HB4440ham001 95TH GENERAL ASSEMBLY

Health Care Availability and Access Committee

Filed: 3/11/2008

09500HB4440ham001 LRB095 14153 RAS 46701 a

AMENDMENT TO HOUSE BILL 4440

AMENDMENT NO. ______. Amend House Bill 4440 by replacing everything after the enacting clause with the following:

"Section 1. Short title. This Act may be cited as the Certified Professional Midwife Licensure Act.

Section 5. Findings and purpose. This Act is intended to establish a licensing procedure for certified professional midwives in Illinois. The General Assembly finds and declares the following:

(1) The intent of this Act is to encourage and enable the practice of midwifery by certified professional midwives so that this profession can be recognized and regulated independently, according to the principles recommended by the Pew Health Professions Commission and the American Public Health Association, to increase the availability of midwives to meet the maternal-child health needs of Illinois families.

(2) Consumers continue to request the care of direct-entry midwives.

(3) Direct-entry midwives have continued to provide services to families in Illinois despite being unregulated since 1963 and have participated in national credentialing organized to meet professional standards.

(4) The Midwives Model of Care, as defined by the Midwifery Task Force, includes (i) monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle, (ii) providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support, (iii) minimizing technological interventions, and (iv) identifying and referring women who require obstetrical attention. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and Cesarean section.

(5) In recognition of major changes in health care regulation and practice, the Pew Health Professions Commission, through its Taskforce on Health Care Workforce Regulation, recommends that "until national models for scopes of practice can be developed and adopted, states should explore and develop mechanisms for existing professions to evolve their existing scopes of practice and for new professions (or previously unregulated professions) to emerge", and further recommends that "a number of professions and disciplines that use non-mainstream therapies safely and effectively should be recognized and regulated as appropriate".

(6) In its April 1999 report, the Pew Health Professions Commission, in conjunction with the Center for the Health Professions, recommended that "midwives should be recognized as independent and collaborative practitioners" and recommended "legislative action that ensures: appropriate entry-to-practice standards" and the "elimination of requirements that midwives be directed or supervised by other health care professionals".

(7) In its resolution, "Increasing access to out-of-hospital maternity care services through state-regulated and nationally-certified direct-entry midwives", the American Public Health Association (i) supports efforts to increase access to out-of-hospital maternity care services and increase the range of quality maternity care choices available to consumers, through recognition that legally regulated and nationally certified direct-entry midwives can serve clients desiring safe, planned, out-of-hospital maternity care services, and (ii) encourages the development and implementation of guidelines for the licensing and certification of direct-entry midwives and the practice of midwifery for use by state and local health agencies, health planners, maternity care providers, and professional organizations.

Section 10. Definitions. As used in this Act:

"Approved program of midwifery education" means an education program accredited or pre-accredited by a direct-entry midwifery accreditation agency recognized by the United States Department of Education, such as the Midwifery Education Accreditation Council (MEAC) or its successor.

"Certified professional midwife" means a person who has met the standards for certification set by the North American Registry of Midwives or its successor and has been awarded this credential.

"Consultation" means the process whereby a licensed midwife seeks the advice or opinion of a physician or another member of a health care team.

"Council" means the Licensed Midwife Council.

"Department" means the Department of Financial and Professional Regulation.

"Secretary" means the Secretary of Financial and Professional Regulation.

"Informed consent" means a document that includes, but is not limited to, disclosure of the midwife's education, skill level, liability insurance coverage, and written plan for medical emergencies.

"Licensed midwife" means a person who is licensed under this Act.

"Midwifery" means the provision, on a continuing basis and within a health care system that provides for consultation and referral as needed, of the necessary care and education to women during pregnancy, labor, and the postpartum and interpartum periods; attending deliveries that the individual is responsible for; and caring for the newborn infant. "Midwifery" also includes the provision of additional primary health care services to women and their families, which include, but are not limited to, well-woman gynecological services such as non-pharmacological family planning and routine pap smears.

"North American Registry of Midwives" or "NARM" means the international agency, or its successor, that has established and has continued to administer certification for the credentialing of certified professional midwives.

"Peer review" means an educational review process in accordance with current NARM peer review standards that includes a certificate of participation document.

