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SB 908

Janell Green Smith Maternal Health Acc. Act.

2025-2026 Session Introduced by Natalie Murdock and 3 co-sponsors

Creates a statewide maternal health accountability system with licensure for midwives, standardized transfers, and data-driven oversight to improve safety and access.

Passed 1st Reading
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WeVote Research Nonpartisan
Bill Summary · SB 908

Summary of SB 908 (Session 2025) – Janell Green Smith Maternal Health Accountability Act (North Carolina)

Note: The bill text provided is filed in 2026 but is identified as Senate Bill 908 from the 2025 session. The summary below reflects the substantive provisions as written.

1) Purpose and Intent

  • Recognize and promote maternal health initiatives and expand the licensure and recognition of midwives (CNMs, CMs, and CPMs) in North Carolina.
  • Establish a comprehensive maternal health accountability framework focused on safety, transparency, workforce sustainability, informed consent, and equitable access.
  • Honor Dr. Janell Green Smith’s legacy in patient-centered maternity care and system accountability.

2) Key Provisions and Changes

A. New Maternal Health Accountability Framework (Article 10B within Chapter 90)

  • Title: “Dr. Janell Green Smith, DNP, CNM, Maternal Health Accountability Act.”
  • Core principles (definitions and aims):
    • Accountability for patient safety, respectful care, and measurable outcomes.
    • Clear, accessible avenues for reporting harm and seeking support.
    • Recognition, regulation, and support for CNMs, CMs, and CPMs across birth settings.
    • Acknowledgment of community-based organizations, including midwifery practices and doula groups, as essential public health infrastructure.
    • Sustainable, accessible, and fairly compensated maternal health workforce.
    • Demonstrated improvement in continuity of care, safety, and birth outcomes with licensed midwifery across hospital and community settings.

B. Hospital Accountability and Safe Discharge (90-178.14)

  • Hospitals offering maternal or emergency obstetric services must:
    • Implement a safe labor discharge plan before discharge.
    • Adopt standardized clinical escalation and emergency response protocols.
    • Provide annual training in respectful maternity care and implicit bias for relevant staff.
    • Maintain collaboration/transfer agreements with CNMs, CMs, and CPMs to ensure safe transitions of care.
    • Prohibit denial or delay of care based on provider type or planned birth setting.
    • Permit perinatal healthcare providers in birthing rooms as part of the care team (not counted as family).

C. Reporting and Oversight (90-178.15)

  • Annual reporting by August 1 from hospitals and perinatal providers on:
    • Maternal mortality, severe maternal morbidity, emergency postpartum readmissions, discharges during active labor, C-section rates, labor induction rates, NICU admissions, and transfers between settings.
    • Data disaggregated by race, ethnicity, payer, geography, and provider type; public on DHHS website.
  • Departmental oversight includes audits, corrective action plans for noncompliance, technical assistance, and evaluation of outcomes across birth settings.

D. Patient Advocacy and Navigation (90-178.16)

  • Establish a statewide maternal health reporting and navigation system:
    • Help with hospital grievance processes, referrals to legal resources, licensing boards, community health workers, and perinatal mental health services.
    • DHHS to allocate available funds to community-based organizations to provide these services where practicable.

E. Transfers and Infrastructure (90-178.17, 90-178.18)

  • Standardized transfer protocols to prioritize patient safety and continuity, while respecting professional autonomy.
  • State support for midwifery education, apprenticeships, scholarships, continuing education, workforce development, and funding to community-based organizations and birth centers for care coordination, billing, compliance, and supervision.

F. Doula Workforce Sustainability (90-178.19)

  • Recognizes doulas as essential to the maternal health workforce.
  • Establish fair reimbursement standards, fund doula hubs and mentorships, provide operational grants to community organizations, and conduct regional workforce assessments.
  • Prohibits a model that relies on unpaid or volunteer doula labor.

