HB1194

SECTION 1. Chapter 457J, Hawaii Revised Statutes, is amended by adding seven new sections to be appropriately designated and to read as follows:

"§457J-A Scope of practice of midwifery. (a) The scope of practice of midwifery as a licensed midwife means the full practice of midwifery, regardless of compensation or personal profit, as determined by the director, rules adopted by the director, and midwifery standards established or recognized by the director pursuant to this chapter. The scope of practice of midwifery as a licensed midwife includes but is not limited to observation, assessment, development, implementation, and evaluation of a plan of care; health and wellness education and counseling; supervision and teaching of other personnel; teaching of individuals, families, and groups; provision of midwifery services via telehealth; administration, evaluation, supervision, and coordination, including the delegation of administrative and technical clinical tasks, of midwifery practice; provision of health care to the client in collaboration with other members of the health care team as autonomous health care professionals providing the midwifery component of health care; diagnosis, selection, and administration of therapeutic measures as authorized pursuant to this chapter and within the licensed midwife's role, education, and certification; or use of reasonable judgment in carrying out prescribed medical orders of a licensed physician or osteopathic physician licensed pursuant to chapter 453 or an advanced practice registered nurse licensed pursuant to chapter 457; orders of a physician assistant licensed and practicing with physician supervision pursuant to chapter 453 and acting as the agent of the supervising physician; or orders of a licensed midwife in accordance with this chapter.

(b) The scope of practice of midwifery as a certified midwife includes but is not limited to:

(1) Assessment and the diagnosis, prescription, selection, and administration of therapeutic measures, including over the counter drugs; legend drugs; the provision of expedited partner therapy pursuant to section 453-52; and controlled substances within the licensed midwife's education, certification, and role; and

(2) The Standards for the Practice of Midwifery, or successor document, of the American College of Nurse-Midwives and American Midwifery Certification Board, or successor organizations; provided that the American College of Nurse-Midwives and American Midwifery Certification Board shall have no legal authority over the director and shall have no legal authority or powers of oversight of the director in the exercise of the director's powers and duties authorized by law.

(1) Assessment and the diagnosis, selection, and administration of therapeutic measures according to the formulary of this chapter within the certified professional midwife's education, certification, and role; and

(2) The Essential Competencies for Midwifery Practice, or successor document, as defined by the International Confederation of Midwives, or successor organization; provided that the International Confederation of Midwives shall have no legal authority over the director and shall have no legal authority or powers of oversight of the director in the exercise of the director's powers and duties authorized by law.

(d) The scope of practice of midwifery shall be based on and be consistent with a licensed midwife's education and national certification, including but not limited to:

(1) Evaluating the physical and psychosocial health status of clients through a comprehensive health history, physical examination, and risk assessment using skills of observation, inspection, palpation, percussion, and auscultation, and using diagnostic instruments and procedures;

(2) Providing education and counseling related to the health promotion, disease prevention, and health care of midwife clients, with a particular focus on a healthy pregnancy and childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of midwife clients;

(3) Ordering, interpreting, and performing diagnostic, screening, and therapeutic examinations, tests, and procedures;

(4) Formulating a diagnosis;

(5) Initiating and maintaining accurate records and authorizing appropriate regulatory and other legal documents;

(6) Obtaining informed consent in accordance with the licensee's professional requirements, as required by section 671-3;

(7) Serving as a consultant and resource of midwifery clinical knowledge and skills to those involved directly or indirectly in client care;

(8) Operating within a health care system that provides for consultation, collaborative management, and referral with other health care professionals;

(9) Referring clients who require care beyond the scope of practice of the licensed midwife to an appropriate health care provider;

(10) Assisting in surgery; provided that this paragraph shall only apply to licensed midwives practicing as certified midwives;

(11) Admitting and discharging clients for inpatient care at facilities licensed in the State as:

(A) Birth centers; and

(B) Hospitals; provided that this subparagraph shall only apply to licensed midwives practicing as certified midwives; and

(12) Participating in joint and periodic evaluation of services rendered such as peer review, including chart reviews, case reviews, client evaluations, and outcome of case statistics.

