A N.C. House bill that would establish a licensing requirement for birthing centers gained new life Tuesday after being inserted into a Senate bill by the House Health committee.

House Bill 575, with state Rep. Donny Lambeth, R-Forsyth, as a co-primary sponsor, cleared the House by a 114-1 vote July 10. The bill has not been acted upon in the Senate Rules and Operations committee.

The language from HB575 was placed into Senate Bill 432 in what is known as a “gut and amend” process that takes out the original language of the bill, in this case amending state motor-vehicle laws to regulate mini-trucks.

The strategy is a way to get House-approved legislation through the Senate, which must approve changes.

The House Health committee recommended SB432 to the House Finance committee, which has not set its next meeting.

The second part of the revised SB432 requires licenses for pharmacy benefits managers. It would prevent benefits managers from barring pharmacies from dispensing any drugs. The legislation also would forbid retroactive denials or reduction of paid claims for most submissions.

The addition of language from House Bill 534 might prevent passage of the revamped SB432 since the pharmacy benefits bill was never heard in a House committee.

The birthing center language would create the N.C. Birth Center Commission and set a services fee schedule for the centers.

A licensed birthing center would be limited to low-risk, uncomplicated deliveries.

The N.C. Department of Health and Human Services would be in charge of licensing and inspecting the centers.

The state health secretary would be able to suspend the services of a birthing center, and the DHHS would be able to deny, suspend or revoke a license “with a substantial failure to comply” with the law in terms of safety and compliance.

The bill also would establish “basic standards and enforcement for the care and treatment of mothers and infants in birth centers.”

Individuals who operate a birthing center without a license would be guilty of a Class 3 misdemeanor, considered as the least serious type of misdemeanor with a maximum penalty of 20 days in jail and a $200 fine.

People found in violation would be subject to a $50 fine for the first offense and no more than $500 for subsequent offenses. Each day of continuing violation after conviction would be considered a separate offense.

The impetus for the bill was the recent deaths of three infants over a seven-month period at the Baby+Co free-standing birthing center in Cary. The group closed that center, as well as ones in Winston-Salem and Charlotte, and has left North Carolina.

Lambeth said Baby+Co’s decision to leave the state could possibly be connected to the bill’s introduction.

“We have been working on this for months, and many in the industry knew it was being worked on but did not necessarily know what was in the bill, so it could have been one factor of many,” Lambeth said.

“When the situation occurred in Cary, it may have started the discussions about the future of birthing centers in a more regulated environment and was that a business model they could sustain long term.”

Lambeth said other factors in the Baby+Co decision could be the implementation of Medicaid reform between now and early 2020, as well as additional competition from Wake Forest Baptist Medical Center’s plans to resume providing low-risk birthing centers in late July.

The bill would require birthing centers to report any deaths or serious physical injury to a mother or infant to the DHHS within 15 days for investigation.

Restrictions would include: no abortions; no general or conduction anesthesia allowed; and no performing of vaginal births after the mother previously had a cesarean section.

The centers would be required to offer mothers an ultrasound between the 18th and 22nd week of their pregnancies, as recommended by the American College of Obstetricians and Gynecologists, and to have transfer policies in place for complicated births that require deliveries in a hospital setting.

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rcraver@wsjournal.com 336-727-7376 @rcraverWSJ

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