician-patient relationship or any
other legal relationship with the physician. A nurse-midwife
shall be solely responsible for the services the nurse-
midwife provides to a patient.
(2) In order to maintain safe midwifery practice during
a collaboration with a physician, a nurse-midwife shall, at a
minimum, take all of the following actions:
(i) Maintain a medical record for each patient.
(ii) In the case of a transfer of care to another
health care provider or facility, transfer a patient's
medical records to the health care provider or facility.
(f) Disclosures.--A nurse-midwife who is not an employee of
a public or private health system, hospital, licensed birth
center or part of an interdisciplinary group practice in which
at least one physician practices in the specialty area of the
care the midwife will provide, shall disclose, verbally and in
written form, the information specified in paragraphs (1) and
(2) to a prospective patient at the beginning of the
professional relationship between nurse-midwife and the patient.
The discussion must be documented by the use of a disclosure
form. The patient shall sign and date the disclosure under this
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subsection at the same time the nurse-midwife and patient enter
into an agreement for services. The nurse-midwife shall file
this disclosure under this subsection in the patient's medical
record. The disclosure shall include all the following
information:
(1) The nurse-midwife's name.
(2) The patient's name, contact information and the name
of the patient's primary care provider, if applicable.
(3) An individual emergency plan established between the
nurse-midwife and patient. The plan shall include all of the
following:
(i) The patient's name, address and telephone
number.
(ii) The arrangements for transport from the
delivery site to a nearby hospital with obstetric
services.
(iii) The name, address and telephone number of the
hospital with obstetric services that will be used for an
emergency transfer.
(iv) The name, address and telephone number of the
hospital with obstetric services that will be used for a
nonemergency transfer.
(v) The name and telephone number of the
collaborating physician or another physician, group
practice, public or private health system or hospital
with which the nurse-midwife has a collaborative
agreement or which provides backup care or co-management
care to the patient.
Section 4. The act is amended by adding a section to read:
Section 35.1. Certified midwife license.
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(a) General rule.--A certified midwife license shall empower
the licensee to practice midwifery in this Commonwealth as
provided in this act. The board shall issue rules and promulgate
regulations as may be necessary for the examination, licensing
and proper conduct of the practice of midwifery.
(b) Requirements.--An applicant for a certified midwife
license must have completed an academic and clinical program of
study in midwifery which has been approved by the board or an
accrediting body recognized by the board.
(c) Authorization.--
(1) A certified midwife may practice midwifery under the
following conditions:
(i) A certified midwife who is not an employee of a
public or private health system, hospital, licensed birth
center or part of an interdisciplinary group practice in
which at least one physician practices in the specialty
area of the care the midwife will provide, shall practice
pursuant to a collaborative agreement with a physician or
physician interdisciplinary group practice in accordance
with the regulations promulgated by the board.
(ii) A certified midwife who is an employee of a
public or private health system, hospital, licensed birth
center or part of an interdisciplinary group practice in
which at least one physician practices in the specialty
area of the care the midwife will provide, shall obtain
and maintain clinical staff privileges at the public or
private health system, hospital or licensed birth center
and shall adhere to the established internal mechanisms
at the facility of the public or private health system,
hospital or licensed birth center for quality
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improvement, consultation, collaboration or referral in
accordance with the certified midwife's clinical practice
privileges and the facility's policies and procedures as
approved by the Department of Health.
(2) A certified midwife who possesses a master's degree
or its substantial equivalent and national certification may
prescribe, dispense, order and administer drugs, including
legend drugs and Schedule II through Schedule V controlled
substances, as defined in the act of April 14, 1972 (P.L.233,
No.64), known as The Controlled Substance, Drug, Device and
Cosmetic Act, if the certified midwife demonstrates to the
board that:
(i) The certified midwife has successfully completed
at least 45 hours of coursework specific to advanced
pharmacology during their midwifery education.
(ii) As a condition of biennial license renewal by
the board, a certified midwife shall complete at least 16
hours of continuing education in pharmacology in that
two-year period. Beginning with the license period
designated by regulation, licensees shall be required to
attend and complete 30 hours of mandatory continuing
education during each two-year license period. Nationally
certified education courses shall be considered as
creditable, in addition to any other courses the board
deems creditable toward meeting the requirements for
continuing education.