(e) A licensed midwife shall comply with the requirements of this chapter; recognize limits of the licensed midwife's training and experience and have transfer of care protocols for situations that exceed the scope of authorized practice; consult with or refer clients to other health care providers, as appropriate; and participate in data submission and peer review requirements adopted by the department; provided that peer review conducted outside of the department may not be used to replace investigations against licensed midwives by the regulated industries complaints office.

§457J-B Care provided by licensed midwives; requirements. (a) Licensed midwives shall continually assess the appropriateness of the planned location of birth and shall refer to the American College of Nurse-Midwives Clinical Bulletin Number 61: Midwifery Provision of Home Birth Services (November 2015), or succeeding document, for guidance, taking into account the health and condition of the midwife's client; provided that the American College of Nurse-Midwives shall have no legal authority or powers of oversight over the director in the exercise of the director's powers and duties authorized by law.

(b) If the licensed midwife determines that a condition of the licensed midwife's client or clients is outside of the licensed midwife's scope of practice, the licensed midwife shall refer the client or clients to an appropriate health care provider.

(c) If the licensed midwife is attending a community birth and determines during the midwife's care that the client or clients faces imminent morbidity or mortality, the licensed midwife shall activate the 911 system.

(d) If the licensed midwife transfers care of the midwife's client or clients during the intrapartum or immediate postpartum period, the midwife shall provide the receiving provider with, at minimum, the information regarding the midwife's client or clients listed on the transfer form adopted by the department.

(e) If the midwife's client, or the midwife's client's guardian declines assistance from appropriate licensed health care providers or the 911 system, the licensed midwife shall continually urge the client or the client's guardian to transfer care to an appropriate licensed health care provider and may continue to provide care to save a life; provided that the licensed midwife shall only perform actions within the licensed midwife's scope of practice.

§457J-C License renewal continuing education requirement. (a) Beginning July 1, 2026, each licensed midwife shall provide documentation of successful completion of thirty contact hours during the prior triennium of appropriate continuing education that is related to the practice of midwifery.

(b) Each licensee practicing as a certified midwife shall provide documentation of successful completion of continuing education that is from accredited colleges or universities or approved by an organization recognized by the Continuing Education Policy, or successor document, of the American Midwifery Certification Board, or successor organization; provided that a minimum of eight hours of continuing education shall be in pharmacology.

(c) Each licensee practicing as a certified professional midwife shall provide documentation of successful completion of continuing education that is from an accredited college or university or granted by an accrediting organization recognized by the North American Registry of Midwives, or successor organization; provided that six hours of continuing education shall include treatment of shock/intravenous therapy and suturing.

(d) This section shall not apply to a licensee who has graduated from a midwifery program approved by the director within the twelve months prior to the renewal date of the licensee's first license renewal period.

(e) The director may extend the deadline for compliance with the continuing education requirements established by this section on a case-by-case basis; provided that prior to the expiration of a license, the licensed midwife seeking an extension shall submit a written request for the extension and any documentation required by the director to substantiate the reason for an extension of the deadline for compliance with the continuing education requirements established by this section.

(f) Each licensee shall maintain the licensee's continuing education records for no less than six years.

(g) The director may conduct random audits of licensees to determine compliance with the continuing education requirement. The director shall provide written notice of an audit to all licensees randomly selected for audit. Within sixty days of notification, the licensee shall provide the director with documentation verifying compliance with the continuing education requirement established by this section.

§457J-D Global signature authority. Licensed midwives shall be authorized to sign, certify, or endorse all documents relating to health care provided for their clients within their scope of practice, including workers' compensation verification documents, temporary disability insurance forms, verification and evaluation forms of the department of human services and department of education, verification and authorization forms of the department of health, and physical examination forms; provided that nothing in this section shall be construed to expand the scope of practice of licensed midwives.

§457J-E Prescriptive authority. (a) Prescriptive authority shall be granted solely to licensed midwives practicing as certified midwives and shall not be granted to licensed midwives practicing as certified professional midwives. Licensed midwives practicing as certified midwives shall only prescribe those drugs appropriate to midwifery care as recognized by the director and in accordance with the current exclusionary formulary defined by the board of nursing for advanced practice registered nurses.

