Health Facilities and Health Insurance - Palliative Care - Required Access and Coverage (Edna G. Neal Palliative Care Act)
Summary
HB1251, the Doula and Birth Policy Transparency Act, requires hospitals and certain health care facilities that provide obstetric care to adopt written policies on three topics: doula access, informed consent for significant medical interventions, and transfer/acceptance procedures for patients and records, including transfers from home births and licensed direct-entry midwives. The bill defines a doula as a nonmedical support professional and identifies significant medical interventions to include cesarean sections, labor induction or augmentation, operative vaginal delivery, and episiotomy.
The bill also requires hospitals to submit evidence to the Maryland Department of Health that these policies have been adopted by January 1, 2026, or upon establishment if the facility opens later, and to resubmit when policies are updated. The Department must adopt regulations to implement the law and make hospital policies available to the public on request. In addition, medical professional liability insurers that issue policies in Maryland must, on request, provide the Department information about their coverage policies for obstetric services, including coverage for vaginal birth after cesarean (VBAC).
Impact
The bill adds new provisions to the Health-General and Insurance articles of Maryland law. It creates a new subtitle governing hospital obstetric services policies, imposes policy-adoption and reporting obligations on hospitals and freestanding ambulatory care facilities that provide obstetric care, and gives the Maryland Department of Health oversight and public-disclosure responsibilities. It also adds a new insurer reporting requirement related to obstetric liability coverage, expanding state visibility into how obstetric services are handled by both providers and insurers.
Sentiment
The recorded floor votes were unanimous in both chambers, with 138-0 in the House and 42-0 in the Senate, indicating broad bipartisan support. No committee transcript excerpts were provided, but the voting history suggests the bill was not controversial at final passage and was generally viewed favorably by legislators.
Contention
The main policy issues embedded in the bill concern patient autonomy, doula access, and hospital control over labor and delivery practices. Supporters are likely to favor the transparency and informed-consent requirements, as well as clearer transfer procedures for home births and midwife-assisted births. Potential points of concern for hospitals and insurers include the administrative burden of documenting policies, the public availability of hospital policies, and the insurer disclosure requirement regarding obstetric liability coverage, including VBAC coverage. The bill also preserves hospital discretion to limit the number of doulas or authorized guests, which may reflect a compromise on access.