Summary of SB 964 (Session 2025) – North Carolina
Purpose and overall aim
- SB 964 seeks to expand access to maternal care by:
- Requiring NC Medicaid to cover doula services during pregnancy and the postpartum period.
- Providing funding to support services for the doula workforce.
- Establishing a licensing framework for Certified Professional Midwives (CPMs) via a new article in Chapter 90.
- Establishing a licensure process and fees for birth centers, including a Birth Center Licensure Act and a new Birth Center Commission.
Key provisions
1) Medicaid coverage for doula services
- The Department of Health and Human Services (DHB) must seek CMS approval to implement Medicaid coverage of doula-provided healthcare services during pregnancy and the postpartum period.
- DHB, in partnership with the Division of Public Health, will define covered services, update clinical policies, set reimbursement for doula services, and determine credentialing requirements.
- Credentialing considerations include: basic newborn care, childbirth education, client empowerment, understanding common medical interventions, coping strategies, lactation support, referrals, and cultural competence.
- Coverage, once CMS approves, should be implemented as soon as practicable, with a report due to the Joint Legislative Oversight Committee on Medicaid by March 1, 2027 detailing coverage specifics, reimbursement, and estimated recurring costs.
2) Funding for doula workforce support
- General Fund appropriations:
- DHHS, Division of Health Benefits: $1,000,000 in recurring funds starting 2026-2027.
- DHHS, Division of Public Health: $550,000 in recurring funds starting 2026-2027 to provide support services and technical assistance to the doula workforce.
3) Certified Professional Midwives Licensing Act (Article 10B added to G.S. Chapter 90)
- Title: Accessing Certified Professional Midwives Act.
- Key definitions and framework:
- CPM: Nationally certified by NARM.
- Council: North Carolina Council of Certified Professional Midwives (subcommittee of DHHS Division of Health Service Regulation).
- Collaboration and consultation definitions with physicians or other health care providers.
- Licensure requirements (Section 90-178.15):
- Application on a council-approved form.
- Completion of approved education and clinical training, including emergency skills and NACPM/NARM core competencies; national CPM credential from an NCCA-accredited body.
- CPR and NRP certifications.
- Agreement to practice under this Article’s guidelines.
- Payment of licensure fees.
- Responsibilities and standards (Section 90-178.16):
- CPMs must provide primary maternity care for low-risk pregnancies, obtain informed consent, collaborate with medical providers, order necessary screenings, develop emergency transfer plans, monitor labor, stay with mother postpartum, and assist with birth certificate processes.
- Display license publicly.
- Licensure management (Section 90-178.17):
- Licenses valid for 2 years; biennial renewal with proof of current certification, ongoing CPR/NRP, and CE requirements.
- Provisions for inactive status and reinstatement.
- Reciprocity with substantially equivalent out-of-state licensure.
- Fees set by the Council up to $500 over a 2-year period.
- Enforcement and discipline (Sections 90-178.21, 90-178.22):
- Grounds for discipline (false information, felony/serious misconduct, substance abuse, gross negligence, prior licensure denials, etc.).
- Disciplinary processes including hearings and potential injunctions; vicarious liability protections for health care providers in certain situations.
- Formulary and practice standards (Section 90-178.20):
- Establishment of a formulary for drugs and devices; adherence to NACPM standards.
4) Birth center licensure and regulation (Birth Center Licensure Act)
- New Part 7 of Article 6, Chapter 131E, establishing the Birth Center Commission and licensure framework.
- Definitions and standards:
- Birth center: non-hospital facility for normal, uncomplicated deliveries.
- Commission duties include setting licensure standards, reviewing license applications, and recommending approval.
- Commission composition (Section 131E-154.22):
- Seven members: physicians (via NC Obstetrical and Gynecological Society), CPMs (via NC Affiliate of the American College of Nurse-Midwives), and one public member.
- Terms: four-year terms, staggered; no more than two consecutive terms.
- Licensure requirements and operation (Sections 131E-154.17, 131E-154.23, 131E-154.25):
- Birth centers must obtain a license from DHHS; initial license valid for one year, with annual renewal.
- Licensure requires adherence to Commission rules, accreditation (CABC), and related reporting.
- Fees: annual license fee of $400 plus $17.50 per birthing room; license non-transferable.
- Inspections, reporting, and enforcement:
- Department inspections for safety and incident review; mandatory reporting of adverse events; penalties for operating without a license (Class 3 misdemeanor) and ongoing violations.
- Adverse action processes and confidentiality provisions regarding information disclosed to enforcement bodies.
- Effective dates:
- Various sections become effective on different dates (e.g., fee schedule review by Oct 1, 2026; licensing rules and initial appointments by late 2026).
- Some provisions, including a new criminal offense for unlicensed birth centers, become effective December 1, 2026.
Potential impact and considerations
- Expands access to doula support through Medicaid and state funding.
- Creates formal CPM licensure and oversight, potentially increasing professional standards in midwifery.
- Establishes a regulatory framework for birth centers, including accreditation, licensing, and ongoing quality monitoring.
- Aims to balance consumer safety with expanded access to non-hospital childbirth options.
- Implementation hinges on CMS approval for Medicaid coverage and the timely promulgation of rules by the new Birth Center Commission.