(b) Only a licensed midwife practicing as a certified midwife may communicate, represent, or imply in any manner, including through the use of a sign, card, or device, that the person is a licensed midwife who is authorized to prescribe.

(c) A licensed midwife practicing as a certified midwife shall comply with all applicable federal and state laws, regulations, and rules relating to the prescription, dispensing, and administration of drugs. A licensed midwife practicing as a certified midwife shall only prescribe and administer over the counter drugs, legend drugs, and controlled substances pursuant to this chapter and chapter 329. A licensed midwife practicing as a certified midwife may request, receive, and dispense a manufacturer's prepackaged samples of over the counter and non-controlled legend drugs to patients under the midwife's care; provided that the licensed midwife practicing as a certified midwife shall not request, receive, or sign for samples of controlled substances. A licensed midwife practicing as a certified midwife may prescribe, order, and dispense medical devices and equipment that are appropriate to the licensed midwife's scope of practice and plan and initiate a therapeutic regimen that includes nutritional, diagnostic, and supportive services including home health care, hospice, and physical and occupational health.

(d) Prescriptions issued by a licensed midwife practicing as a certified midwife shall be written in accordance with section 329-38.

(e) It shall be a violation of this chapter for a licensed midwife practicing as a certified professional midwife to communicate, represent, or imply in any manner, including through the use of any sign, card, or device, that the person is a licensed midwife with prescriptive authority.

§457J-F Reporting requirements. (a) Every midwife licensed pursuant to this chapter who does not possess professional liability insurance shall report in writing any settlement or arbitration award of a claim or action for damages for death or personal injury caused by negligence, error, or omission in practice, or the unauthorized rendering of professional services. The report shall be submitted to the midwives licensing program within thirty days after any written settlement agreement has been reduced to writing and signed by all the parties thereto or within thirty days after service of the arbitration award on the parties.

(b) Failure of a licensed midwife to comply with this section is an offense punishable by a fine of no less than $100 for the first offense, $250 to $500 for the second offense, and $500 to $1,000 for any subsequent offense.

§457J-G Peer review requirements; license renewal. (a) Beginning June 30, 2029, a licensed midwife shall, as a condition of license renewal:

(1) Participate in a Hawaii based peer review committee during each triennium subject to the requirements of section 624-25.5; and

(2) Attest that the licensed midwife has completed a peer review for a minimum of five of the licensed midwife's clinical cases from the prior triennium, with at least two midwives licensed in the State who were not involved in the clinical cases under review participating in the peer review process; and

(3) Attest that the licensed midwife has completed a peer review within ninety days of any case that includes conditions outside of the licensed midwife's scope of practice; urine rupture; or maternal or neonatal hospitalization for infection, blood transfusion, intensive care unit admission, emergent transfer of care, or mortality.

(b) If the licensed midwife has served fewer than five clients in the prior triennium, the requirements of subsection (a)(2) may be waived upon a determination by the department; provided that if the requirements of subsection (a)(2) are waived, the licensed midwife shall participate in the review of five cases of another licensed midwife practicing in the State.

(c) The licensed midwife shall receive written confirmation of participation in a peer review process from the Hawaii based peer review committee and shall maintain copies of the licensed midwife's participation records.

(d) The department shall begin verifying compliance with this section beginning June 30, 2029.

§457J-H Data submission requirements; license renewal. (a) Beginning June 30, 2029, a licensed midwife shall, as a condition of license renewal:

(1) Submit data on all courses of care for every gestational parent and newborn under the midwife's care to a national or state research organization approved by the department. If a gestational parent declines to participate in the collection of data, the midwife shall follow the protocol of the approved national or state research organization; and

(2) Attest that the licensed midwife has submitted data annually during the prior triennium.

(b) The data submission requirements may be waived if the licensed midwife attests that the midwife has not provided midwifery care to any clients during the prior triennium.

(c) The licensed midwife shall receive written confirmation of participation in data submission from the national or state research organization and shall maintain copies of the licensed midwife's participation records.