(iii) An individual applying for the first time for
licensure in this Commonwealth shall be exempted from the
continuing education requirement for the biennial renewal
period following initial licensure.
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(iv) The certified midwife acts in accordance with
the following restrictions:
(A) A certified midwife shall not prescribe,
dispense, order or administer a controlled substance
except for a woman's acute pain, for a woman's
medication assisted treatment for opioid use
disorder, or for primary gynecologic health
conditions.
(B) For a Schedule II controlled substance for
acute pain, the dose shall be limited to 72 hours and
shall not be extended except with the approval of a
collaborating physician.
(C) For a Schedule III or IV controlled
substance, the prescription shall be limited to 30
days and shall only be refilled with the approval of
the collaborating physician.
(D) A certified midwife, when working with a
physician or physician group prescribing medication
treatment for opioid use disorder, may prescribe,
dispense, order and administer United States Food and
Drug Administration-approved prescription drugs,
including buprenorphine, methadone and naltrexone,
for medication-assisted treatment for opioid use
disorders consistent with Federal laws and
regulations.
(3) A certified midwife may, consistent with the
certified midwife's academic educational preparation and
national certification, prescribe, dispense, order and
administer:
(i) Medical devices.
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(ii) Immunizing agents.
(iii) Laboratory tests.
(iv) Therapeutic, diagnostic and preventative
measures.
(d) (Reserved).
(e) Consultation, collaboration or referral.--
(1) A certified midwife who is an employee of a public
or private health system, hospital, licensed birth center or
part of an interdisciplinary group practice in which at least
one physician practices in the specialty area of the care the
midwife will provide, shall identify deviations from normal
and appropriate interventions, including the management of
complications and emergencies utilizing consultation,
collaboration or referral to or with a physician as indicated
by the health status of a patient. A consultation between a
certified midwife and a physician shall not alone establish a
physician-patient relationship or any other legal
relationship with the physician. A certified midwife shall be
solely responsible for the services the certified midwife
provides to a patient.
(2) In order to maintain safe midwifery practice during
a collaboration with a physician, a certified midwife shall,
at a minimum, take all of the following actions:
(i) Maintain a medical record for each patient.
(ii) In the case of a transfer of care to another
health care provider or facility, transfer a patient's
medical records to the health care provider or facility.
(f) Disclosures.--A certified midwife who is not an employee
of a public or private health system, hospital, licensed birth
center or part of an interdisciplinary group practice in which
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at least one physician practices in the specialty area of the
care the midwife will provide, shall disclose, verbally and in
written form, the information specified in paragraphs (1) and
(2) to a prospective patient at the beginning of the
professional relationship between certified midwife and the
patient. The discussion must be documented by the use of a
disclosure form. The patient shall sign and date the disclosure
under this subsection at the same time the nurse-midwife and
patient enter into an agreement for services. The certified
midwife shall file the disclosure under this subsection in the
patient's medical record. The disclosure shall include all the
following information:
(1) The certified midwife's name.
(2) The patient's name, contact information and the name
of the patient's primary care provider, if applicable.
(3) An individual emergency plan established between the
certified midwife and patient. The plan shall include all of
the following:
(i) The patient's name, address and telephone
number.
(ii) The arrangements for transport from the
delivery site to a nearby hospital with obstetrics
services.
(iii) The name, address and telephone number of the
hospital with obstetric services that will be used for an
emergency transfer.
(iv) The name, address and telephone number of the
hospital with obstetric services that will be used for a
nonemergency transfer.
(v) The name and telephone number of the
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collaborating physician or another physician, group
practice, public or private health system or hospital
with which the certified midwife has a collaborative
agreement or which provides backup care or co-management
care to the patient.
(g) Mcare Act.--A certified midwife licensed under this
section is subject to the same provisions as a certified nurse
midwife is under the act of March 20, 2002 (P.L.154, No.13),
known as the Medical Care Availability and Reduction of Error
(Mcare) Act.
Section 5. This act shall take effect in 60 days.
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