Sections 1-14 are definitions of words or phrases.

Section 15 says that this law does not apply to other healthcare providers. It also says that it doesn't affect anyone who is helping in an emergency or is providing free care for a friend or family member.

Section 16 says that DHHS can accept any gifts of money to help toward expenses incurred by a midwifery board.

Section 17 creates the Board of Licensed Certified Professional Midwives. The Board would be appointed by the administrator of DDHS based on nominations. Members must live in Nevada. The Board members would not be paid. Members would include:

• 4 LCPMS

• 1 CNM or OB

• 1 pediatrician

• 1 Nevada citizen who has had care from a CPM

• 1 NON VOTING social worker or community organizer that has experience in public health 

• 1 NON VOTING member as a liaison to DHHS

Section 18 says if not all Board members are present for a meeting, a majority of members is enough to move ahead with the meeting and/or take votes. The Board must meet at least once a year. The Board must come up with evidence based regulations and changes to regulations as needed. The Board can meet more often if needed and can be afforded.

Section 19 says that the Board will decide on the following things:

• Steps and timeline for issuing, renewing, or reinstating license

• Steps for filing a complaint about a LCPM or student

• Under what situations disciplinary actions are warranted and how would those be enacted

• Regulations for obtaining and administering medication

• Create a list of complicating conditions in labor, birth, or postpartum and create regulations about how LCPMs should handle those situations

• Create informed refusal form to allow breech, twins, postdates to 43 week births, and VBACs

• Regulations about STI screening

• Regulations about keeping medical records for midwifery clients

• Any other regulations the Board feels is important for LCPMs
  
  Section 20 says LCPM applicants will pay a fee decided by the Board no greater than $1000 and will be required to show proof of certification as a CPM: either PEP with Bridge Certificate or training in line with the US MERA statement. Additionally if there is extra money, DHHS will take some of the fees paid for licenses and set it aside for applicants of marginalized identities to help pay for their licensing fees.
  
  Section 21 says that LCPMs may use a birth assistant. The requirements to be a birth assistant are:

• at least 18 years old

• take a class in cultural humility or elimination of racism or bias

• training in neonatal resuscitation approved by the AAP

• current certificate in CPR

• be properly trained for the tasks they are expected to assist with and have this documented by the supervising midwife

The assistant must be supervised by a midwife on-site to perform clinical tasks. (This does not include doula support.) If the assistant is alone with a birthing person and the birth is imminent without a midwife present, the assistant may help the birthing person but must also call 911.

Section 22 says a LCPM applicant needs to provide their social security number as well as sign a form that affirms they are in compliance with any court ordered child support arrangement. If child support is not up to date, the license will not be issued until they are in compliance.

Section 23 says that students must be supervised by a midwife on-site to perform clinical tasks. (This does not include doula support.) Preceptors must be certified by NARM. Preceptors are required to let clients know that a student may be involved in their care and what tasks they may perform. The preceptor agrees to always be present to review any clinical task performed by the student. If the student is alone with a birthing person and the birth is imminent without a midwife present, the student may help the birthing person but must also call 911.

Section 24 says that all types of midwives (CPMs, CNMs, uncertified midwives) attending births outside the hospital must provide their clients with a form explaining the different types of midwives in Nevada: which type of midwife they are, the type of education and training received, what care will be provided. This form must be signed by the client and kept by the midwife for 5 years. LCPMs will be required to provide their clients with additional paperwork including information on what limitations on practice the LCPM has, how to file a complaint with DHHS, and an emergency plan. This must also include whether the LCPM carries liability insurance or not.

Section 25 lists the medications and devices LCPMs will be legally allowed to obtain and administer. The Board could authorize more in the future.

Section 26 says there is an option for a special endorsement for an LCPM which would allow the LCPM to administer, prescribe and dispense certain additional medications like treatment for UTI, severe morning sickness, itching, birth control including IUDs, antivirals, etc. This will require additional training, licensing steps, and an additional fee. The State Board of Pharmacy would be consulted by the Board in writing these regulations.