(d) The department shall begin verifying compliance with this section beginning June 30, 2029.

§457J-I Traditional Hawaiian healers; disclosure. (a) Pursuant to article XII, section 7 of the Hawaii state constitution, a person acting as a traditional Hawaiian healer engaged in traditional practices of pale keiki, hoohanau, or other hanau practices established in existence before November 25, 1892, which may incorporate but are not limited to the practices of laau lapaau, laau kahea, lomilomi, hooponopono, kilo, pule, and ai pono, and are intended to assist pregnant people during pregnancy, birth, and the postpartum period shall, at the time care is first initiated, disclose to each client verbally and in writing on a form adopted by the department:

(1) That the person is not a licensed midwife and is not engaging in the practice of midwifery;

(2) That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants;

(3) That the person's education and qualifications to provide assistance through traditional Hawaiian healing practices to people during pregnancy, birth, and the postpartum period have not been reviewed by the State;

(4) The person's education and training;

(5) That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs;

(6) Any judgment, award, disciplinary action, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing regulatory authority, territory, state, or any other jurisdiction; and

(7) A plan for transporting the client to the nearest hospital if a problem arises during the provision of care.

(b) The person acting as a traditional Hawaiian healer shall maintain a copy of the form required by subsection (a) for no less than ten years and shall make the form available for inspection upon request by the department.

(c) This section shall not apply if the person acting as a traditional Hawaiian healer is also a midwife licensed under this chapter."

SECTION 2. Section 26H-4, Hawaii Revised Statutes, is amended to read as follows:

"§26H-4 Repeal dates for newly enacted professional and vocational regulatory programs. (a) Any professional or vocational regulatory program enacted after January 1, 1994, and listed in this section shall be repealed as specified in this section. The auditor shall perform an evaluation of the program, pursuant to section 26H-5, prior to its repeal date.

(b) Chapter 466L (appraisal management companies) shall be repealed on June 30, 2023.

[~~(c) Chapter 457J (midwives) shall be repealed on June 30, 2025.~~]"

SECTION 3. Section 329-1, Hawaii Revised Statutes, is amended as follows:

1. By adding a new definition to be appropriately inserted and to read:

""Licensed midwife practicing as a certified midwife" means a person licensed under chapter 457J who is registered under this chapter to administer or prescribe a controlled substance; provided that a licensed midwife practicing as a certified midwife shall not be authorized to request, receive, or sign for professional controlled substance samples."

2. By amending the definition of "designated member of the health care team" to read:

""Designated member of the health care team" includes physician assistants, advanced practice registered nurses, licensed midwives practicing as certified midwives, and covering physicians who are authorized under state law to prescribe drugs."

3. By amending the definition of "practitioner" to read:

""Practitioner" means:

(1) A physician, dentist, veterinarian, scientific investigator, or other person licensed and registered under section 329-32 to distribute, dispense, or conduct research with respect to a controlled substance in the course of professional practice or research in this State;

(2) An advanced practice registered nurse with prescriptive authority licensed and registered under section 329-32 to prescribe and administer controlled substances in the course of professional practice in this State; [~~and~~]

(3) A licensed midwife practicing as a certified midwife licensed and registered under section 329-32 to prescribe and administer controlled substances in the course of professional practice in this State; and

[~~(3)~~] (4) A pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in this State."

SECTION 4. Section 453-51, Hawaii Revised Statutes, is amended by amending the definition of "health professional" to read as follows:

""Health professional" means any of the following:

(1) A person licensed or otherwise authorized by law to practice medicine or surgery under this chapter and whose scope of practice includes the diagnosis and treatment of sexually transmitted diseases;

(2) An advanced practice registered nurse with prescriptive authority under chapter 457 and duly licensed in the State; [or]

(3) A licensed midwife practicing as a certified midwife with prescriptive authority under chapter 457J and duly licensed in the State; or

[~~(3)~~] (4) For the purpose of dispensing antibiotic therapy under this section, a pharmacist who is licensed or otherwise authorized to engage in the practice of pharmacy under chapter 461."