"Referral" means the process whereby a licensed midwife directs the client to a physician or other health care professional for management of a particular problem or aspect of the client's care.

Section 15. License required.

(a) Beginning July 1, 2009, no person shall practice midwifery in this State without a license under this Act, except as provided in Section 20.

(b) No person shall use in connection with the person's name any letters, words, or insignia indicating or implying that the person is a licensed midwife unless the person is licensed in accordance with this Act. A person so licensed may use the abbreviation "L.M." in connection with the person's name.

Section 20. Exemptions. Nothing in this Act shall be construed to prohibit or to require registration under this Act, with regard to any of the following:

(1) The gratuitous rendering of services.

(2) The rendering of services by a person if such attendance is in accordance with the person's religious faith and is rendered to persons with a similar religious faith.

(3) Certified nurse midwives authorized under the Advanced Practice Nursing Board to practice in Illinois.

(4) Licensed physicians or other licensed health care providers authorized to provide maternity care.

(5) Midwifery that is included in the educational programs of student midwives enrolled in approved programs of midwifery education.

Section 25. Licensed Midwife Council. There shall be established within the Department of Financial and Professional Regulation a Licensed Midwife Council composed of 7 members appointed by the Secretary. The appointed members of the Council shall include 4 licensed midwives and 3 consumers. A consumer is a person who (i) has never been a midwife nor studied to be a midwife, (ii) has no financial interest in the practice of midwifery or in any health care facility, agency, or insurer, and (iii) has engaged a provider who practices or has practiced as a midwife in an out-of-hospital birth setting. Of the members first appointed to the Council, 3 members shall be appointed for a term of 3 years, 2 members shall be appointed for a term of 2 years, and 2 members shall be appointed for a term of one year. Thereafter, all members shall serve 3-year terms. In making appointments to the Council, the Secretary shall consider the recommendations of individuals and organizations directly involved with midwifery in this State. A vacancy in an unexpired term shall be filled in the same manner as the original appointment. The Secretary may remove a Council member for misconduct, incapacity, or neglect of duty, but only after notice and a public hearing, unless the notice and hearing are waived by the member in writing. The Council shall elect from its membership a chairperson. The Council may meet as needed, but shall meet at least twice a year.

Section 30. Powers of the Council. The Licensed Midwife Council is authorized to:

(1) Conduct hearings and disciplinary conferences on disciplinary charges of those licensed as provided in Section 75 and those in violation of Section 15.

(2) Report to the Department, upon completion of a hearing, the disciplinary actions recommended to be taken against a person violating this Act.

(3) Approve, deny, or withdraw approval of required education and continuing educational programs.

Section 35. Council members; immunity from suit. The members of the Council are immune from suit in any action based upon disciplinary proceedings or other acts performed as members of the Council, except those involving willful or wanton misconduct.

Section 40. Council members; compensation. Members of the Council shall serve without compensation, but shall be reimbursed for actual expenses necessarily incurred in the discharge of their duties.

Section 45. Powers and duties of the Department.

(a) The Department shall exercise the powers and duties necessary to effectuate the purposes of this Act. None of the functions, powers, or duties of the Department with respect to licensure shall be exercised by the Department except upon review and approval by the Council.

(b) The Department shall have the authority and responsibility to:

(1) license individuals who qualify for licensure; and

(2) issue quarterly reports to the Council on the status of all formal complaints filed by the Department and on significant issues as determined by the Council.

Section 50. Eligibility.

(a) A person is eligible to be licensed as a midwife if that person meets the following qualifications:

(1) holds the credential of certified professional midwife;

(2) has completed an approved program of midwifery education with a minimum of 1,800 contact hours or its equivalent;

(3) is in good standing with the North American Registry of Midwives;

(4) participates in peer review at least twice per year; and

(5) provides the Department with an annually updated informed consent document.

(b) For a period of 5 years following the effective date of this Act, the Council shall have the authority and discretion to license applicants who have practiced midwifery prior to the effective date of this Act and have had an application accepted by the North American Registry of Midwives for certification. Such license shall terminate automatically 2 years after the date of registration unless the applicant has, by such time, successfully completed the examination provided by the North American Registry of Midwives.