G. Licensure for Midwives (Article 10C)

  • Establishes the North Carolina Council of Certified Professional Midwives.
  • Defines credentials (CM, CPM) and requires licensure through the Council.
  • Creates a framework for collaboration/consultation with physicians and other providers.

H. Council Structure and Powers (90-178.29–90-178.37)

  • Council composition: 7 members (4 CPMs/CMs, 1 physician with midwifery knowledge, 2 community birth consumers).
  • Appointment by DHHS Secretary; terms and qualifications specified; public meetings and records; rulemaking authority; investigations and disciplinary actions; fee setting (not to exceed $500 over a two-year period).
  • Council to maintain licensure lists, credential verification, disciplinary actions, and annual reporting.

I. Licensure Details (Article 10C; 90-178.30–90-178.36)

  • Licensure requirements: approved application, national certification (AMCB for CNMs/CMs, NACPM/NARM for CPMs), CPR/NRP credentials, agreement to practice under the Article, and applicable fees.
  • Practice standards aligned with NACPM or Council standards; duties and responsibilities for licensed midwives outlined (informed consent, emergency planning, transfer planning, postpartum care, etc.).
  • License duration: initial license valid for 2 years; subsequent renewals every 2 years with continued certification and education requirements.
  • Reciprocity provisions for licensure from other jurisdictions when standards are equivalent.

J. Formulary and Medications (90-178.35)

  • Establishes a formulary of drugs/devices appropriate for CPM/CM care; midwives must comply with applicable laws and maintain records.

K. Licensure Sanctions and Enforcement (90-178.36–90-178.37)

  • Grounds for disciplinary action include misrepresentation, criminal conviction indicating unfitness, substance abuse, gross negligence, disciplinary actions in other jurisdictions, or violations of the Article or rules.
  • Enjoin illegal practices; vicarious liability considerations for non-midwife providers during childbirth.

L. Effective Date

  • General effective date: October 1, 2026 (with certain components triggering earlier or later dates, such as Medicaid parity provisions).

3) Who Would Be Affected

  • Mothers and pregnant/postpartum individuals receiving maternity care in North Carolina.
  • Certified Nurse Midwives (CNMs), Certified Midwives (CMs), Certified Professional Midwives (CPMs), and other perinatal health care providers.
  • Hospitals and perinatal care providers (including birthing centers and community-based midwifery practices).
  • Doulas and community-based maternal health organizations.
  • The North Carolina Department of Health and Human Services (DHHS) and its divisions, particularly the Division of Health Service Regulation (DHSR) and Medicaid program.
  • The North Carolina Council of Certified Professional Midwives (new/renamed governing body).

4) Procedural and Timeline Aspects

  • Departments and councils are tasked with establishing rules within specified timelines (e.g., Council rulemaking within one year of initial meeting).
  • Initial Council appointments target by October 1, 2026 (or within three months of the Article becoming law, whichever is later).
  • Data reporting to be published annually; oversight and annual reporting to legislative committees (Joint Legislative Health and Human Services Oversight Committee) by October 1 each year.
  • Insurance parity provisions are phased in with targeted effective dates (e.g., October 1, 2026 for certain coverage-relation provisions).

5) Notable Fiscal/Policy Implications

  • Potential increased regulatory oversight and licensure administration costs shifted to the Council; fees capped at $500 over two years.
  • Requirements for data collection, reporting, and public availability may affect hospital and provider data practices.
  • Medicaid reimbursement parity for midwives under Section 1(d) aims to reduce payment disparities between CNMs and CPMs/CMs and aligns Medicaid policies with new licensure framework.

Overall, SB 908 proposes a comprehensive reform to integrate midwives more formally into North Carolina’s maternal health system, enhance accountability and transparency, expand the midwifery workforce through licensure and education, recognize doulas, and ensure parity in maternity care reimbursement.

Compiled from official sources — confirm details with the bill’s official record.

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