SECTION 5. Section 457J-1, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-1[]] Findings and purpose. The legislature finds that:

(1) Midwives offer reproductive health care and maternity and newborn care [~~from the antepartum period through the intrapartum period to the postpartum period;~~] to clients seeking midwifery services;

(2) The improper practice of midwifery poses a significant risk of harm to [~~the mother or newborn,~~] any client receiving midwifery services and may result in death; and

(3) The regulation of the practice of midwifery is reasonably necessary to protect the health, safety, and welfare of [~~mothers~~] persons choosing midwifery services and their newborns."

SECTION 6. Section 457J-2, Hawaii Revised Statutes, is amended as follows:

1. By adding five new definitions to be appropriately inserted and to read:

""American College of Nurse-Midwives" means the professional association that represents and sets the standards for practice through core competencies and scope of practice for certified nurse-midwives/certified midwives in the United States.

"Community birth" means birth taking place in a birth center, home, or location within the community.

"Peer review" means the candid review and evaluation, subject to section 624-25.5, of the practice of midwifery. "Peer review" includes but is not limited to reviewing the care provided by licensed midwives, making recommendations for quality improvement, and identifying areas where additional education or skills training is needed.

"Practice of midwifery" means the independent provision of care, including initial and ongoing comprehensive assessment, diagnosis, and treatment during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; family planning services, including preconception care; primary care for individuals from adolescence through the lifespan, healthy newborns, and adults according to the midwife's scope of practice for all persons seeking midwifery care in all settings through the performance of professional services commensurate with the educational preparation and demonstrated competency of the individual having specialized training, and skill based on the principles of the biological, physical, behavioral, and sociological sciences and midwifery theory, whereby the individual shall be accountable and responsible to the client for the quality of midwifery care rendered. Pursuant to article XII, section 7 of the Hawaii state constitution, "practice of midwifery" does not include healing practices performed by traditional Hawaiian healers engaged in traditional practices of pale keiki, hoohanau, or other hanau practices established in existence before November 25, 1892, which may incorporate but are not limited to the practices of laau lapaau, laau kahea, lomilomi, hooponopono, kilo, pule, and ai pono, and are intended to assist pregnant people during pregnancy, birth, and the postpartum period.

"Telehealth" means the use of telecommunications as that term is defined in section 269-1 including but not limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit client health care information, including diagnostic-quality digital images and laboratory results for health care interpretation and diagnosis, for the purpose of delivering enhanced health care services and information to parties separated by distance. Standard telephone contacts, facsimile transmissions, or electronic mail texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this chapter."

2. By amending the definitions of "interconception" and "International Confederation of Midwives" to read:

""Interconception" means care provided to [~~mothers~~] birthing people between pregnancies to improve health outcomes for [~~women,~~] birthing people and newborns[~~, and children~~].

"International Confederation of Midwives" means the accredited nongovernmental organization and representative of midwives and midwifery to organizations worldwide to achieve common goals in the care of [~~mothers~~] birthing people and newborns."

3. By amending the definition of "postpartum" to read:

""Postpartum" means the period of time immediately after and up to [~~eight~~] six weeks following [~~the~~] birth [~~of the baby~~]."

4. By repealing the definition of "midwifery":

["~~"Midwifery" means the provision of one or more of the following services:~~

~~(1)~~ Assessment, monitoring, and care during pregnancy, labor, childbirth, postpartum and interconception periods, and for newborns, including ordering and interpreting screenings and diagnostic tests, and carrying out appropriate emergency measures when necessary;

~~(2)~~ ~~Supervising the conduct of labor and childbirth; and~~

~~(3)~~ ~~Provision of advice and information regarding the progress of childbirth and care for newborns and infants.~~"]

SECTION 7. Section 457J-6, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-6[]] Exemptions. (a) [~~A person may practice midwifery without a license to practice midwifery if the person is:~~

~~(1)~~ [~~A certified nurse-midwife holding a valid license under chapter 457;~~

~~(2)~~ ~~Licensed and performing work within the scope of practice or duties of the person's profession that overlaps with the practice of midwifery;~~