Section 55. Scope of practice; informed consent.

(a) A licensed midwife may perform any of the midwifery services and skills established by the North American Registry of Midwives, including, but not limited to, antepartum, intrapartum, and postpartum care of women; newborn assessment and care of newborns; and well-woman gynecology and non-prescriptive family planning. However, the midwife must practice within the standards for practice and code of ethics of the North American Registry of Midwives.

(b) A copy of the informed consent document, signed and dated by the client, must be kept in each client's chart.

Section 60. Application for license. A person shall apply for licensure as a midwife to the Secretary on a form furnished by the Department. The application shall be accompanied by payment of the specified fee and evidence that the person meets the eligibility requirements of this Act.

Section 65. Renewals. A midwife license must be renewed every 3 years. An applicant for renewal shall submit to the Department (i) a renewal application and (ii) a renewal fee.

Section 70. Fees. The Department shall have the authority to (i) charge each candidate for licensure a fee, which must be submitted with his or her application and (ii) charge each licensed midwife a fee for renewal of his or her license.

Section 75. Disciplinary action.

(a) A licensed midwife or applicant for licensure, renewal, or reinstatement shall not engage in unprofessional conduct, which includes:

(1) fraudulently procuring or using a license;

(2) willfully making or filing false reports or records, willfully impeding or obstructing the filing of reports or records, or willfully failing to file required reports or records in the practice of midwifery;

(3) using dishonest or misleading advertising;

(4) failing to comply with any statutes related to the practice of midwifery;

(5) conviction of a crime related to the practice of midwifery as described in this Act;

(6) failing to provide, in a timely manner, copies of all records of the care provided to a person after a written request is received from the person who received care; and

(7) engaging in gross or repeated malpractice.

(b) After a hearing, and upon making a finding of unprofessional conduct, the Licensed Midwife Council shall (i) reprimand the licensed midwife or applicant, (ii) revoke the license or refuse to issue or renew a license, or (iii) seek an injunction against the continuation of the conduct.

Section 80. Penalties. A person who knowingly violates any of the provisions of this Act is guilty of a Class A misdemeanor.

Section 85. Reimbursement. A midwife licensed to practice midwifery is eligible for compensation as a provider under the Illinois Medicaid program and any other third party reimbursement plan, including Medicare, subject to the laws of this State and applicable federal law.

Section 90. Advertising. A person licensed under this Act may advertise the availability of professional services in the public media or on the premises where such professional services are rendered, provided that the advertising is truthful and not misleading.

Section 95. Women's rights regarding the birth of the baby. Women have a right to give birth where and with whom they choose. This Act does not prohibit the attendance at birth of the mother's choice of family, friends, and other persons.

Section 100. Liability of licensed midwives. Licensed midwives shall be liable for their acts or omissions in the performance of the services that they provide, and no physician, nurse, pre-hospital emergency personnel, or health care institution shall be liable for any act or omission resulting from the administration of services by any licensed midwife. The provisions of this Section shall not relieve any other licensed midwife, physician, nurse, pre-hospital emergency personnel, or health care institution from liability for any willful or wanton act or omission or any act or omission constituting gross negligence, or under circumstances where a licensed midwife has a business relationship with any such licensed midwife, physician, nurse, pre-hospital emergency personnel, or health care institution. A physician, nurse, pre-hospital emergency personnel, or health care institution shall not be deemed to have established a business relationship solely by providing consultation or accepting a referral from the midwife in accordance with this Act.

Section 105. No authority to make or promulgate rules. Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this Act. If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this Act, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly's discretion. Nothing contained in this Act shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given. For the purposes of this Act, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.

Section 900. The Regulatory Sunset Act is amended by adding Section 4.29 as follows:

(5 ILCS 80/4.29 new)

Sec. 4.29. Act repealed on January 1, 2019. The following Act is repealed on January 1, 2019:

The Certified Professional Midwife Licensure Act.

Section 905. The Medical Practice Act of 1987 is amended by changing Section 4 as follows:

(225 ILCS 60/4) (from Ch. 111, par. 4400-4)

(Section scheduled to be repealed on December 31, 2008)

Sec. 4. Exemptions.