Section 27 lists conditions which may arise during pregnancy which require a consult, co-management or referral to another provider. If the condition is a previous cesarean (client wants a VBAC), a twin birth, or a breech birth, the LCPM must recommend the client see a doctor. In these 3 specific situations, the client can decline to see a doctor, sign an informed refusal form, and care with the LCPM can continue. The midwife will need to chart this thoroughly. If the client does not consent to consult, co-management, or referral for the other conditions on the list, the LCPM will not be liable for any damages. However if the condition is an immediate threat to the life of the pregnant person or newborn, the LCPM must call 911. Other providers are only liable for the care they provided.

Section 28 says when an LCPM renews their license, they must also turn in a report that lists several statistics regarding care provided with their practice.

Section 29 says if DHHS receives a copy of a court order and an LCPM is out of compliance with child support, their license will be suspended after 30 days. The license will be reinstated once the LCPM is in compliance.

Section 30 discusses what information is available to the public and what is confidential regarding complaints or investigations of a LCPM's care.

Section 31 says that a person who is not an LCPM or is suspended or revoked may not call themselves a licensed midwife or an LCPM. They may use these terms if they are licensed in a different state if they also disclose which state when using the terms. Students may not call themselves CPMs, LMs, or LCPMS. If someone someone has repeatedly violated this rule, DHHS can notify the Attorney General or other law enforcement who may, at their discretion, take appropriate action.

Section 32 says that DHHS or the attorney general can bring a suit against any person violating any of the rules in this law according the the regulations created by the Board. Actual damage does not need to have occurred to bring the suit.

Existing Law changes

Section 34 related to if the State decides to offer a reciprocal agreement regarding licensure with other states.

 

Here is an example of a reciprocal or reciprocity agreement. This bill does not establish one, only creates a guideline should the State choose to create one at some point in the future. 

https://www.mbc.ca.gov/Licensing/Licensed-Midwives/apply/

Section 35 adds LCPMs to the list of 'providers of healthcare.'

Section 36 allows LCPMs to accept Medicaid.

Section 103 amends Section 20 to remove the PEP + MBC to qualify for licensure as of January 1, 2026 (See section 110 for date). It also discusses conditions under which LCPM applicants could continue to use the PEP educational pathway with Midwifery Bridge Certificate to qualify for licensure.

Section 104 amends Section 22 to remove the requirement for providing a social security number.

Section 105  deleted by amendment  

Section 106 says the Board of Certified Professional Midwives will come up with regulations no later than 6 months after receiving recommendations from the Collaboration and Transfer Guideline Workgroup, taking those recommendations into consideration when creating the regulations.

Section 107 creates the Collaboration and Transfer Guideline Workgroup. This workgroup will be made up of:

• 1 OB or CNM from Northern Nevada

• 1 OB or CNM from Southern Nevada

• 1 L&D nurse manager from Northern Nevada

• 1 L&D nurse manager from Southern Nevada

• 1 EMS provider from Northern Nevada

• 1 EMS provider from Southern Nevada

• 1 non-voting member who serve as a liaison with the State Board of Health

• 4 LCPMs, ideally 2 from Northern Nevada and 2 from Southern Nevada

• 1 Nevada Hospital Association may also appoint a member of their association

 

The Workgroup can be divided into subcommittees based on Northern and Southern locations.
This group will make recommendations to the Board of LCPMs about transferring clients to medical facilities. Those recommendations should be evidence based or best practices.
Once these recommendations are made, the workgroup no longer exists unless the Board of LCPMs requests that it continue to meet.

Section 108 says that CPMs can be appointed to the Board until licensure is available to those CPMs. If they don't become licensed by 7/1/24, they can no longer serve on the Board. The first appointed public member will be able to serve a full term with only experience with the care of a CPM rather than an LCPM.

Section 110 gives time frames for when the things created by this law would happen.

• 106 and 107 are effective when the bill passes

• 1-102, 106, and 107 are effective once a Board is appointed and regulations are made or 1/1/24, whichever is more applicable

• 103 is effective on 1/1/26

• 105  deleted by amendment