~~(3)~~ ~~A student midwife who is currently~~] Nothing in this chapter shall be construed to prohibit:

(1) The practice of midwifery that is incidental to the program of study engaged by a student currently enrolled in [a] an accredited midwifery educational program and under the direct supervision of a qualified midwife preceptor; or

[~~(4)~~ ~~A person rendering aid in an emergency where no fee for the service is contemplated, charged, or received; or~~

~~(5)~~ ~~A person acting as a birth attendant on or before July 1, 2023, who:~~

~~(A)~~ ~~Does not use legend drugs or devices, the use of which requires a license under the laws of the State;~~

~~(B)~~ ~~Does not advertise that the person is a licensed midwife;~~

~~(C)~~ Discloses to each client verbally and in writing on a form adopted by the department, which shall be received and executed by the person under the birth attendant's care at the time care is first initiated:

~~(i)~~ ~~That the person does not possess a professional license issued by the State to provide health or maternity care to women or infants;~~

~~(ii)~~ ~~That the person's education and qualifications have not been reviewed by the State;~~

~~(iii)~~ ~~The person's education and training;~~

~~(iv)~~ ~~That the person is not authorized to acquire, carry, administer, or direct others to administer legend drugs;~~

~~(v)~~ Any judgment, award, disciplinary sanction, order, or other determination that adjudges or finds that the person has committed misconduct or is criminally or civilly liable for conduct relating to midwifery by a licensing or regulatory authority, territory, state, or any other jurisdiction; and

~~(vi)~~ ~~A plan for transporting the client to the nearest hospital if a problem arises during the client's care; and~~

~~(D)~~ ~~Maintains a copy of the form required by subparagraph (C) for at least ten years and makes the form available for inspection upon request by the department.~~

(b) Nothing in this chapter shall prohibit healing practices by traditional Hawaiian healers engaged in traditional healing practices of prenatal, maternal, and child care as recognized by any council of kupuna convened by Papa Ola Lokahi. Nothing in this chapter shall limit, alter, or otherwise adversely impact the practice of traditional Native Hawaiian healing pursuant to the Constitution of the State of Hawaii.

~~(c)~~] (2) Service in the case of emergency or the domestic administration of family remedies.

(b) Nothing in this chapter shall prohibit a person from administering care to a person's spouse, domestic partner, parent, sibling, or child."

SECTION 8. Section 457J-8, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-8[]] Application for license as a midwife. (a) To obtain a license under this chapter, the applicant shall provide:

(1) An application for licensure;

(2) The required fees;

[~~(3)~~ ~~Proof of current, unencumbered certification as a:~~

~~(A)~~ ~~Certified professional midwife; or~~

~~(B)~~ ~~Certified midwife;~~

~~(4)~~ ~~For certified professional midwives, proof of a successful completion of a formal midwifery education and training program that is either:~~

~~(A)~~ ~~An educational program or pathway accredited by the Midwifery Education Accreditation Council; or~~

~~(B)~~ A midwifery bridge certificate issued by the North American Registry of Midwives for certified professional midwife applicants who either obtained certification before January 1, 2020, through a non-accredited pathway, or who have maintained licensure in a state that does not require accredited education;

~~(5)~~] (3) If applicable, evidence of any licenses held or once held in other jurisdictions indicating the status of the license and documenting any disciplinary proceedings pending or taken by any jurisdiction;

[~~(6)~~] (4) Information regarding any conviction of any crime which has not been annulled or expunged; [~~and~~

~~(7)~~] (5) Any other information the department may require to investigate the applicant's qualifications for licensure[.];

(6) Any additional requirements adopted by the director; and

(7) Evidence of qualifications for licensure.