(a) This Act does not apply to the following:

(1) persons lawfully carrying on their particular profession or business under any valid existing regulatory Act of this State;

(2) persons rendering gratuitous services in cases of emergency; or

(3) persons treating human ailments by prayer or spiritual means as an exercise or enjoyment of religious freedom.

(b) (Blank).

(c) Nothing in this Act shall be construed as prohibiting the practice of midwifery by persons licensed under the Certified Professional Midwife Licensure Act.

(Source: P.A. 93-379, eff. 7-24-03.)

Section 910. The Nurse Practice Act is amended by changing Section 50-15 as follows:

(225 ILCS 65/50-15) (was 225 ILCS 65/5-15)

(Section scheduled to be repealed on January 1, 2018)

Sec. 50-15. Policy; application of Act.

(a) For the protection of life and the promotion of health, and the prevention of illness and communicable diseases, any person practicing or offering to practice advanced, professional, or practical nursing in Illinois shall submit evidence that he or she is qualified to practice, and shall be licensed as provided under this Act. No person shall practice or offer to practice advanced, professional, or practical nursing in Illinois or use any title, sign, card or device to indicate that such a person is practicing professional or practical nursing unless such person has been licensed under the provisions of this Act.

(b) This Act does not prohibit the following:

(1) The practice of nursing in Federal employment in the discharge of the employee's duties by a person who is employed by the United States government or any bureau, division or agency thereof and is a legally qualified and licensed nurse of another state or territory and not in conflict with Sections 50-50, 55-10, 60-10, and 70-5 of this Act.

(2) Nursing that is included in the program of study by students enrolled in programs of nursing or in current nurse practice update courses approved by the Department.

(3) The furnishing of nursing assistance in an emergency.

(4) The practice of nursing by a nurse who holds an active license in another state when providing services to patients in Illinois during a bonafide emergency or in immediate preparation for or during interstate transit.

(5) The incidental care of the sick by members of the family, domestic servants or housekeepers, or care of the sick where treatment is by prayer or spiritual means.

(6) Persons from being employed as unlicensed assistive personnel in private homes, long term care facilities, nurseries, hospitals or other institutions.

(7) The practice of practical nursing by one who is a licensed practical nurse under the laws of another U.S. jurisdiction and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a licensed practical nurse and who is qualified to receive such license under this Act, until (i) the expiration of 6 months after the filing of such written application, (ii) the withdrawal of such application, or (iii) the denial of such application by the Department.

(8) The practice of advanced practice nursing by one who is an advanced practice nurse under the laws of another state, territory of the United States, or country and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as an advanced practice nurse and who is qualified to receive such license under this Act, until (i) the expiration of 6 months after the filing of such written application, (ii) the withdrawal of such application, or (iii) the denial of such application by the Department.

(9) The practice of professional nursing by one who is a registered professional nurse under the laws of another state, territory of the United States or country and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a registered professional nurse and who is qualified to receive such license under Section 55-10, until (1) the expiration of 6 months after the filing of such written application, (2) the withdrawal of such application, or (3) the denial of such application by the Department.

(10) The practice of professional nursing that is included in a program of study by one who is a registered professional nurse under the laws of another state or territory of the United States or foreign country, territory or province and who is enrolled in a graduate nursing education program or a program for the completion of a baccalaureate nursing degree in this State, which includes clinical supervision by faculty as determined by the educational institution offering the program and the health care organization where the practice of nursing occurs.

(11) Any person licensed in this State under any other Act from engaging in the practice for which she or he is licensed.

(12) Delegation to authorized direct care staff trained under Section 15.4 of the Mental Health and Developmental Disabilities Administrative Act consistent with the policies of the Department.

(13) The practice of midwifery by persons licensed under the Certified Professional Midwife Licensure Act.

(13) Nothing in this Act shall be construed to limit the delegation of tasks or duties by a physician, dentist, or podiatrist to a licensed practical nurse, a registered professional nurse, or other persons.

(Source: P.A. 95-639, eff. 10-5-07; revised 12-7-07.)

Section 999. Effective date. This Act takes effect upon becoming law.".