(b) Evidence of qualifications for licensure as a certified midwife shall consist of the following:

(1) Proof of current, unencumbered certification as a certified midwife by the American Midwifery Certification Board or a successor organization;

(2) Proof of successful completion of a graduate-level midwifery program accredited by the Accreditation Commission for Midwifery Education, or successor organization, leading to a master's degree or higher as a midwife; and

(3) Proof of successful completion of at least thirty contact hours, as part of a master's degree program or higher from a college or university accredited by the Accreditation Commission for Midwifery Education, or successor organization, of advanced pharmacology education, including advanced pharmacotherapeutics that is integrated into the curriculum, within three years immediately preceding the date of application. If the advanced pharmacology education in a master's degree program was completed prior to the three-year time period immediately preceding the date of application, then one of the following shall be completed within the three-year time period immediately preceding the date of application for initial prescriptive authority:

(A) At least thirty contact hours of advanced pharmacology, including advanced pharmacotherapeutics, from a college or university accredited by the Accreditation Commission for Midwifery Education, or successor organization; or

(B) At least thirty contact hours of continuing education in advanced pharmacology, including advanced pharmacotherapeutics, approved by the Continuing Education Policy, or successor document, of the American Midwifery Certification Board, or successor organization; provided that the continuing education pharmacology contact hours shall be related to the applicant's scope of midwifery practice.

(1) Proof of current and valid certification as a certified professional midwife by the North American Registry of Midwives or a successor organization; and

(2) Proof of successful completion of a formal midwifery education and training program as follows:

(A) An educational program or pathway accredited by the Midwifery Education Accreditation Council, or successor organization; or

(B) A midwifery bridge certificate issued by the North American Registry of Midwives, or successor organization, for certified professional midwife applicants who obtained certification before January 1, 2020."

SECTION 9. Section 457J-10, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-10[[] Renewals. (a) Every license issued under this chapter shall be renewed triennially on or before June 30, with the first renewal deadline occurring on June 30, 2023. Failure to renew a license shall result in a forfeiture of the license. Licenses [~~which~~] that have been so forfeited may be restored within one year of the expiration date upon payment of renewal and penalty fees. Failure to restore a forfeited license within one year of the date of its expiration shall result in the automatic termination of the license. Relicensure after termination shall require the person to apply as a new applicant and again satisfy all licensing requirements in place at the time of the new application.

(b) For each license renewal, the licensee shall:

(1) Pay all required nonrefundable fees;

(2) Submit a completed renewal application;

(3) Provide documentation of successful completion during the prior triennium of appropriate continuing education as required pursuant to section 457J-C; and

(4) By June 30, 2029, and every triennium thereafter, complete the peer review requirements of 457J-6; and

(5) By June 30, 2029, and every triennium thereafter, complete the data submission requirements of 457J-H."

SECTION 10. Section 457J-11, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-11[]] Authority to purchase and administer certain legend drugs and devices. (a) A midwife licensed under this chapter may purchase and administer non-controlled legend drugs and devices that are used in pregnancy, birth, postpartum care, newborn care, or resuscitation, and that are deemed integral to providing care to the public by the department.

(b) Legend drugs authorized under subsection (a) are limited for:

(1) Neonatal use to prophylactic ophthalmic medications, vitamin K, epinephrine for neonatal resuscitation per neonatal resuscitation guidelines, and oxygen; and

(2) Maternal use to antibiotics for Group B Streptococcal antibiotic prophylaxis per guidelines adopted by the Centers for Disease Control and Prevention[,]; postpartum antihemorrhagics[,]; Rho(D) immune globulin[,]; epinephrine for anaphylactic reaction to an administered medication[,]; intravenous fluids[,]; amino amide local anesthetic[,]; nitrous oxide for pain relief when used in an accredited birth facility and in accordance with facility policies; non-hormonal contraceptives; hormonal implants pursuant to any manufacturer certification requirements, as prescribed by a licensed health care provider with prescriptive authority under this chapter, chapter 453, or section 457-8.6; and oxygen.

Legend drugs authorized under subsection (a) shall not be used to induce, stimulate, or augment labor during the first or second stages of labor or before labor.

(1) Injection of medications;

(2) The administration of intravenous fluids;

(3) Adult and infant resuscitation;

(4) Rupturing amniotic membranes;

(5) Repairing vaginal tears; [~~and~~]

(6) Postpartum hemorrhage[.]; and

(7) Mechanical, non-pharmacologic cervical dilation when used at or after thirty-nine weeks gestation in pregnancy.

(d) A pharmacist who dispenses drugs and devices to a midwife as authorized by this section and in conformity with chapter 461 is not liable for any adverse reactions caused by the midwife's administration of legend drugs and devices.

(e) Nothing in this section shall preclude a licensed midwife practicing as a certified professional midwife from carrying out the prescribed medical orders of a licensed physician or osteopathic physician licensed pursuant to chapter 453 or advanced practice registered nurse licensed pursuant to chapter 457; orders of a physician assistant licensed and practicing with physician supervision pursuant to chapter 453, and acting as the agent of the supervising physician; or orders of a recognized licensed midwife practicing as a certified midwife in accordance with this chapter."

SECTION 11. Section 457J-12, Hawaii Revised Statutes, is amended to read as follows:

"[[]§457J-12[]] Grounds for refusal to grant, renew, reinstate, or restore licenses and for revocation, suspension, denial, or condition of licenses. In addition to any other acts or conditions provided by law, the director may refuse to grant, renew, reinstate, or restore, or may deny, revoke, suspend, or condition in any manner, any license for any one or more of the following acts or conditions on the part of the licensee or the applicant thereof:

(1) Failing to meet or maintain the conditions and requirements necessary to qualify for the granting of a license;

(2) Failing to notify the department in writing that the licensee's certification as a certified professional midwife or as a certified midwife is no longer current or unencumbered within thirty days of the change in status;

(3) Engaging in false, fraudulent, or deceptive advertising, or making untruthful or improbable statements;

(4) Being addicted to, dependent on, or a habitual user of [~~a narcotic, barbiturate, amphetamine, hallucinogen, opium, or cocaine, or other drugs or derivatives of a similar nature;~~ illicit substances, or abusing controlled substances, or both;

(5) Practicing as a licensed midwife while impaired by, at minimum, alcohol, drugs, non-accommodated physical disability, or mental instability;

(6) Procuring a license through fraud, misrepresentation, or deceit;

(7) Aiding and abetting an unlicensed person to directly or indirectly perform activities requiring a license;

(8) Engaging in professional misconduct as defined by the program in accordance with its own rules, incompetence, gross negligence, or manifest incapacity in the practice of midwifery;

(9) Failing to maintain a record or history of competency, trustworthiness, fair dealing, and financial integrity;

(10) Engaging in conduct or practice contrary to recognized standards of ethics for the practice of midwifery;

(11) Violating any condition or limitation upon which a conditional license was issued;

(12) Engaging in business under a past or present license issued pursuant to this chapter, in a manner causing injury to one or more members of the public;

(13) Failing to comply, observe, or adhere to any law in a manner such that the director deems the applicant or licensee to be an unfit or improper person to hold a license;

(14) Having a revocation, suspension, or other disciplinary action by a territory, or by another state or federal agency against a licensee or applicant for any reason provided by the licensing laws or this section;

(15) Having a criminal conviction, whether by nolo contendere or otherwise, of a penal crime directly related to the qualifications, functions, or duties of a licensed midwife;

(16) Failing to report in writing to the director any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty days of the disciplinary decision;

(17) Employing, utilizing, or attempting to employ or utilize at any time any person not licensed under this chapter where licensure is required;

(18) Violating this chapter, any other applicable licensing laws, or any rule or order of the director; or

(19) Using or removing without authorization controlled substances or drugs, including diverting or attempting to divert drugs or controlled substances for unauthorized use."

SECTION 12. Section 671-1, Hawaii Revised Statutes, is amended by amending the definition of "health care provider" to read as follows:

""Health care provider" means a physician, osteopathic physician, surgeon, or physician assistant licensed under chapter 453[~~, a~~]; podiatrist licensed under chapter 463E[~~, a~~]; health care facility as defined in section 323D-2[,]; midwife licensed under chapter 457J; and the employees of any of them. Health care provider shall not mean any nursing institution or nursing service conducted by and for those who rely upon treatment by spiritual means through prayer alone, or employees of the institution or service."

SECTION 13. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 14. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 15. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 16. This Act shall take effect on June 29, 2025.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	1194
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII