AT A GLANCE

This bill permits abortion when an Alabama-licensed attending physician determines it is necessary to prevent a serious health risk, including rape or incest pregnancies, and requires convicted perpetrators to pay related medical costs and undergo court-ordered vasectomy or castration.

FULL SUMMARY

The bill amends Alabama’s abortion restrictions in the Code of Alabama, expanding when abortion is “permitted” and adding a new mechanism tying abortion-related costs and certain injunctive relief to a convicted rapist/incest perpetrator and to disputed paternity.

It revises definitions in §26-23H-3 (including “MAN,” “MEDICAL EMERGENCY,” and the scope/requirements for “SERIOUS HEALTH RISK TO THE UNBORN CHILD’S MOTHER”) and updates §26-23H-4. Under §26-23H-4, abortion is unlawful except when permitted. Abortion is permitted when an Alabama-licensed attending physician determines it is necessary to prevent a serious health risk to preserve the health of the unborn child’s mother, with (except for medical emergency) confirmation in writing by a second Alabama-licensed physician. Abortion is also permitted when the pregnancy results from rape or incest. Additionally, if the man who committed the rape or incest is convicted and the act resulted in pregnancy, the court must require him to (i) pay all medical expenses associated with the resulting pregnancy and abortion and (ii) undergo either a vasectomy or castration as ordered by the court.

The bill adds §26-23H-4.1, creating a civil-court process for allocating pregnancy and abortion medical expenses and adjudicating paternity disputes. The mother may petition circuit court to require the unborn child’s father to pay all medical expenses associated with the pregnancy and abortion, including complications. A father required to pay may petition for relief if he agrees to undergo a vasectomy and provides documentation of the vasectomy to the court. If the man disputes paternity, he may petition to adjudicate paternity; if the court finds him the biological father, he must either pay the required expenses or petition for relief under the vasectomy provision. Venue is set in the circuit court of the county where the alleged father resides or where the mother resides, and proceedings are given precedence; the court must rule within 48 hours after filing (excluding Saturdays, Sundays, and legal holidays).

The act takes effect October 1, 2026.

AT A GLANCE

This bill prohibits health care providers from knowingly performing or inducing an abortion when a detectable fetal heartbeat is present or when the provider fails to run the required gestation-appropriate test.

FULL SUMMARY

The bill creates Alaska’s “Heartbeat Act” framework by establishing new abortion limits tied to detecting a “detectable fetal heartbeat,” along with related documentation, private enforcement, and procedural restrictions. It adds new statutory provisions in AS 18.16.100–18.16.270 requiring (1) a health care provider determination of whether a fetal heartbeat is detectable using an appropriate test consistent with standard medical practice and appropriate for gestational age, (2) recording specified test and timing information in the woman’s medical record, and (3) a prohibition on knowingly performing or inducing an abortion when a fetal heartbeat is detected or when the provider fails to perform the required fetal-heartbeat test. It also provides exceptions for medical emergencies (with recordkeeping requirements) and for abortions performed at the behest of a federal agency/employee/contractor where preemption or intergovernmental immunity would be violated.

The bill also modifies Alaska’s existing informed-consent and related abortion-procedure provisions by changing terminology to “health care provider” (rather than physician/physician or surgeon in referenced places) and revising content/requirements for consent, including the gestational estimation and disclosure components, while retaining notice/consent procedures for minors. It amends liability standards tied to failure to obtain informed consent (including definitions of “clinical judgment” and “medical emergency” in emergency-related consent defenses) and adjusts notice mechanics for parental involvement in minor abortions (including timing of attempts, use of constructive notice after unsuccessful attempts, and related documentation/reporting duties).

For civil enforcement, the bill sharply limits public enforcement and establishes exclusive private civil actions: state and local officials (including district attorneys) may not enforce or threaten to enforce the fetal-heartbeat prohibitions, nor use them to justify enforcement of other laws; enforcement is “exclusively through” private civil actions under AS 18.16.150. The bill authorizes lawsuits by private plaintiffs (with broad coverage including persons who perform/induce abortions in violation and certain aid/abet and intent-to-engage conduct), mandates injunctive relief, statutory damages of at least $10,000 per violation and additional nominal/compensatory damages where injury/harm is shown, and allows attorney fees and costs; it also imposes a six-year statute of limitations and lists specific non-defenses (e.g., ignorance of law, reliance on overruled or nonbinding decisions, and consent of the woman) while including limited affirmative defenses for certain defendants under defined circumstances. Additional lawsuit constraints bar actions against the woman, limit certain suits involving common carriers unaware of intent, and exclude claims based on conduct of pregnancy from certain enumerated circumstances, while further restricting state participation (e.g., no acting in concert, establishing fiduciaries, controlling litigation decisions, or intervening).

The bill adds additional procedural requirements and safeguards for abortion procedures: it creates sonogram requirements (performed before sedatives/anesthesia and at least 24 hours before the abortion, with a waiver for women living 100+ miles from the nearest abortion provider meeting specific criteria), requires display of images and layperson-accessible oral explanations (including fetal heartbeat audibility where present), requires an election form with specified statements, and adds detailed reporting requirements for health care providers performing abortions at abortion facilities (monthly submission to the Department of Health on a secure electronic system, with confidentiality protections and limited permitted disclosures; violations are a Class A misdemeanor). It also includes construction/interpretation provisions stating there is no right to abortion before fetal heartbeat detection, provides severability rules intended to preserve enforceable applications if portions are invalidated, sets constitutional interpretation language about protecting human life and not securing/funding abortion rights, and includes uncodified provisions that condition the effect of certain court-rule/venue and attorney-fee provisions on a supermajority vote in each house. The bill takes effect immediately.

AT A GLANCE

This bill bars a physician from knowingly performing or inducing an abortion unless the physician first makes the required fetal-heartbeat detection determination and records detailed results in the patient’s medical record.

FULL SUMMARY

The bill establishes an “Alaska Heartbeat Act” framework that restricts abortion once a detectable fetal heartbeat (cardiac activity) is present and creates civil enforcement mechanisms rather than public enforcement. It amends existing licensing and informed-consent procedures for abortions (including by revising the physician’s required written/verbal information and updating the consent statute’s structure), and it adds a new Article 2 in AS 18.16 governing fetal heartbeat determination, prohibitions, exceptions, and civil enforcement.

Under new AS 18.16.100–18.16.110, a physician may not knowingly perform or induce an abortion unless a required fetal-heartbeat detection determination is made using an appropriate test consistent with standard medical practice, and detailed results and documentation are recorded in the woman’s medical record. AS 18.16.110 generally prohibits performing/inducing an abortion when a fetal heartbeat is detected or when the required heartbeat test is not performed. The bill provides exceptions: a medical-emergency exception (AS 18.16.120) where compliance with the heartbeat requirements is excused if a medical emergency prevents compliance, with specific recordkeeping duties; and an intergovernmental immunity/preemption exception (AS 18.16.130) for abortions conducted at the behest of a federal agency/contractor/employee where federal law would be violated.

The bill requires private civil enforcement only (AS 18.16.140), barring state/local prosecutors and officials from enforcing or threatening to enforce the heartbeat prohibition except through the private actions it creates. New AS 18.16.150 authorizes a private civil action by specified claimants against abortion providers and certain aiders/abettors (including conduct that pays/reimburses abortion costs through insurance or otherwise) for violations of the heartbeat restrictions; it also limits defenses and restricts the ability of the state/government to participate or influence plaintiffs. If a claimant prevails, the court must award injunctive relief, statutory damages of at least $10,000 per covered abortion violation (and per abortion the defendant aided/abetted), plus nominal/compensatory damages for harm and attorney fees/costs; however, the bill includes a limit on certain statutory-damages and attorney-fees awards if the defendant previously paid full statutory damages for the same abortion or aiding/abetting conduct. The bill sets a six-year statute of limitations and includes multiple “not a defense” provisions.

New AS 18.16.220–18.16.250 add operational requirements and procedures tied to the heartbeat regime: documentation for medical-emergency abortions, maternal-health limitation documentation for non-emergency abortions, a mandatory sonogram prior to sedation/anesthesia and an abortion (with an allowance to waive the 24-hour waiting period if the woman lives 100 miles or more from the nearest abortion provider or if conditions are met), an election/consent form for the sonogram and audible heartbeat, physician monthly reporting requirements that avoid patient identification, and misdemeanor penalties for specified reporting/documentation violations. The bill adds “severability” and constitutional-interpretation provisions (AS 18.16.200, 18.16.260) and defines key terms (including fetal heartbeat and gestational age) in AS 18.16.270. Finally, it includes conditional/unpaid effect language: certain venue/plaintiff-filed change provisions take effect only if specified constitutional vote thresholds are met, referencing Rule changes to Alaska Civil Procedure Rule 3 and Alaska Civil Procedure Rule 82 and Alaska Appellate Procedure Rule 508 via the uncodified conditional-effect sections.

The bill changes Alaska law governing abortion-inducing drugs by restricting prescribing/dispensing/administering and adding new procedural requirements for in-state health care providers.

Specifically, it amends AS 08.64.364(c) to require that a physician may not prescribe, dispense, or administer an abortion-inducing drug unless the physician complies with AS 18.16.010. It also tightens the “internet questionnaire/electronic mail” limitation by extending it so that neither a physician nor a physician assistant may prescribe, dispense, or administer a prescription drug in response to an internet questionnaire or email to a person with whom the provider does not have a prior physician-patient relationship.

The bill further amends AS 18.16.010 by adding a new subsection (k). Under this subsection, a health care provider who prescribes, dispenses, or administers an abortion-inducing drug must (1) conduct an in-person physical examination before prescribing/dispensing/administering, and (2) schedule a follow-up appointment that occurs no later than 14 days after the abortion to confirm the pregnancy was terminated and to assess continued blood loss.

AT A GLANCE

This bill requires abortion clinics to provide in-person, oral informed consent at least 24 hours before an abortion, including prescribed ultrasound offers, certification, and documentation for each patient.

FULL SUMMARY

The bill makes multiple changes to Arizona’s statutes governing abortion and related provider duties, clinic requirements, informed-consent procedures, parental consent for minors, and reporting/recordkeeping obligations. It (1) modifies abortion definitions and consent/informed-consent rules; (2) adds provider and clinic compliance requirements tied to counseling, ultrasound viewing and fetal heartbeat offer, waiting/“reflection” timing constraints, and fetal-condition-specific counseling; (3) increases or restructures administrative enforcement tools and civil remedies; and (4) expands state reporting requirements for abortion events and for provision of consent/ultrasound services.

Clinic and patient-screening requirements are expanded under rules directed to the department of health services. For abortion clinics, the bill adds/strengthens rulemaking requirements for facility physical standards, equipment and supply standards (including ultrasound equipment), staffing requirements (including availability of specific health care providers and presence/coverage rules during procedures), medical screening and evaluation for each patient (including ultrasound for all patients and documentation/training requirements for operators who are not physicians), and abortion procedure standards (including monitoring, local anesthesia/analgesia/sedation when ordered, and inpatient/hospitalization arrangements if complications exceed clinic capability). It also strengthens follow-up visit standards and incident reporting/enforcement rules for noncompliance, including incident reporting deadlines and definitions of “serious injury.”

Informed consent and timing rules are tightened and made more prescriptive. The bill revises consent requirements to require in-person, oral disclosure at least 24 hours before the abortion, with specified categories of information (medical risks; alternatives; probable gestational age and fetal characteristics; risks of carrying to term; benefits/assistance information; and rights related to consent withdrawal). It also imposes additional procedural steps tied to ultrasound: for certain abortions, before any anesthesia or medication, the provider must perform fetal ultrasound imaging and fetal heartbeat auscultation, offer the patient an opportunity to view the active ultrasound image and hear the heartbeat if audible, provide simultaneous explanation, and offer a physical picture of the ultrasound image; the patient must certify in writing that she was offered and opted to view/hear or decline. Separately, it includes a prohibition on writing/communicating prescriptions to induce abortion or requiring/obtaining payment for abortion services until the 24-hour reflection period expires.

For providers and enforcement, the bill adjusts scope restrictions for physician assistants by prohibiting them from performing “surgical abortions” as defined and adds amendments to related physician-assistant medication/controlled-substance limitations. It also reworks informed-consent-related civil liability provisions: it specifies eligible plaintiffs for civil actions, delineates available damages (including statutory damages pegged to $5,000 or multiple of costs), attorney-fee/cost recovery, and a six-year statute of limitations for bringing civil actions. The bill repeals an existing abortion-related section (36-2160) and amends the state’s abortion reporting statutes (36-2161 and 36-2162.01) to expand the categories of data reported by facilities and providers, including detailed patient and clinical information (without identifying the patient by name) and operational/consent/ultrasound-related reporting metrics. It further amends “viable fetus/embryo delivered alive” requirements (36-2301 and related provisions), including duties to promote and document life-preserving measures and clinic/hospital policies at or after 20 weeks’ gestational age, backed by judicial enforcement and civil actions by specified parties.

AT A GLANCE

This bill prohibits physician assistants from performing “surgical abortions” as defined in A.R.S. § 36-2151 and bars covered family planning services from including abortion or abortion counseling.

FULL SUMMARY

HB 2653 repeals multiple provisions of Arizona law governing abortion and related topics, and makes targeted amendments within Title 15 (education), Title 32 (health professions), Title 35 (public monies/research), Title 36 (health/vital records/Medicaid services), Title 41 (administrative rule review), Title 44 (minor consent), and Title 48 (medical facility construction). It also repeals entire Title 36 chapters/articles and specific sections related to fetal protection, and modifies certain definitions and operational rules in medical and pharmacy practice statutes.

Key statutory removals include: (1) outright repeal of specific abortion-related statutes and multiple sections across Titles 13, 15, 20, 32, 35, 36, and 48, as listed in the bill’s repeal sections; (2) repeal of Title 36, chapter 4, article 10; Title 36, chapter 20; and Title 36, chapter 23, articles 1 and 3; and (3) repeal of particular research/funding restrictions (notably sections 32-3246 and 35-196.02). The bill also changes the chapter heading of Title 36, chapter 23 from “Protection of Fetus or Embryo” to “EmbrYos.”

Among amendments that remain operative, the bill: (a) amends multiple scope-of-practice and definitions provisions for licensed medical professions (notably physician assistants), including a prohibition on physician assistants performing “surgical abortions” as defined in A.R.S. § 36-2151 (added/clarified in the physician assistant scope section) and an added limit barring “prescription medication intended to perform or induce an abortion” (A.R.S. § 32-2532); (b) modifies Medicaid/Arizona Health Care Cost Containment Program covered family planning services by excluding “abortion or abortion counseling” from covered family planning and adding related operational language (A.R.S. § 36-2907); and (c) amends public monies and family planning contracting/funding rules by prohibiting contracts/grants to entities that perform “nonfederally qualified abortions” or maintain facilities where such abortions are performed, and by defining/enforcing relevant terms (A.R.S. § 35-196.05).

The bill also adjusts administrative law and confidentiality/disclosure rules in Title 36: it amends the Medicaid “covered services” section to incorporate the family planning abortion exclusion, amends sections governing rule/agency petition processes (A.R.S. § 41-1033 largely reorganized/clarified procedural timing/voiding effects during council review), amends certain licensing fee waiver rules (A.R.S. § 41-1080.01), and makes additional amendments to nursing/physician unprofessional-conduct or related definitional provisions—while preserving or expanding existing public funding, reporting, and disciplinary enforcement structures. Finally, it changes facility-construction statutes to add an explicit ban on drugs/surgical procedures/services “for the purpose of causing…an abortion of an unborn embryo or fetus at any stage of development” in medical services provided at medical clinics under the relevant chapter (A.R.S. § 48-2212).

The proposed legislation requires public school employers and community college districts in California to provide up to 14 weeks of paid leave for employees affected by pregnancy, miscarriage, childbirth, termination of pregnancy, or recovery from these conditions. This leave applies to all employees, including certificated, classified, and academic staff.

Key provisions stipulate that the leave must be fully paid and cannot be deducted from other available leave options. Employees may begin their paid leave before childbirth and continue it afterward if they are disabled due to the specified conditions. Importantly, there are no eligibility requirements based on hours worked or length of service for those seeking this leave.

Additionally, employers are mandated to maintain group health coverage for employees on leave at the same level as if they had not taken any leave. This legislation aims to create uniform leave policies across public education institutions in California, which could significantly impact the education sector.

While the specific financial implications are not detailed, the requirement for paid leave and health coverage maintenance may lead to increased operational costs for school districts and community colleges. The effective date for these changes has not been specified.

The Reproductive Health Emergency Preparedness Program (RHEPP) is designed to improve access to reproductive and sexual health care in California's emergency departments. This initiative addresses the increasing demand for abortion and related services, particularly in areas with a shortage of primary care providers and obstetrician-gynecologists.

The healthcare industry, especially emergency departments and outpatient clinics, will be significantly impacted as they expand their services to include comprehensive reproductive health care. This expansion will involve training and resources for medical staff to provide essential services such as abortion care, contraception, and treatment for pregnancy loss.

Funding for the program will come from appropriations by the Legislature or private sources, with grants awarded competitively to participating emergency departments. The financial support aims to facilitate various initiatives, including education, clinical fellowships, and the integration of medication abortion services.

The RHEPP will become effective upon the availability of funds and will remain in effect until January 1, 2030. The program seeks to ensure that reproductive health services are accessible and affordable, addressing the needs of over 36 million women and individuals who may become pregnant in light of recent legal changes affecting abortion rights.

The legislation introduces comprehensive protections for medical information related to gender-affirming health care in California, specifically aimed at safeguarding the rights of transgender and gender nonconforming individuals. It prohibits health care providers and related entities from disclosing medical information in response to subpoenas or requests from other states that conflict with California's laws, thereby preventing harassment and intimidation.

Additionally, the bill restricts cooperation with out-of-state agencies and federal law enforcement regarding inquiries into gender-affirming health care. It establishes regulations for the Controlled Substance Utilization Review and Evaluation System (CURES), mandating that healthcare practitioners report specific information about controlled substances dispensed while ensuring patient privacy and data security.

The legislation also addresses the reporting of prescriptions for testosterone and mifepristone, exempting them from certain reporting requirements and mandating the removal of related records by a specified date. Overall, the changes emphasize the importance of protecting sensitive health information and ensuring that individuals can access gender-affirming care without fear of legal repercussions from other states.

The document outlines significant changes to the licensing and Medi-Cal reimbursement provisions for alternative birth centers in California. These changes primarily affect alternative birth centers and primary care clinics that operate as such, requiring them to adhere to new licensure and reimbursement standards.

Under the new provisions, Medi-Cal reimbursement for facility-related delivery costs at alternative birth centers will be established at a statewide all-inclusive rate per delivery, capped at 80% of the average reimbursement received by general acute care hospitals with Medi-Cal contracts. This rate will be updated annually based on reports from the California Medical Assistance Commission and will not exceed the charges for similar services provided to non-Medi-Cal patients.

The new reimbursement structure is set to take effect no earlier than July 1, 2017, pending necessary federal approvals. Additionally, starting July 1, 2022, alternative birth centers will be exempt from certain payment reductions imposed by existing regulations.

Regulatory changes include the removal of the requirement for alternative birth centers to be certified as providers of comprehensive perinatal services under Medi-Cal. New criteria for hospital transfer policies and quality assurance programs have also been introduced.

Overall, these changes aim to improve the operational framework for alternative birth centers while ensuring compliance with updated standards and reimbursement protocols.

The document outlines a legislative proposal aimed at enhancing perinatal services in rural areas of California, particularly in Humboldt and Plumas Counties. The initiative seeks to address the inadequate distribution of maternal and infant health services in medically underserved regions by establishing a pilot project that introduces "standby perinatal services" in critical access hospitals. This project is designed to improve access to essential perinatal care and ensure better health outcomes for mothers and newborns.

Key components of the proposal include requirements for hospitals to comply with professional standards, maintain necessary equipment and supplies, and develop quality improvement programs. Additionally, hospitals will be mandated to collect and evaluate data on safety, outcomes, and utilization, with a report to be submitted to the Legislature after the pilot project's completion. The initiative emphasizes the importance of regulatory compliance and the establishment of operational requirements for participating hospitals.

The proposal also includes provisions for continuing education and training programs for medical and nursing staff involved in perinatal services. This encompasses mandatory biennial rotations at higher-level care facilities, participation in simulation-based training for obstetric emergencies, and annual verification of nursing competencies. Furthermore, the legislation aims to enhance patient safety through collaboration with higher-level care facilities and adherence to licensed nurse-to-patient ratios.

Overall, this legislative effort is focused on improving maternal and newborn health outcomes in rural California by ensuring access to necessary perinatal services and enhancing the training and competencies of healthcare providers in these areas. The initiative represents a significant step toward addressing the challenges faced by rural hospitals in delivering comprehensive perinatal care.

The legislation reaffirms the legality of medication abortion in California, specifically focusing on the use of mifepristone and misoprostol. It aims to protect access to abortion care in response to the U.S. Supreme Court's reversal of Roe v. Wade, which has heightened threats to reproductive rights and led to ongoing legal challenges affecting access to these medications.

Key provisions include the lawful delivery, mailing, and transportation of abortion-related drugs, as well as protections for manufacturers, distributors, healthcare providers, and individuals involved in the provision of medication abortion. These protections are retroactive to January 1, 2020, ensuring that those involved in the process are shielded from civil or criminal liability.

The legislation emphasizes the safety and effectiveness of medication abortion, which constitutes over 60% of abortions in the U.S. and is associated with a low risk of complications. By safeguarding access to safe abortion care, the Act aims to promote the health and welfare of Californians.

Additionally, the provisions of the Act are severable, ensuring that if any part is deemed invalid, the remaining sections will still be enforceable. Overall, the legislation seeks to ensure continued access to essential reproductive healthcare in California.

AT A GLANCE

This bill requires health care entities to allow providers acting in good faith, within scope and the accepted standard of care, to provide comprehensive medically accurate counseling on reproductive and gender-dysphoria care without adverse action.

FULL SUMMARY

The bill establishes definitions (effective July 1, 2026) for “gender-affirming health care services,” “health care entity,” “health care provider,” and “medically accurate and appropriate information and counseling,” and defines “reproductive health care services” to include medical/surgical/counseling/referral services relating to the reproductive system (including sexual health, pregnancy, contraception, and termination of pregnancy).

It requires that, when a health care provider is acting in good faith within the provider’s professional scope of practice (including education/training/specialty/board certification) and within the accepted standard of care, a health care entity must not limit the provider’s ability to provide patients (1) comprehensive medically accurate and appropriate information and counseling regarding the patient’s reproductive health status and/or gender dysphoria/incongruence care (including diagnosis, prognosis, recommended treatments and alternatives, and potential risks), and (2) comprehensive medically accurate information and counseling about available and relevant community services/resources and how to access them to obtain care of the patient’s choosing.

The bill prohibits health care entities from discharging, demoting, suspending, disciplining, or otherwise taking adverse action against a provider solely because the provider provided the above information/counseling, but it includes conditions and carve-outs. A health care entity may perform relevant peer review, and may require providers to comply with (a) preferred provider network/utilization review requirements for insurance programs, (b) established health care quality and patient safety guidelines/rules, or (c) instructions requiring providers to give patients the full range of information on available legal options for care as determined by the entity (including but not limited to vaccinations); adverse action is permitted in the narrow circumstance where the provider fails to comply with those entity instructions.

The bill states it takes effect July 1, 2026, and it creates new statutory sections corresponding to the definitions and the provider-information/adverse-action limitations described above.

The Connecticut Department of Public Health has amended regulations regarding abortion services, effective August 1, 2023. These changes authorize a broader range of healthcare providers, including physicians, advanced practice registered nurses, nurse-midwives, and physician assistants, to perform medication and abortion procedures under specific conditions.

Key updates include enhanced reporting requirements for healthcare providers, who must submit details about the abortion procedures they perform to the commissioner of public health within seven days, while ensuring patient confidentiality. Additionally, abortions after the second trimester are mandated to be conducted in licensed hospitals or ambulatory surgery centers to meet national standards of care.

The informed consent process has been revised to guarantee that patients receive thorough information about the procedure, associated risks, and necessary follow-up care. Furthermore, outpatient clinics are now required to establish quality assurance and risk management programs, which include annual evaluations and audits.

These amendments aim to align state regulations with best practices in healthcare, ensuring that abortion services are delivered safely and effectively. The changes may also lead to financial implications for healthcare facilities, particularly concerning compliance costs and adjustments to operational procedures.

The Connecticut Department of Public Health has amended regulations regarding abortion services, effective August 1, 2023. These changes expand the eligibility of healthcare providers, allowing certified nurse-midwives, advanced practice registered nurses, and physician assistants to perform medication and abortion procedures, in line with recent legislative updates.

Healthcare providers are now required to report specific details about abortions performed to the commissioner of public health within seven days, ensuring patient confidentiality while maintaining oversight. Outpatient clinics offering abortion services must comply with national standards set by the American College of Obstetricians and Gynecologists to guarantee quality medical care.

The regulations also emphasize the importance of informed consent, mandating that healthcare providers furnish comprehensive information about the procedures, associated risks, and necessary follow-up care. Additionally, clinics are required to develop safety plans to address various emergencies, thereby prioritizing patient safety.

These amendments are anticipated to impact the healthcare industry, particularly facilities providing abortion services, by increasing compliance costs related to reporting, facility standards, and staff training. The heightened focus on quality assurance and risk management may lead to additional operational expenses for clinics.

AT A GLANCE

This bill adds to Delaware’s Constitution a fundamental right to reproductive freedom, prohibiting the State from denying, burdening, or infringing it, including protecting pregnancy-related decisions.

FULL SUMMARY

The bill proposes a constitutional amendment to Delaware’s Article I by adding/defining a new constitutional right to “reproductive freedom” (Article I, § 22). It establishes that every individual has a fundamental right to reproductive freedom that includes making and effectuating decisions about matters relating to the individual’s pregnancy—specifically prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care. It further provides that the right may not be denied, burdened, or infringed.

The bill also sets a regulatory boundary for abortion care after fetal viability: the State may regulate abortion care after fetal viability, but it may not prohibit an abortion when, in the good-faith medical judgment of a treating attending health care professional, the abortion is medically indicated to protect the life or physical or mental health of the pregnant individual.

Compared to Senate Bill No. 5 (per the bill’s synopsis on page 1), the substitute’s key clarifications are: (1) the right is tied to matters relating to the individual’s pregnancy; (2) the medical judgment standard is “good-faith medical judgment” rather than “professional judgment”; and (3) the judgment must be made by the “treating attending health care professional” rather than the “attending health care professional.”

The bill requires constitutional amendment procedures involving a supermajority vote: passage requires a two-thirds affirmative vote of members elected to each house of the Delaware General Assembly (as noted on page 2). It also states that constitutional amendments require approval of the same changes after the next general election by the next General Assembly.

The bill proposes a constitutional change to the Delaware Constitution, Article I, adding and/or revising a new “Right to reproductive freedom” provision. It would establish that every individual has a fundamental right to reproductive freedom, including the right to make and effectuate decisions regarding pregnancy-related matters such as prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care.

It would prohibit the right from being denied, burdened, or infringed. It also authorizes the State to regulate abortion care after fetal viability, but only with a protective limitation: the State may not prohibit an abortion that, in the professional judgment of an attending health care professional, is medically indicated to protect the life or physical or mental health of the pregnant individual.

The measure is drafted as a constitutional amendment that requires passage both within this General Assembly and again after the next general election by the next General Assembly, with constitutional amendment approval requiring an affirmative vote of two-thirds of the members elected to each house.

AT A GLANCE

This bill prohibits any person from performing or inducing an abortion of a pain-capable unborn child unless the unborn child has a nonviable health condition or the abortion is necessary to avert the woman’s death or serious irreversible impairment.

FULL SUMMARY

The bill creates (by repeal and reenactment within Title 24, Chapter 17, Subchapter IX) a “Pain-Capable Unborn Child Protection Act” structure that regulates abortion based on an unborn child’s “pain-capable post-fertilization age” (defined as 5 months or more) and provides procedural, reporting, and penalty provisions. It updates key definitions in § 1702 and in the subchapter’s definitions section, including how “reproductive health services,” “viability,” “post-fertilization age,” and related medical-judgment terms are defined.

Key operational prohibitions are set out in §§ 1794 (consent prior to termination—repealed—and abortion of a pain-capable fetus prohibited) and 1791–1793: no person may perform or induce (or attempt) an abortion of an unborn child capable of feeling pain unless (1) the unborn child has a nonviable health condition, or (2) the abortion is necessary to avert the pregnant woman’s death or to avert a serious health risk involving substantial and irreversible impairment of a major bodily function (excluding psychological/emotional conditions), under a physician’s reasonable medical judgment tied to the “probable post-fertilization age” reaching the “pain-capable” threshold. The bill also maintains limits on what counts as a “medical emergency” and specifies that no condition qualifies as a medical emergency if based on the woman engaging in conduct intended to cause death or serious impairment.

The bill includes a reporting and transparency regime in § 1794A: health-care practitioners must report all instances where they perform, induce, or attempt abortion to the Department on a schedule and no less frequently than by December 31 each year, using Department forms and including (among other items) probable post-fertilization age determinations (and whether ultrasound was used), method of abortion, and bases for determinations when the threshold is met and the “best opportunity for the fetus to survive” method requirement is addressed. Reports must not contain identifying patient information and must be kept in strict confidence, with disclosure only under court order; starting June 30, 2026, and annually thereafter, the Department must publish public statistical reports for prior calendar years while taking steps to prevent patient identification.

Enforcement is strengthened through § 1794B (Penalties): intentional or reckless violations of the act’s abortion prohibitions are classified as a Class D felony for “any person,” and health-care practitioners are deemed to have acted outside the scope permitted by law and are subject to discipline by their licensure board, including possible loss of professional license. The bill also authorizes civil remedies, including actual and punitive damages actions by the woman (and in some cases the father), injunctive relief actions (including by the Department of Justice), attorney’s fee shifting rules tied to litigation outcomes, and clarification that no penalties may be assessed against the patient for the abortion itself. A severability clause preserves enforceability of remaining provisions if any part is held invalid.

AT A GLANCE

This bill prohibits health-care practitioners from performing abortions on unborn children capable of feeling pain after the pain-capable post-fertilization age threshold unless a statutory exception applies.

FULL SUMMARY

The bill establishes a Delaware “Pain-Capable Unborn Child Protection Act” within Title 24, Chapter 17, Subchapter IX, replacing the existing statutory framework for “termination of human pregnancy” in those sections. It includes legislative findings about fetal pain capability and severability intent, and creates definitions and operative rules limiting abortion decisions based on (1) whether an unborn child is “capable of feeling pain” at a specified post-fertilization age threshold and (2) categories of exceptions. It also requires health-care practitioners to report specified abortion-related data to the Department of Health and Social Services and sets enforcement and civil/remedial pathways.

Key definitional changes move or conform terms within Subchapter IX and Title 24 generally. Section 1702 is revised to change which cross-references define abortion-related concepts (“Abortion” references § 1790A) while also retaining and clarifying the definition of “viability” tied to a physician’s good-faith medical judgment about fetal survival outside the uterus without extraordinary measures. The bill also revises the definition of “nonviable” in Subchapter IX to clarify that “nonviable” means a lethal anomaly rendering the unborn child incompatible with life outside the uterus such that death will occur upon birth or shortly thereafter, and that “nonviable” excludes health conditions under which the child may survive outside the uterus with medical treatment.

Substantively, it prohibits abortions of an unborn child capable of feeling pain after the “pain-capable post-fertilization age” threshold (set at 5 or more months of probable post-fertilization age) unless one of the statutory exceptions applies: (1) the unborn child has a nonviable health condition, or (2) the abortion is necessary to prevent the death of the pregnant woman (with the bill specifying that no condition may qualify as a “medical emergency” based on a claim that the woman intends to engage in conduct resulting in her death). It also requires that, even when an abortion is permitted under these exceptions, the practitioner must terminate in the manner providing the best opportunity for fetal survival unless doing so would pose a greater risk of the patient’s death, and it reiterates that provider determinations cannot rely on intent-based self-harm claims.

The bill creates/updates administration, confidentiality, and enforcement. Health-care practitioners must report all instances of performing/inducing or attempting to perform/induce abortions to the Department, including probable post-fertilization age information and other details about method and exception basis; reports may not include identifying patient information and must be kept confidential by the Department and released only by court order. The Department must issue a public statistical report starting June 30, 2027, annually thereafter (covering the prior calendar year) without information that could reasonably identify patients. Penalties are established for intentional or reckless violations (class D felony for prohibited abortion acts; license-discipline consequences for health-care practitioners considered outside the scope of permitted practice), along with civil remedies: no penalties against the patient; possible actual and punitive damages actions for the woman (and, in certain cases, the father) against the violator; injunctive relief actions available to the woman/parent or guardian or the Department of Justice; and attorney-fee shifting based on litigation outcomes (including fee awards against plaintiffs for frivolous/bad-faith suits). Technical changes also conform Title 24 cross-references and related provisions, including to § 1702.

AT A GLANCE

This bill requires health-care practitioners in Delaware, except in a medical emergency, to offer an active ultrasound image and fetal heart tone auscultation before terminating a human pregnancy and obtain the patient’s signed acknowledgment.

FULL SUMMARY

The bill establishes requirements in Delaware law (Title 24, Chapter 17, Subchapter IX) governing what health-care practitioners must offer to a patient before terminating a human pregnancy. It requires offering ultrasound imaging and fetal heart tone auscultation, specifies what those services must include, allows the patient to decline to view/listen, and requires the patient’s signed acknowledgment before termination. It also ties proof of compliance to accreditation requirements.

It changes § 1791A of Title 24 by (1) requiring, except for medical emergency, a health-care practitioner (or agent) to offer ultrasound imaging and auscultation of fetal heart tones before terminating a human pregnancy; (2) requiring the offered ultrasound image to be an “active ultrasound image” of quality consistent with standard medical practice that includes fetal dimensions and an accurate portrayal of external members and internal organs; and (3) requiring the offered fetal heart tone auscultation to be of quality consistent with standard medical practice that the patient may hear. It maintains that the patient may choose not to view the ultrasound image or listen to the fetal heart tone.

The bill defines “health-care practitioner” to include individuals who may act to terminate, attempt to terminate, or assist in termination of a human pregnancy (including by prescribing medication) and defines “medical emergency” as a condition, based on good-faith clinical judgment, necessitating immediate termination to avert the patient’s death or where delay creates serious risk of substantial and irreversible impairment of a major bodily function; it further specifies that a condition is not a medical emergency if based on a claim or diagnosis that the pregnant patient will engage in conduct intended to cause the patient’s death or substantial and irreversible impairment of a major bodily function.

Before terminating the pregnancy, the bill requires the practitioner to obtain the patient’s signature on a form indicating the patient was offered the ultrasound image and auscultation services. It also requires proof of compliance to be used for accreditation under the referenced Title 16 provision, and it designates the law as “The Woman’s Right to Know Act.”

AT A GLANCE

This bill bars physicians from performing abortions on unemancipated minors under age 16 until at least 24 hours’ notice and written parental or authorized consent procedures, or a Family Court waiver, are satisfied.

FULL SUMMARY

The bill amends Delaware’s Title 24, Chapter 17, by revising the statutory framework governing parental notice consent for abortion by an unemancipated minor under age 16. It updates the definitions in §1782 (including “minor” as female under age 16, plus definitions of “coercion,” “emancipated minor,” “licensed mental health professional,” and “medical emergency”) and revises the parental notice consent requirement structure in §1783 and the waiver process in §1784.

Under the revised §1783, no physician or other medically authorized person may perform an abortion on an unemancipated minor until specified notice and written parental consent procedures are followed, subject to exceptions for medical emergency or for a court waiver (via §1784). The procedure requires at least 24 hours’ actual notice and consent obtained from one or both parents (custodial or noncustodial), a grandparent, a licensed mental health professional (with limitations on employment/contracting with abortion providers, except acute-care hospital employees/contractors), or the legal guardian. If the contacted person is not a parent or guardian, the contacted person must explain adoption, abortion, and full-term pregnancy, and agree that granting a waiver of the parental notice requirement is in the minor’s best interest; a contacted licensed mental health professional must certify that an assessment was performed regarding relevant factors and consequences to the minor. The consent form must include specified items (minor’s name; consenting parent/guardian information and signatures; attending physician information; and a voluntary understanding/consent statement), and the bill includes provisions prohibiting referral fees for those authorized to receive notice/give consent and clarifies that child abuse reporting obligations remain unaffected.

The revised §1784 establishes/maintains the Family Court waiver mechanism when parental notice consent is not possible or is inappropriate due to abuse, neglect, or coercion, and sets out required contents of the minor’s written petition and the court’s grounds for waiver using “clear and convincing evidence.” It requires that the Family Court bypass the notice consent requirement if it finds the minor is mature and well-informed enough to decide independently or that obtaining parental consent is not in the minor’s best interest, including in cases of abuse, neglect, or coercion. The bill also adds procedural rules: a presumption related to confidentiality/confidants for “married parents not separated” and grandparents for waiver requests, a timing rule deeming the petition granted if the court fails to rule within five calendar days, logistics for issuing and mailing orders and attempting to notify the minor, an expedited appeal to the Delaware Supreme Court with a right to court-appointed counsel at no cost to the minor (and expedited proceedings), and a no-fee/no-cost rule for proceedings under the waiver subchapter.

The act takes effect 30 days after enactment. In short, it maintains and refines Delaware’s parental notice/consent requirement for minors seeking abortion, while expanding or clarifying the definitions, the consent/notice procedures, and the Family Court waiver and expedited judicial review process.

The document repeals sections 286.31, 286.311, and 381.00321, which previously restricted the use of state funds for travel related to abortion services, sex-reassignment procedures, and protected healthcare providers' conscience rights. It establishes new requirements for healthcare entities to provide written notices of refused services, submit lists of such services to the Department of Health, and maintain publicly accessible information on refused services, with policies to be adopted by October 1, 2026, and enforcement mechanisms including fines up to $5,000 per day. The department is tasked with developing rules, publishing lists of refused services, and overseeing compliance.

Additionally, the bill mandates that providers promote childbirth exclusively, ensure informational materials are current and cite sources, and deliver services that are noncoercive and free of religious content. It introduces detailed reporting obligations on service provision and expenditures, and restricts third-trimester abortions to specific conditions such as physician certification, emergencies, fetal abnormalities, or cases involving rape, incest, or trafficking, with documentation requirements. In-person physician performance of abortions is required, while telehealth and mailing of medications for medical abortions are prohibited. The bill grants the agency authority to regulate abortion clinics, including licensing, inspections, and record-keeping, and repeals section 395.3027.

The definition of "sex" is clarified to be based on reproductive anatomy, chromosomes, and hormones present at birth, and "sex-reassignment procedures" are clarified to exclude treatments for genetic or physical disorders, infections, injuries, or illnesses that could be caused or worsened by such procedures. Telehealth providers are prohibited from performing abortions via telehealth, including medical abortions. Statutes related to emergency jurisdiction and child custody enforcement are amended to include protections concerning sex-reassignment procedures. Medicaid reimbursement policies are modified to include protections for gender-affirming care, with specific provisions for hospital services and local government funding.

Finally, the bill enhances oversight of Medicaid fraud and abuse by establishing detailed reporting requirements, including annual reports to the Legislature, policy recommendations with fiscal analyses, and performance standards. It also updates provisions related to Medicaid recipient communication, the licensing deadline for Medicaid mental health service providers (set for December 31, 1998), and authorizes Medicaid payments for gender-affirming care.

The document establishes a new Section 383.295 in Florida Statutes to create the Doula Support for Healthy Births pilot program, which will operate in Broward, Miami-Dade, and Palm Beach Counties. The pilot aims to provide evidence-based doula support services to pregnant and postpartum women, particularly those overcoming substance use disorders, with the goal of improving birth outcomes. The program's duration is set between 12 and 24 months, contingent upon funding, and involves collaboration with healthcare providers and community organizations to ensure doulas meet specified criteria. Definitions for "doula" and "doula services" are included to clarify the scope of services provided.

Additionally, a Doula Certification Task Force is established within the Department of Health to review the scope of practice, develop core competencies, and recommend certification standards for doulas. The task force is tasked with setting minimum certification requirements, including education, training, supervised practice hours, background screening, and ethics education. The final report from the task force is due by January 1, 2028, and the task force will operate temporarily until October 2, 2029.

The document introduces new requirements and clarifications related to parental consent, notification, and access concerning minors' health and educational services. It mandates written parental consent for minors to receive health care services, procedures, and the use of biofeedback devices, with specific exceptions such as emergency situations or court orders. Parents are granted the right to review, inspect, and consent to surveys or questionnaires involving sensitive information, including biofeedback device results, prior to their minors' participation. The bill clarifies that minors acting alone can provide written consent for the disclosure of their treatment records, and that parental consent for disclosure is only necessary when the minor also consents. It emphasizes that minors' consent to treatment has the same legal effect as that of adults and maintains parental participation rights for involuntary admissions.

Additionally, the bill revises confidentiality and parental notification provisions for minors receiving substance abuse treatment, specifying that minors can independently consent to the disclosure of their treatment records to parents or guardians, and that parental consent for disclosure is only valid if the minor also consents. It reinforces that minors' consent to treatment is legally equivalent to that of adults and clarifies that parental rights to access health and education records are protected, including notification of changes in a student's health or related services. The bill also establishes detailed procedures and protections for parental involvement in student health services, mental health screenings, and dispute resolution processes within schools.

Furthermore, the bill reenacts statutory provisions to specify that failure to comply with parental consent requirements constitutes grounds for disciplinary action, effective July 1, 2026. Definitions are provided for terms such as "biofeedback device," "informed consent," "minor," "guardian," and related concepts to clarify the scope of these provisions. Overall, the changes reinforce parental rights and consent procedures across minors' health and educational services, emphasizing transparency, confidentiality, and the legal equivalence of minors' consent.

AT A GLANCE

This bill establishes a fundamental right for every individual to make autonomous decisions about reproductive health care, prohibits the state from denying or interfering, and bars civil or criminal penalties for exercising those rights.

FULL SUMMARY

The bill creates Fla. Stat. s. 381.0026 (“Reproductive Freedom Act”) establishing a state statutory fundamental right to reproductive health care. It defines key terms (“abortion,” “pregnancy” beginning with an implanted human embryo, and “reproductive health care”) and declares legislative findings grounded in the Florida Constitution’s principles of liberty, privacy, and equality.

The statute provides that every individual has a fundamental right to make autonomous decisions about their own reproductive health, including the right to use or refuse reproductive health care. It also provides that individuals who become pregnant have a fundamental right to choose whether to continue the pregnancy and give birth or obtain an abortion, and to make autonomous decisions about how to exercise that right. The state is prohibited from denying or interfering with access to reproductive health care.

State and local law enforcement agencies and officials are prohibited from harassing or discriminating against an individual for providing or obtaining reproductive health care or assisting another person in doing so. The bill also prohibits penalizing, prosecuting, or taking adverse action against individuals based on their exercise of the reproductive health rights or on actual, potential, perceived, or alleged pregnancy outcomes (including miscarriage, stillbirth, or abortion). The bill further provides civil-liability protections: individuals may not be subject to civil liability for exercising the fundamental rights, and individuals who aid or assist another in exercising those rights may not be subject to civil liability for such aiding or assisting. It states that a fertilized egg, embryo, or fetus does not have independent rights under Florida law.

Local governments may not regulate an individual’s ability to freely exercise the fundamental right in a more restrictive manner than the statute. The new section applies to all state and local laws, ordinances, regulations, rules, policies, procedures, practices, and government actions, and it supersedes any conflicting provision in chapter 390. The bill includes a severability clause and repeals Fla. Stat. ss. 286.31, 381.00321, and 765.113; it takes effect upon becoming a law.

The document introduces several significant changes to Florida's healthcare statutes and regulations. It repeals statutes related to the prohibition of using state funds for travel to other states for abortion services, sex-reassignment procedures, and protections for healthcare providers' conscience rights. It establishes new requirements for covered entities to adopt policies, submit lists of refused services, notify the Department of Health of changes, and include such lists in grant or contract applications, with a deadline of October 1, 2026. The Department is tasked with publishing current refused service lists, developing public education programs, and maintaining an online list of covered entities and their refused services by January 1, 2027.

The bill mandates that health care facilities disclose refused services to patients and the Department, with penalties for non-compliance up to $5,000 per day. It also clarifies that the section does not alter existing legal liabilities or rights related to health care service denials. Additionally, it requires the development of public education and awareness programs about service denials and their impacts.

A new requirement is added that pregnancy and parenting support services must constitute at least 85% of contract funds, replacing the previous 90% threshold. The bill also prohibits telehealth abortions and the mailing or couriering of medications for medical abortions, mandating in-person performance of pregnancy termination procedures by licensed physicians.

Legal definitions are introduced or clarified for sex-reassignment prescriptions or procedures, with specific exceptions for treatments related to genetic disorders, injuries, or illnesses posing imminent danger. Emergency jurisdiction is expanded to include cases where minors are subjected to or threatened with sex-reassignment procedures, allowing courts to issue custody warrants if serious harm is likely. Reimbursement policies for Medicaid are revised to allow retroactive recalculations based on updated cost reports, with full payment at the new rate, and provisions are included for adjusting reimbursement rates, fees, and service parameters to align with available funds and legislative intent. The bill also emphasizes increased reporting and transparency in Medicaid fraud prevention, including detailed fiscal analyses, performance standards, and educational materials for recipients, along with provisions for emergency license suspension of practitioners arrested for certain offenses, including sex-reassignment procedures for minors.

AT A GLANCE

This bill bars state and local law enforcement from arresting anyone for performing or aiding an abortion or administering related treatment under specified conditions, and it prohibits investigations and penalties for pregnancy-outcome care actions or omissions.

FULL SUMMARY

The bill establishes legal protections for healthcare professionals who provide medical treatment to pregnant women (including treatment related to abortion outcomes) by (1) adding a broad “no investigation/no penalty/no rights deprivation” provision tied to pregnancy or pregnancy outcome actions or omissions, and (2) revising abortion-related medical-justification language in the abortion restrictions statute. It also revises Georgia’s feticide and related unborn-child offense framework by adding a new subsection and clarifying a limitation on state/local law enforcement arrests when the abortion is performed under the referenced abortion statute. In addition, it changes the medical licensing “unprofessional conduct” grounds by revising the specific provision covering participation in a criminal abortion in violation of the statute.

Concretely, the bill changes Code Section 16-5-80 by (a) revising subsection (b) to expressly bar state/local law enforcement from arresting anyone for performing or aiding in an abortion, or administering treatment that may lead to an abortion, when the abortion is performed in accordance with Code Section 16-12-141, and (b) adding subsection (c.1) that prohibits investigations and civil or criminal penalties (and deprivation of rights) under the article based on actions or omissions regarding pregnancy or pregnancy outcomes (including miscarriage, stillbirth, ectopic pregnancy, abortion, or perinatal death due to causes occurring in utero), notwithstanding any other law. It also revises Code Section 16-12-141(h)(1) to clarify when a licensed physician’s treatment resulting in accidental/unintentional injury or death of an unborn child (or death of the pregnant woman) is permissible, including the timing/conditions involving averting the pregnant woman’s death or avoiding serious risk of substantial or irreversible impairment of a major bodily function or death of the unborn child.

Finally, the bill amends Code Section 43-34-8(a)(8) (grounds permitting license/certificate/permit discipline and related actions) by revising the “unprofessional conduct” language covering performing, procuring, aiding/abetting a criminal abortion, specifically tying the violation to Code Section 16-12-141(h)(1). The bill includes a general repeal clause for conflicting laws.

The document outlines significant amendments to the Official Code of Georgia Annotated, primarily focusing on reproductive health rights and regulations surrounding abortion. Key changes include the clarification that unborn children are not considered "natural persons" in certain demographic analyses, which may affect data collection. Additionally, existing provisions related to criminal abortion and the "Woman's Right to Know Act" have been repealed, potentially altering operational protocols for healthcare providers and facilities that perform abortion services.

The amendments also address parental notification requirements for unemancipated minors seeking abortions, mandating that healthcare professionals provide at least 24 hours' notice to a parent or guardian. Exceptions to this requirement are outlined, allowing for cases where notifying a parent may cause harm or if the minor is deemed capable of giving informed consent. Healthcare providers will need to adapt their practices to comply with these new notification and consent protocols.

Further changes include the establishment of the "Reproductive Freedom Act," which asserts fundamental rights regarding pregnancy, abortion, and contraception, stating that a fertilized egg, embryo, or fetus does not have independent rights under state law. This act aims to protect personal reproductive autonomy and prohibits discrimination in the enforcement of reproductive rights based on various factors.

The amendments also impact the healthcare and insurance sectors by repealing certain restrictions on abortion services and altering tax implications related to dependents. Notably, the Department of Community Health is mandated to provide payment for abortion services for recipients of medical assistance, which may increase the financial burden on the state's public health budget.

Overall, these changes are poised to significantly influence healthcare practices, insurance policies, and legal frameworks surrounding reproductive rights in Georgia, affecting various stakeholders, including healthcare providers, families, and legal professionals.

The proposed legislation amends various chapters of the Official Code of Georgia Annotated, significantly impacting reproductive health rights and abortion regulations. Key changes include the redefinition of "natural person" to encompass unborn children, which may alter legal interpretations in multiple contexts. The legislation repeals existing provisions related to criminal abortion and the licensing of medical facilities for abortion procedures, potentially reshaping how abortion services are provided and regulated in Georgia.

Additionally, the bill allows for the repeal of prohibitions on insurance coverage for certain abortions, which could affect health insurance providers and their policies. It also specifies that an unborn child with a detectable human heartbeat is not considered a dependent minor for income tax purposes, influencing tax liabilities for individuals. Furthermore, the legislation mandates that the Department of Community Health provide payment for all abortion and abortion-related services under Medicaid, potentially increasing access to these services for eligible individuals.

The amendments also introduce new parental notification requirements for unemancipated minors seeking abortions, necessitating at least 24 hours' notice to a parent or guardian. Exceptions to this requirement are outlined, allowing healthcare professionals to bypass notification if it may cause harm to the minor. The legislation emphasizes the protection of reproductive rights, establishing fundamental rights regarding pregnancy, abortion, and contraception, while clarifying that a fertilized egg, embryo, or fetus does not possess independent rights under state law.

These changes are likely to influence various business sectors, including healthcare providers, insurance companies, and legal services. The requirement for health benefit policies to cover prescribed contraceptive methods, while not mandating coverage for abortion, may alter the dynamics of the insurance market. Additionally, the potential for civil lawsuits against state or local officials for violations of the new regulations could increase demand for legal representation in reproductive rights cases.

Overall, the amendments aim to enhance reproductive rights and delineate the responsibilities of healthcare providers and insurance companies, with significant legal and financial implications for various stakeholders in Georgia.

The proposed legislation amends existing Georgia law to establish that life is valued and protected from the moment of conception, granting unborn children the same rights and protections as all persons under the U.S. Constitution and Georgia law.

This change may have significant implications for various industries, particularly those related to healthcare, reproductive health services, pharmaceuticals, and family planning. It could lead to alterations in healthcare costs, legal liabilities, and shifts in the demand for services.

The effective date of these changes has not been specified.

The document presents a legislative proposal designed to provide financial compensation to pregnant women who are required to carry a pregnancy to term due to fetal heartbeat laws. Eligible women can receive support for various expenses, including living, legal, medical, psychological, and psychiatric costs associated with prenatal, intrapartal, and postpartal care. Additional benefits may include tax credits, home visits from trained nurses, public assistance eligibility, funeral expenses in the event of loss, and support for children with congenital disabilities.

To qualify for compensation, women must submit an affidavit to the Department of Human Services, stating that they would have opted for termination if not for the law. This affidavit can be filed after a detectable heartbeat is confirmed and before the child is born.

The proposal is expected to have significant implications for healthcare providers, legal services, and social services, as these sectors will need to adjust to new requirements for care and compensation processing.

Furthermore, the General Assembly is responsible for creating a separate fund to ensure adequate annual appropriations for the compensation and operational costs associated with the proposal. Overall, the initiative aims to establish a structured support system for women impacted by restrictive abortion laws, emphasizing financial assistance and healthcare services.

The proposed amendment to the Official Code of Georgia Annotated seeks to establish the rights of life from the moment of conception, asserting that unborn children are entitled to the same rights and protections as all persons under U.S. and Georgia law. This amendment emphasizes the value of life and aims to clarify the definitions surrounding abortion and abortifacients.

Healthcare providers, particularly those involved in reproductive health services, as well as pharmaceutical companies that produce contraceptives and abortifacients, may be significantly impacted by this amendment. The financial implications could include increased legal and operational costs for compliance with the new regulations, along with potential changes in patient care practices.

Importantly, the amendment does not create or recognize a right to abortion, nor does it prohibit the use of contraception. The document does not specify when these changes would take effect.

AT A GLANCE

This bill urges all Hawaii hospitals receiving Medicare funding to provide EMTALA-compliant emergency medical screening and stabilizing treatment to pregnant patients, regardless of religious affiliation, without denial or delay when medically necessary.

FULL SUMMARY

The Senate Concurrent Resolution affirms and supports that hospitals receiving Medicare funding must provide life-saving emergency medical care to pregnant people, including reproductive and abortion services, when medically necessary to stabilize a patient under the federal Emergency Medical Treatment and Active Labor Act (EMTALA).

It recounts EMTALA’s core requirement—medical screening and stabilizing treatment for emergency medical conditions without regard to ability to pay—and asserts that EMTALA has been interpreted to require abortion care when it is the necessary stabilizing treatment for life- or health-threatening conditions (e.g., hemorrhage, ectopic pregnancy, or preeclampsia). It also highlights recent federal policy guidance disputes as creating confusion while maintaining that the statute remains in effect.

The resolution urges all Hawaii hospitals, “regardless of religious affiliation,” to uphold established standards of emergency stabilizing care and to ensure that no pregnant patient experiencing a medical emergency is denied or delayed stabilizing care. It specifically rejects any religious exemption approach by noting EMTALA does not allow religious exemptions, while acknowledging that some religiously affiliated hospitals have raised conscience-based objections.

Finally, it directs transmission of certified copies to the Governor, the Director of Health, key healthcare association leadership (including the Healthcare Association of Hawaii and Hawaii Primary Care Association), and the leadership of Hawaii’s health plan and medical associations.

AT A GLANCE

This bill affirms that EMTALA-covered hospitals must provide medical screening examinations and, when medically necessary to stabilize life- or health-threatening emergency conditions, stabilizing “abortion care,” including for pregnant patients.

FULL SUMMARY

The bill is a House Concurrent Resolution that affirms and supports the federal Emergency Medical Treatment and Active Labor Act (EMTALA) requirement that hospitals providing emergency care (as covered by EMTALA) must conduct a medical screening examination and provide stabilizing treatment for emergency medical conditions, including when needed to stabilize a pregnant patient.

It specifically affirms the position that, under EMTALA as it has been interpreted, hospitals must provide “abortion care” when it is the medically necessary stabilizing treatment for life- or health-threatening conditions (e.g., the resolution cites hemorrhage, ectopic pregnancy, and preeclampsia as examples of conditions that may require such care). It further urges hospitals—regardless of religious affiliation—to continue upholding established standards of emergency care and to ensure that pregnant patients in medical emergencies are not denied or delayed needed stabilizing care.

The resolution notes recent shifts in federal policy and guidance that have created confusion about EMTALA’s application, while asserting that the EMTALA statutory requirements remain in effect. It also cites that some states have explicitly defined emergency abortion care as EMTALA-required stabilizing treatment and references Hawaii’s existing practice and support by Hawaii hospitals and emergency physicians for providing stabilizing care, including emergency abortion care, when medically necessary.

Operationally, it directs transmission of certified copies of the resolution to specified Hawaii officials and healthcare organizations (including the Governor and relevant healthcare associations).

AT A GLANCE

This bill affirms that hospitals receiving Medicare funding must comply with EMTALA by providing medical screening and stabilizing emergency treatment to all patients, including medically necessary life-saving care for pregnant patients.

FULL SUMMARY

The resolution affirms and supports that hospitals receiving Medicare funding must comply with the Emergency Medical Treatment and Active Labor Act (EMTALA) obligation to provide a medical screening examination and stabilizing treatment to any person with an emergency medical condition.

It specifically affirms that, where medically necessary to stabilize a pregnant patient under EMTALA, hospitals must provide life-saving emergency care that can include reproductive and abortion services (i.e., emergency abortion care treated as a required stabilizing treatment when needed for stabilization, such as in life- or health-threatening conditions like hemorrhage, ectopic pregnancy, or preeclampsia).

The resolution urges all Hawaii hospitals, “regardless of religious affiliation,” to continue upholding established standards of care and to ensure no pregnant patient experiencing a medical emergency is denied or delayed stabilizing care; it also notes that EMTALA provides no religious exemption for refusal of required care.

Finally, it directs transmission of certified copies to specified recipients: the Governor; the Director of Health; and multiple Hawaii healthcare and medical stakeholders (including the Healthcare Association of Hawaii, the Hawaii Primary Care Association, the Hawaii Association of Health Plans, and the Hawaii Medical Association).

AT A GLANCE

This bill urges all Hawaii hospitals, regardless of religious affiliation, to continue providing timely EMTALA medical screening and stabilizing treatment to pregnant patients without delay or denial when necessary.

FULL SUMMARY

The document establishes a non-binding policy position through a House resolution. It affirms and supports the obligation under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that hospitals providing care to Medicare-funded emergency patients must furnish a medical screening examination and stabilizing treatment for any emergency medical condition, including when pregnant patients present life- or health-threatening conditions.

The resolution specifically endorses the interpretation that, when medically necessary to stabilize a pregnant patient, emergency stabilizing treatment may include reproductive and abortion services (e.g., the resolution cites conditions such as hemorrhage, ectopic pregnancy, and preeclampsia as examples of life- or health-threatening emergencies for which abortion care may be required if it is the necessary stabilizing treatment). It urges that the continued provision of timely stabilizing care—without delay or denial—is necessary to prevent medical deterioration, permanent injury, or death.

It also urges all Hawaii hospitals, “regardless of religious affiliation,” to continue upholding established emergency-care standards and to ensure that no pregnant patient experiencing a medical emergency is denied or delayed stabilization. In support of the position, the resolution notes national confusion created by shifts in federal policy and guidance, and identifies that several other states have defined emergency abortion care as stabilizing treatment under EMTALA.

Finally, it directs that certified copies of the resolution be transmitted to specified state and health-sector recipients, including the Governor, the Director of Health, leadership of the Healthcare Association of Hawaii and the Hawaii Primary Care Association, the Hawaii Association of Health Plans, and the Hawaii Medical Association.

AT A GLANCE

This bill requires the person in charge of fetal remains disposition to register and file fetal death certificates within 14 days when the fetal death meets specified gestational or weight thresholds.

FULL SUMMARY

The bill establishes new, threshold-based and time-based requirements for fetal death registration and reporting under Hawaii’s vital statistics law, and clarifies permitting and certification procedures tied to fetal remains disposition. It creates five new sections in HRS Chapter 338 addressing (1) compulsory registration for certain fetal deaths, (2) filing/preparation of certificates of fetal death, (3) issuance of certificates of fetal death for miscarriages under 20 weeks (and/or under 350 grams) upon parent request, and (4) late determination of the cause when it cannot be determined within the standard period, including how written notification is used to enable permits. It also creates a new general rule authorizing issuance of permits for removal/burial/other disposition of fetal remains and sets a gestational/weight-based exception to permit requirements.

Key changes to existing law include: (a) adding gestational age/weight thresholds (20 weeks gestation and/or at least 350 grams, with an alternate threshold when gestational age is unknown) and aligning the submission window for fetal death certificates to 14 days after fetal death; (b) making certificates not required for fetal deaths below those thresholds and for fetal deaths from intentionally terminated pregnancies performed under specified abortion statutes; and (c) extending the reporting timeline and clarifying how cause-of-death certification delays affect permit eligibility. The bill also updates other Chapter 338 provisions governing death and fetal death certificates, departmental authority, and permit prerequisites by removing/adjusting cross-references and reducing ambiguity about whether fetal deaths are governed alongside general death reporting.

Procedurally, the new sections specify who must file (the person in charge of disposition), where the filing must occur (Honolulu or the local agent in the district where the fetal death occurred), and that certificates must be filed before interment or other disposition when required. For miscarriages below the compulsory threshold, the state registrar must issue a certificate only if the parent requests on a registrar form and provides either a health care provider signed statement confirming the miscarriage or an accurate copy of the parent’s medical records. If the cause cannot be determined within 14 days, the attending clinician/coroner’s physician may file late but must notify the local agent in writing so a permit for disposition can be issued.

The bill further amends the existing general death-registration and permit provisions to reflect the new framework: it changes when bodies (including dead bodies/fetal remains) may be disposed or removed from the registration district (with an explicit exception structure tied to the new fetal-death sections), clarifies that permits are prerequisites once certificates have been filed in accordance with the applicable circumstances, and updates statutory language to substitute “department” terminology for “department of health.” The act takes effect July 1, 2026.

AT A GLANCE

This bill requires gestational-carrier assisted reproduction agreements to be fully executed with each party separately represented by independent licensed attorneys and notarized or equivalent witnessing before embryo transfer or injectable medication begins.

FULL SUMMARY

The bill establishes a new Hawaii statutory framework governing written assisted reproduction agreements, specifically for gestational carriers (including both traditional and gestational surrogacy arrangements). It defines key terms (assisted reproduction, assisted reproduction agreements, intended parents, donors of oocytes, gestational carriers, surrogates, and traditional surrogates) and sets required content and execution conditions for gestational-carrier agreements.

For gestational-carrier assisted reproduction agreements, the bill requires inclusion of specified information: execution date; gamete-origin details (with an exception allowing identification by type—eggs, sperm, or embryos—when donated gametes are used without naming the donor); identity of the intended parent(s); and disclosure of how intended parents cover the gestational carrier’s and newborn(s)’ medical expenses, including a review and disclosure of relevant health-insurance policy provisions for surrogate pregnancy, potential liability and coverage issues, third-party liability liens, and notice requirements affecting coverage or liability (with a clarification that the disclosure/review is not legal advice, and that a statement is sufficient if liability coverage is uncertain). Before executing the agreement, each side (the surrogate and intended parent(s)) must be represented by separate independent licensed attorneys chosen by that party; the agreement must be notarized or witnessed through an equivalent method; and no embryo transfer or commencement of injectable medication for embryo-transfer preparation may occur until the agreement is fully executed consistent with the attorney-representation and notarization/witnessing requirements.

The bill creates a streamlined parentage determination process for children conceived via gestational-carrier agreements. An action to establish parentage may be filed before birth and in multiple specified circuits, and the gestational-carrier agreement must be lodged in the court action. The parties must attest under penalty of perjury to compliance with the chapter, and submitting declarations does not waive lawyer-client privilege. A notarized agreement signed by all parties with attached declarations of independent attorneys, and lodged with the family court, rebuts listed parentage presumptions under existing provisions as to the gestational carrier, and the gestational carrier’s spouse/partner. Upon petition, the family court must issue a judgment or order establishing the intended parent(s) relationship and specifying that the gestational carrier (and the carrier’s spouse/partner) is not a parent and has no parental rights or duties, with enforcement stayed until birth; issuance is without further hearing/evidence unless there is a good-faith, reasonable belief that the agreement or attorney declarations were not executed as required, and a party may request a hearing. The court is still permitted to find intended parentage where compliance was not met, but sufficient proof is required. The bill also includes protections for confidentiality: certain filings and related documents are generally not open to inspection beyond the parties, their attorneys, and the Department of Human Services absent a judge’s written authority (and in exceptional circumstances), and on request and court order the clerk must withhold documents or copies unless identifying information for the gestational carrier is deleted. Finally, it provides that an executed agreement that complies with the chapter is presumptively valid and cannot be rescinded or revoked except by court order; any failure to comply rebuts the validity presumption.

The bill’s effective date is upon approval.

AT A GLANCE

This bill requires the governor to deny extradition demands tied to lawful gender-affirming or reproductive health care unless the conduct would also be a crime in Hawaii.

FULL SUMMARY

The bill establishes a “Health Care Access Protection Act” that limits enforcement of out-of-state laws and actions targeting lawful reproductive health care services and gender-affirming health care services. It amends Hawaii’s existing health-care–access protections to add gender-affirming health care services alongside reproductive health care services, and it creates additional public-policy and jurisdictional safeguards in child-custody and professional licensing contexts.

In the child-protection and civil-procedure arena, the bill adds a new public-policy rule in HRS ch. 583A stating that an out-of-state law authorizing removal of a child from a parent/guardian based on permitting gender-affirming health care is contrary to Hawaii public policy and will not be enforced in Hawaii cases pending in Hawaii courts. It further amends HRS ch. 323J confidentiality and evidentiary-disclosure rules to prohibit covered entities from disclosing communications/information relating to reproductive health care and gender-affirming health care that is lawful under Hawaii law without written patient/authorized-representative consent, while also carving out permitted disclosures for certain litigation/oversight contexts. The bill also expands prohibitions on out-of-state/interstate subpoenas and agency conduct that seeks civil or criminal liability for lawful gender-affirming care (including restrictions on state agencies expending resources or providing nonpublic information in furtherance of such investigations), and it adds “gender-affirming health care outcomes” to state “no adverse action” protections.

In interstate criminal-process protections, the bill requires the governor to deny demands for surrender tied to specified conduct involving lawful gender-affirming and reproductive health care unless the acts would also be a crime in Hawaii; it also declares out-of-state laws authorizing civil actions or criminal prosecutions based on lawful gender-affirming or reproductive health care to be contrary to Hawaii public policy and not applied in Hawaii court cases. It also amends witness-compulsion procedures to prevent summoning witnesses in Hawaii to testify in another state for criminal violations involving lawful gender-affirming or reproductive health care—unless the conduct would be an offense in Hawaii.

The bill expands professional licensing and discipline protections by amending multiple licensing statutes (marriage and family therapy, medical practice, mental health counseling, nursing, psychology, and other related board authorities) to treat convictions, disciplinary actions, or other adverse outcomes tied to lawful gender-affirming health care services similarly to how reproductive health care services are treated. It adds/clarifies gender-affirming health care services definitions in HRS ch. 583A and modifies the Uniform Child-Custody Jurisdiction and Enforcement Act provisions (HRS ch. 583A) to (1) allow temporary emergency jurisdiction when a child cannot obtain gender-affirming health care services, (2) treat a child’s presence in Hawaii for obtaining gender-affirming health care services as sufficient for certain jurisdictional requirements, (3) prohibit inconvenient-forum findings where the other state’s law/policy limits a parent’s ability to obtain gender-affirming health care for the child, and (4) exclude attempts to weigh against a petitioner the taking/retention of the child for obtaining gender-affirming health care where the other state limits that ability.

The bill includes a severability clause and an effective-date clause: it takes effect upon approval, except that specific amendments to HRS sections 451J-12 and 453D-13 (made by this act) are not repealed until the amendments made by Act 93 (Session Laws of Hawaii 2024) to those sections take effect on July 1, 2026.

AT A GLANCE

This act generally prohibits physicians from performing or attempting abortions of pain-capable unborn children when the probable post-fertilization age is at least 20 weeks, with limited exceptions.

FULL SUMMARY

The bill establishes new Hawaii statutory restrictions on abortion, creating a “Pain-Capable Unborn Child Protection and Dismemberment Abortion Ban Act” as a new chapter in the Hawaii Revised Statutes. It defines key terms (including “abortion,” “pain-capable unborn child,” and “dismemberment abortion”), makes it unlawful for physicians to perform or attempt an abortion except in conformity with the new chapter, and creates a framework for assessing fetal “post-fertilization age,” prohibiting certain abortions, and regulating provider documentation, disclosures, and reporting.

For abortions of pain-capable unborn children: a physician must first determine the probable post-fertilization age (or reasonably rely on another physician’s determination) using inquiries, medical examinations, and tests consistent with reasonable medical judgment. If the probable post-fertilization age is at least 20 weeks, the unborn child is treated as “pain-capable,” and the bill generally prohibits performing or attempting an abortion at that stage. Exceptions exist only where (1) the abortion is necessary to save the life of the pregnant woman due to a physical disorder/illness/injury (excluding psychological/emotional conditions); or (2) the pregnancy results from rape with specified timing/counseling or medical-treatment steps (for adult victims), or with rape reported to law enforcement (at any time before the abortion) (for adult victims); or (4) for rape or incest involving a minor, when the report is made to authorized child-abuse or law-enforcement authorities. Where an exception applies, the bill requires the abortion method (in reasonable medical judgment) to provide the best opportunity for the unborn child to survive, with a documented exception-related process (including requirements that certain counseling/medical-treatment or reporting documentation be placed in the patient’s medical file). It also imposes additional informed-consent steps for abortions under the pain-capable exceptions, including a signed in-person disclosure form containing specific statements about probable age, capacity to feel pain, the limited legal grounds after 20 weeks, the requirement to use the method most likely to allow birth alive unless it significantly risks the mother, and the availability of civil action if requirements are not followed. A separate “additional exception” allows a physician to be exempt from certain method and disclosure requirements to the extent compliance would pose a greater risk of the pregnant woman’s death or substantial and irreversible impairment of a major bodily function (excluding psychological/emotional conditions). The bill further excludes abortion-facility-provided counseling or medical treatment from counting for the rape-based adult exception unless the facility is a hospital.

For dismemberment abortions: the bill generally prohibits physicians from performing dismemberment abortions, with an exception for necessity to save the life of the mother due to physical disorders/illness/injury (excluding psychological/emotional conditions). It clarifies that the dismemberment ban does not prohibit abortions performed by other methods.

Penalties and remedies: violations of the pain-capable provisions (except the data-collection section) are classified as class C felonies; violations of the data-collection requirement are classified as violations; and violations of the dismemberment abortion ban are class C felonies with a maximum imprisonment term capped at two years. The bill bars prosecuting the woman for conspiracy or as an accomplice for violations of the chapter. It also creates civil causes of action for the woman (and, for certain cases, a parent of a minor) for abortions performed or attempted in violation, authorizing objective verifiable money damages, up to triple the abortion cost, punitive damages, reasonable attorney’s fees to a prevailing plaintiff, and fee-shifting against a plaintiff if a suit is frivolous; no monetary damages, fees, or other monetary relief may be assessed against the woman. Separately, it requires annual reporting by physicians who perform or attempt abortions that fall under the rape/life exceptions, including data elements such as probable post-fertilization age (≥20 weeks), method, location, the exception used, and any live birth incidents; patient-identifying information is prohibited, and the Department of Health must compile an annual public report submitted to the legislature before each regular session.

The bill also modifies existing law in Hawaii Revised Statutes §453-16. It changes the scope of the statute by removing/ending the prior special definition language for “abortion” and “nonviable fetus,” replacing it with a cross-reference so that “abortion” has the same meaning as in the new chapter’s definitions. It preserves existing protections that the State may not deny or interfere with a pregnant person’s right to obtain an abortion or terminate a pregnancy when necessary to protect life or health—so long as the abortion complies with the new chapter—and preserves refusal rights for hospitals and persons.

Effective date and transitional clause: the act takes effect July 1, 2025, and provides that it does not affect rights/duties that matured, penalties incurred, or proceedings begun before the effective date.

The bill establishes a proposed constitutional amendment to the Hawaii State Constitution that prohibits the State from denying or interfering with an individual’s reproductive freedom in their most intimate decisions.

The added new constitutional provision defines the protected interests to include (1) the right to choose to obtain an abortion of a nonviable fetus; (2) an abortion necessary to protect the life or health of the parent; and (3) the right to choose to obtain or use contraceptives.

It also specifies the exact ballot question wording asking voters whether the constitution should be amended to prohibit the State from denying or interfering with an individual’s reproductive freedom, explicitly including the right to choose an abortion of a nonviable fetus and the right to obtain or use contraceptives.

The amendment is stated to take effect upon compliance with Article XVII, section 3, of the Hawaii Constitution.

AT A GLANCE

This bill requires abortion-performing physicians to provide medically appropriate, reasonable life-saving and life-sustaining care to any infant born alive, including after an attempted abortion, and to take preservation steps in hospital settings.

FULL SUMMARY

The bill establishes the “Abortion Survivors Protection Act” by creating a new chapter in the Hawaii Revised Statutes. It defines key terms (including “abortion,” “attempt,” “born alive/live birth,” “infant” up to 30 days post-birth, “physician,” and “unborn child”) and requires that an infant born alive—including one born during an attempted abortion—receive medically appropriate and reasonable life-saving and life-sustaining care. It prohibits intentionally denying nourishment or medically appropriate and reasonable medical/surgical care to a born-alive infant intended to cause or allow death, and requires the abortion-performing physician to take medically appropriate steps to preserve the infant’s life and health, including immediate care, informing the mother, and requesting transfer to appropriate on-duty/emergency physicians when the abortion occurs in a hospital.

The bill also assigns responsibility if the abortion physician cannot perform the required steps (duties shift to an attending physician’s assistant, nurse, or other healthcare provider). It requires reporting: any physician, nurse, other healthcare provider, or hospital/office/clinic employee with knowledge of failure to comply must immediately report the failure to law enforcement. It requires wardship under the Department of Human Services if, before the abortion, the mother has stated in writing that she does not wish to maintain custody (and the statement is not retracted before the attempted abortion). It prohibits using a born-alive infant for scientific research or experimentation except as necessary to protect life and health, and provides that a born-alive infant is treated as a legal person under state law with the same right to appropriate and reasonable care.

The bill creates criminal and civil enforcement mechanisms. Intentionally killing a born-alive infant is punishable as second-degree murder; recklessly failing to provide medically appropriate and reasonable care resulting in death is punishable as manslaughter. Concealing the corpse of an infant with intent to conceal birth or to prevent determining whether the infant was born alive or dead is punishable under the state’s concealing-corpse offense. Knowingly violating the “no exploitation/experimentation” provision is punishable by fines up to $10,000 and/or imprisonment up to five years. The mother is barred from prosecution for conspiracy or accomplice liability for the recklessness-based care-failure offense.

The bill authorizes a civil action by the woman upon whom the abortion was performed or attempted if a healthcare provider violates the required-care duty (specifically tied to the hospital/live-birth care obligation in the text). The woman may obtain objective verifiable damages and, among other relief, damages up to three times the abortion/attempted abortion cost, punitive damages, and other appropriate relief; attorney’s fees are awarded to a prevailing plaintiff, with fee-shifting rules if the suit is frivolous. Convictions under the care-failure or killing provisions are admissible in civil suits as prima facie evidence of failure to provide the required care, and monetary relief (including attorney’s fees) cannot be assessed against the woman. Professional discipline is also required: noncompliance provides grounds for license suspension/revocation under existing physician and nursing disciplinary statutes, with any conviction triggering automatic suspension for at least one year.

In addition to creating the new chapter, the bill amends existing professional-licensure discipline statutes (HRS 453-8 for physicians and 457-12 for nurses) to include failure to comply with the new chapter as a disciplinary basis. It also amends HRS 709-901 (concealing the corpse of an infant) to treat an abortion attempted but resulting in a live birth as making the surviving infant a “new-born child” for purposes of the offense. The act takes effect July 1, 2025, with a proviso addressing reenactment timing for the nursing disciplinary amendment.

AT A GLANCE

This bill requires newly issued Hawaii certificates of birth to include a sex designation determined from the person’s genitalia, and it conditions Department of Health issuance of amended certificates on a qualifying examination.

FULL SUMMARY

The bill establishes that newly issued Hawaii certificates of birth must include a sex designation for the person born, determined based on the person’s genitalia (rather than other factors).

It requires updates to the existing statutory process for establishing a new birth certificate. Specifically, it amends the conditions under which the Department of Health may issue a new certificate reflecting a changed sex designation: the physician or physician assistant must “examine” the birth registrant (the prior language requiring treatment/examination and review of medical history is removed), and the issuance is limited to birth registrants who are at least eighteen years old. The bill also changes the operative requirement to rely on whether the sex based on genitalia does not align with the sex designation currently on the birth certificate.

For instances where the new certificate is created pursuant to the sex-designation provision, the bill requires the handling of original documents to reflect the change: the original certificate and supporting evidence are generally sealed and filed in a medical archive, opened only by a court order; however, for documents amended with regard to sex designation, the original certificate must be unsealed and the new certificate marked as amended with regard to sex designation.

The bill also directs that, if a new certificate is established under the sex-designation provision, it must reflect any legal name change made before, simultaneously, or after the sex designation change (with appropriate documentation submitted), and it prohibits the Department from requiring any additional medical information or records beyond those required for the sex-designation change. The bill takes effect upon approval, and it preserves rights, duties, penalties, and proceedings that matured or began before the effective date.

AT A GLANCE

This bill requires licensed midwives to renew their licenses every three years on or before June 30, forfeits the license for nonrenewal, and permits restoration within one year.

FULL SUMMARY

The bill continues and reconstitutes Hawaii’s midwifery regulatory framework by requiring licensure and defining the scope of practice for two license categories: licensed midwives who are either “licensed certified midwives” (with American College of Nurse-Midwives standards) or “licensed certified professional midwives” (with North American Registry of Midwives standards). It creates a new Part within chapter 457J establishing definitions, a licensing program, director powers and a midwives licensing advisory committee, disciplinary and fee provisions, an annual reporting requirement, and explicit limits on who may use protected titles/identifiers as “licensed midwives” or related abbreviations. It also clarifies that certain non-licensed birth-related roles (e.g., doulas, childbirth educators, lactation support providers, emergency aid providers, and specified traditional practices) are not required to obtain a midwifery license, while still restricting misleading claims of being licensed.

For licensed certified midwives, the bill expressly authorizes a broad range of clinical and nonprescribing services and—subject to department authorization and conditions—limited prescriptive authority (including controlled substances, substance-use-disorder medication, and expedited partner therapy medications), hospital/freestanding facility admission/management/discharge, and limited assistance in surgery for certified nurse-midwives only. For licensed certified professional midwives, it authorizes independent care consistent with national standards and—subject to department authorization—limited prescriptive authority for outpatient conditions that do not significantly deviate from normal midwifery care during pregnancy/postpartum, including expedited partner therapy medications, plus the ability to admit/manage/discharge in specified community birthing settings and to obtain devices/supplies for safe practice. The bill also permits delegation of tasks by licensed midwives to other licensed/registered persons and certain unlicensed assistive persons, with specified limits (including that medication-selection authority cannot be delegated unless independently authorized by law) and requires department rules for delegate-proficiency and accountability.

It establishes reimbursement coverage: health benefit plans and health insurance reimbursement (including Medicaid) must cover services rendered by a licensed midwife when within the certified midwife’s or certified professional midwife’s scope of practice, regardless of service location. It sets penalties for violations (fines up to $1,000 per offense) and sets renewal mechanics (renewal every three years on or before June 30; forfeiture on failure to renew; restoration possible within one year; re-licensure requires a new application after termination). It enumerates grounds for denial/refusal, discipline, revocation/suspension/conditions, including impairment, fraud, unethical conduct, failure to maintain competency records, violations of the part/rules/orders, and diversion or unauthorized use of controlled substances.

Beyond midwifery licensing, the bill (1) amends the chapter 26H repeal-date framework for newly enacted professional/vocational regulations by removing the preexisting reference to repealing chapter 457J on June 30, 2025, and (2) creates a home birth task force within the Department of Health for administrative purposes. The task force’s membership is capped (up to 17) and includes specified governmental representatives plus appointed practitioners (including Native Hawaiian customary practices), physicians, EMS, hospital and nursing-midwife representatives, certified professional midwife representation, and eight Hawaii Home Birth Collective stakeholder members (including multiple categories such as certified midwives, elders, traditional/cultural attendants, and public users). The task force is tasked with recommending actions to improve coordination of care and information-sharing across the maternal health system, including education/training, public health information, home birth data, transport issues, and proposed safety/public-health actions; it must report recommendations to the legislature no later than 20 days before the regular session of 2026 and dissolve on June 30, 2026. The bill reorganizes chapter 457J by designating sections 457J-1 to 457J-13 as Part I (“Midwives”) and repeals Part I of chapter 457J to replace it with the new structured provisions; it takes effect upon approval except that the protected-title licensure requirement becomes effective July 1, 2025, and section 2 (the 26H-4 change) is effective June 29, 2025.

AT A GLANCE

This bill requires gestational-carrier assisted reproduction agreements to be fully executed with separate independent attorney representation and notarization before embryo transfer or related medication begins.

FULL SUMMARY

The bill creates a new Hawaii Revised Statutes chapter establishing “assisted reproduction agreements,” including definitions for assisted reproduction; assisted reproduction agreements; donors (oocytes); intended parents; gestational carriers; surrogates (including gestational and traditional surrogates); and traditional surrogates.

It requires that assisted reproduction agreements for gestational carriers include specified terms: execution date; gamete origin information (unless donated gametes are used, in which case donor identity need not be named but the type of donated gametes must be specified); identification of the intended parent(s); and disclosures about how medical expenses for the gestational carrier and newborn(s) will be covered, including a review/disclosure of health insurance policy provisions relevant to surrogate pregnancy, potential liability of the gestational carrier, third-party liability liens or other insurance coverage, and any notice requirements affecting coverage or liability (with an express statement that the review/disclosure is not legal advice; if coverage/liability is uncertain, a statement of that fact satisfies the disclosure requirement). Before executing the agreement, the gestational carrier and intended parent(s) must each be represented by separate independent licensed attorneys of their choosing. The agreement must be executed with notarization or an equivalent method of affirmation as required by the execution jurisdiction. Further, the parties may not undergo embryo transfer or begin embryo-transfer preparation injectable medication until the agreement is fully executed in accordance with the attorney-representation and notarization/witness requirements.

The bill establishes a streamlined family-court procedure to determine parentage in gestational-carrier cases. An action to establish the parent-child relationship between intended parent(s) and the child may be filed before birth and in multiple possible circuits (anticipated birth circuit, intended parent residence circuit, surrogate residence circuit, execution circuit for the agreement, or the circuit where related medical procedures will occur). The assisted reproduction agreement must be lodged in the parentage action, and the parties must attest under penalty of perjury to compliance with the chapter; the declarations do not waive attorney-client privilege. A notarized agreement signed by all parties, with declarations from independent attorneys and lodged with family court, rebuts statutory parentage presumptions that would otherwise apply to the gestational carrier (or the gestational carrier’s spouse/partner) being a parent.

On petition by a party, the family court must issue a judgment or order establishing the intended parent-child relationship (and declaring that the gestational carrier and the gestational carrier’s spouse/partner are not parents and have no parental rights or duties) subject to conditions: the agreement must show compliance with the chapter; enforcement is stayed until birth; and the order may be issued without further hearing/evidence unless the court or a party has a good-faith reasonable belief that the agreement or attorney declarations were not executed in compliance. The bill also creates confidentiality protections for filings in these cases (generally limiting inspection/copying to parties, their attorneys, and the department of human services, with restrictive judge-authorized access in exceptional circumstances) and requires redaction of the gestational carrier’s name/identifying information on request and court order. Finally, assisted reproduction agreements executed in accordance with the chapter are presumptively valid and may not be rescinded or revoked without a court order; any failure to comply rebuts that presumption. The act takes effect upon approval.

AT A GLANCE

This bill requires the Hawaii Department of Health to make available application forms allowing adults to request, and parents or legal guardians to request for minors, birth certificates with a male, female, or “X” sex designation.

FULL SUMMARY

The bill establishes that Hawaii birth certificates will include a third gender option, “X,” and directs updates to the process for changing the sex designation on a birth certificate. It amends HRS § 338-17.7 (new certificate of birth circumstances) by expanding the allowable “sex designation” values in the application process to include male, female, or “X.” It also defines “X” as a third non-binary gender option for purposes of that paragraph.

For changes in sex designation requested by qualified applicants, the bill amends the application requirements within HRS § 338-17.7(a) by specifying that adults may apply for their own birth certificate, while a minor’s parent or legal guardian may apply on the minor’s behalf. The required application now must include (at minimum) the sex designation requested, explicitly permitting “male, female, or X,” in addition to the other listed identifying and contact information. It also maintains procedures allowing a written explanation to be submitted when required information cannot be provided, with the department/state registrar permitted to change the sex designation if circumstances prevent the applicant from knowing one or more required items.

The bill requires additional form-development by the Department of Health: the department must create and make available the necessary application forms for all categories covered in HRS § 338-17.7. It sets an effective date of July 1, 2025, with the birth-certificate sex designation change provisions in section 2 taking effect January 1, 2026.

AT A GLANCE

This act prohibits any person from denying an infant born alive nourishment or medically appropriate and reasonable medical care after an abortion attempt and requires physicians to take life-preserving steps.

FULL SUMMARY

The bill establishes the “Abortion Survivors Protection Act” in a new chapter of the Hawaii Revised Statutes. It defines key terms (including “abortion,” “attempt,” and “born alive/live birth” based on medical evidence of life) and sets duties for healthcare providers and related persons when an infant is born alive following an abortion attempt.

It requires that no person deny an infant born alive nourishment with intent to cause or allow the infant’s death, and no person may deprive an infant born alive of medically appropriate and reasonable medical care/treatment (and surgical care). It directs the physician performing the abortion to take medically appropriate and reasonable steps to preserve the life and health of an infant born alive, including immediate care if a live birth occurs in a hospital, informing the mother, and requesting transfer to an on-duty resident or emergency care physician. If the performing physician cannot fulfill these duties, the attending physician’s assistant, a nurse, or another healthcare provider must assume them. The bill also provides that an infant born alive is treated as a legal person with rights to such care; bars use of surviving infants for scientific research/experimentation except as necessary to protect life/health; requires reporting to law enforcement by persons who know of noncompliance; and, if the mother previously stated in writing she does not want to maintain custody and the writing was not retracted before the attempted abortion, requires the infant (if born alive) to immediately become a ward under the Department of Human Services.

It establishes criminal penalties for violations: intentionally killing an infant born alive is treated as second-degree murder; recklessly failing to provide medically appropriate and reasonable care when the infant dies results in manslaughter charges; knowingly violating the chapter’s prohibition on certain conduct related to use of infants for research/experimentation (as referenced in the bill’s penalty cross-reference) carries a fine up to $10,000 and/or imprisonment up to five years; and concealing the corpse of an infant includes situations where an abortion is attempted but a live birth occurs (the general offense is also conformed to cover such surviving infants). It also creates a civil action for the woman upon whom the abortion was performed or attempted to seek appropriate relief if a physician/nurse/healthcare provider violates the chapter’s care requirements; remedies include objective verifiable money damages tied to the violation, damages up to three times the cost of the abortion/attempted abortion, punitive damages, and attorney’s fees for prevailing plaintiffs, while generally excluding monetary damages and attorney’s fees against the woman if she is the defendant and prevails.

Finally, it expands professional disciplinary consequences tied to failure to comply with the new chapter, including possible suspension or revocation of professional licenses and an automatic minimum license suspension of no less than one year upon a criminal conviction for failure to comply. It also amends: (1) physician licensure discipline standards in Hawaii Revised Statutes §453-8(a) to add “failure to comply with chapter [ ]” as a licensing-discipline trigger; (2) nursing licensure discipline standards in §457-12(a) similarly to add a “violation of chapter [ ]” trigger; and (3) the infant corpse-concealment statute §709-901 to clarify that a live birth following an attempted abortion is treated as a “new-born child” for purposes of that offense. The act takes effect upon approval, and includes a savings clause for rights/duties and proceedings that matured or began before the effective date.

The bill proposes an amendment to Article I of the Hawaii Constitution to expressly protect the right to access contraceptives and to voluntarily engage in contraception. It states that no law may be enacted, and no state action may be taken, that denies or interferes with a person’s right to obtain contraceptives or to voluntarily engage in contraception.

It also specifies ballot language asking voters whether the constitution should be amended to provide that “no law shall be enacted, nor any state action taken” that denies or interferes with the right to obtain contraceptives or voluntarily engage in contraception. The bill includes that new constitutional material is underscored (for legislative presentation purposes).

The amendment is intended to further the privacy right guaranteed by Section 6 of Article I, and the text indicates it is not intended to narrow or limit the constitutional right to privacy.

The proposed constitutional change takes effect upon compliance with Article XVII, Section 3, of the Hawaii Constitution.

The bill establishes a state policy to protect reproductive health care decision-making (including abortion decisions) under Hawaii’s constitutional rights to equality, liberty, and privacy, and it directs action to maintain access to abortion care within state boundaries in light of potential federal restrictions and medication supply-chain disruption.

It requires the Department of Health to coordinate the stockpiling of mifepristone statewide in quantities determined by the department that are not less than a one-year supply (Sections 2 and 1). The bill appropriates $75,000 from Hawaii general revenues for fiscal year 2025–2026 for the purchase of mifepristone, and requires that the appropriation be expended by the Department of Health for the purposes of the Act (Section 3).

The Act’s effective date is stated as July 1, 3000 (Section 4).

AT A GLANCE

This bill bars Hawaii agencies from sharing nonpublic information or using resources to support out-of-state investigations or liability seeking or based on lawful-in-Hawaii gender-affirming health care services.

FULL SUMMARY

The bill establishes the “Health Care Access Protection Act” and expands Hawaii’s existing protections for reproductive health care by adding “gender-affirming health care services” to multiple statutory provisions governing (1) conflicts with other states’ laws, (2) confidentiality/privilege and discovery limits, (3) prohibitions on state agencies providing information or resources for out-of-state enforcement, (4) limits on state action and civil/criminal punishment tied to these services, and (5) related child-custody jurisdiction rules involving children receiving such care.

It creates a new public-policy provision in HRS Chapter 583A stating that out-of-state laws authorizing a state agency to remove a child from a parent or guardian based on allowing the child to receive gender-affirming health care services are contrary to Hawaii public policy and will not be enforced in Hawaii cases pending in Hawaii courts. It also adds the definition of “gender-affirming health care services” by referencing the definition in HRS §323J-1.

The bill amends HRS Chapter 323J (Reproductive Health Care Services and Gender-Affirming Health Care Services) to extend key restrictions and evidentiary/confidentiality protections to gender-affirming health care services. Among other changes, it (a) prohibits covered entities from disclosing communications or information related to gender-affirming health care services that are lawful under Hawaii law, absent the specified exceptions and conditions (including written consent requirements and specified investigative/procedural exceptions); (b) bars subpoenas and limits court orders for subpoenas in aid of out-of-state/interstate investigations or proceedings relating to reproductive or gender-affirming care that is lawful in Hawaii; (c) prohibits Hawaii agencies from providing nonpublic information or spending resources to further out-of-state or interstate investigations/seeking liability tied to seeking/receiving/paying for, providing/responding to inquiries about, assisting/abetting, or attempting to support reproductive or gender-affirming lawful-in-Hawaii services; and (d) establishes “prohibition on state action” against adverse action based on pregnancy or gender-affirming health care outcomes and similarly protects those who aid or assist access when the underlying care is lawful in Hawaii.

The bill further amends multiple professional-licensing and disciplinary confidentiality provisions to narrow when Hawaii boards may deny/revoke/discipline based on out-of-state discipline or convictions—carving out exceptions when the underlying out-of-state/other-jurisdiction action is based on lawful provision or assistance in receiving gender-affirming health care services in accordance with Hawaii law. Specifically, it updates grounds and exceptions in provisions governing marriage and family therapists (HRS §451J-11 and related confidentiality/privilege rules), physicians (HRS §453-8), medical peer discipline (HRS §453-8.6), medicine-related reciprocal discipline (HRS §453D-12), mental health counselors (HRS §§453D-13), nurses (HRS §§457-12 and 457-12.5), and psychology (HRS §465-13). It also modifies the Uniform Child-Custody Jurisdiction and Enforcement Act provisions relating to inconvenient forum (HRS §583A-207) and jurisdiction declined due to conduct (HRS §583A-208) to require that, in cases where providing gender-affirming health care services to the child is at issue, Hawaii courts not determine that another state is a more inconvenient forum when the other state’s law/policy limits a parent’s ability to obtain such care. Finally, it amends the statute addressing enforcement of foreign penal civil actions (HRS §636C-9) to include “protected gender-affirming health care services,” and revises the process for summoning witnesses in Hawaii to testify in another state (HRS §836-2) to exclude subpoenas/summons tied to certain reproductive or gender-affirming lawful-in-Hawaii conduct, with “gender-affirming health care services” and “reproductive health care services” defined by reference to HRS §323J-1.

The bill includes a severability clause and sets an effective date of December 31, 2050. It also provides a limited transition rule: amendments to HRS §451J-12 and HRS §453D-13 made by this act are not repealed when amendments to those sections in Act 93 (2024) take effect on July 1, 2026.

The bill establishes a requirement for Hawaii’s Department of Health to purchase and store a one-year supply of mifepristone, coordinated with one or more in-state pharmacies. The stated policy is to reiterate and bolster privacy and bodily autonomy protections under the Hawaii Constitution for reproductive health care decision-making within state boundaries, including for minors, in response to changes in the federal legal landscape.

Operationally, it directs the Department of Health to determine the quantity of mifepristone it will stockpile and to coordinate with qualifying pharmacies in Hawaii to procure the supply (Section 2). It also appropriates general revenues for fiscal year 2025–2026 for the purchase of a one-year supply of mifepristone, with the appropriated funds expended by the Department of Health for the purposes of the Act (Section 3).

The Act takes effect on December 31, 2050 (Section 4).

The document outlines significant amendments to Hawaii's parentage laws and family law statutes, aimed at modernizing legal frameworks to better reflect contemporary family structures and reproductive technologies. Key changes include the adoption of the Uniform Parentage Act of 2017, which introduces new legal statuses for children born to same-gender couples and clarifies the rights of non-marital children, ensuring they have the same legal rights as those born to married parents.

These updates are expected to impact various industries, particularly legal services, healthcare, and child support enforcement. Law firms specializing in family law may see increased demand for services related to parentage determinations and child support modifications. Healthcare providers, including fertility clinics and birthing centers, will need to adapt to new regulations regarding assisted reproduction and parental rights, while child support enforcement agencies may face operational changes due to the revised definitions of parentage.

The amendments also address the establishment of parent-child relationships in cases involving assisted reproduction and gestational agreements, ensuring that intended parents automatically assume legal custody upon birth. Financial responsibilities associated with surrogacy arrangements are clearly defined, which is anticipated to lead to increased demand for specialized legal services and healthcare coverage related to reproductive health.

Additionally, the revisions expand the definition of a parent to include individuals ordered to pay child support, potentially increasing the number of cases requiring legal representation. The Attorney General is granted concurrent jurisdiction in child support cases, which may lead to increased administrative costs for the state and affect the legal services industry. The court is required to use established guidelines for determining child support amounts, which may standardize payments and provide clearer expectations for parents.

Overall, these amendments aim to create a more equitable legal landscape for families, particularly those formed through assisted reproduction and non-traditional structures. The changes are expected to have significant implications for family law practices, child support enforcement agencies, and healthcare providers, potentially leading to increased legal costs and administrative responsibilities.

AT A GLANCE

This bill amends Idaho’s abortion-trafficking law by redefining prohibited conduct to require recruiting, harboring, or transporting a pregnant minor within Idaho to obtain an abortion-inducing drug for her use.

FULL SUMMARY

The bill revises Idaho’s criminal prohibition on “abortion trafficking” and changes one operative element in the definition of prohibited conduct. It amends Idaho Code § 18-623 to adjust the phrasing/requirements for conduct that constitutes the offense, while retaining the intent-to-conceal framework, the adult liability standard, the affirmative defense for parental/guardian consent, the limitation that provider location outside Idaho is not an affirmative defense, and the state prison sentencing range (no less than 2 years and no more than 5 years). It also declares an emergency and makes the act effective July 1, 2026.

Specifically, the amendment in § 18-623(1) revises the language describing the actus reus for “obtaining an abortion-inducing drug,” changing how the drug-related conduct is characterized (the amended text focuses on obtaining an abortion-inducing drug “for the pregnant minor to use for an abortion” by recruiting, harboring, or transporting the pregnant minor within Idaho). The rest of the statutory structure and qualifiers in subsection (1) are preserved, including that “procure” and “obtain” do not include providing information about a health benefit plan.

The bill keeps existing defenses and jurisdictional rules: it preserves an affirmative defense where the pregnant minor’s parent or guardian consented to the trafficking; it preserves that it is not an affirmative defense that the abortion provider or drug provider is located in another state; and it preserves the Attorney General’s discretionary authority to prosecute if an authorized prosecuting attorney declines. Sentencing remains imprisonment in state prison for 2 to 5 years for anyone who commits abortion trafficking under § 18-623(1).

AT A GLANCE

This bill requires Illinois electronic health networks to prevent disclosure of a patient’s coded private health care information to out-of-state providers and other entities unless a limited exception applies.

FULL SUMMARY

The bill establishes the Reproductive Health Records Privacy Act, which defines “abortion,” “abortion-related health care services,” and two categories of electronic health information—“coded private health care information” and “private health care information”—that specifically include diagnosis/procedure/drug coding related to abortion and abortion-related events, and also include medical diagnosis codes associated with gender dysphoria.

It requires electronic health networks in Illinois to prevent disclosure of a patient’s “coded private health care information” to out-of-state providers, business entities, other electronic health networks, or health information exchanges, except for limited purposes (technical support, quality assurance, payment/health care operations under HIPAA definitions) or disclosures to a specific covered entity based on consent from the patient or, where legally applicable, a parent/guardian/health care surrogate decision maker/power of attorney. It further requires networks to develop out-of-state technological capabilities to (1) parse coded private health care information and otherwise convey other record content not prohibited by law, (2) allow providers to manually segregate/prevent sharing or disclosure of private health care information, (3) allow patients to request and consent to exchange of private health care information to a specific covered entity, and (4) allow patients to opt out of segregation. Networks also may not notify out-of-state entities that private health care information may have been segregated.

The bill allows the Department of Public Health to adopt rules to administer and implement the Act, including setting any necessary exceptions to segregation if the Department adopts rules redefining “private health care information.” It clarifies that the Act should not be read to undermine existing protections for confidential health information or lawful health care activity (including under referenced Illinois privacy/health-activity laws) and does not require health care providers to use electronic health networks. It also permits patients to direct, and revoke, sharing of private health care information with a specific out-of-state covered entity through an electronic health network under a cited federal framework, and requires networks to make covered entities meaningful information available regarding a patient’s direction to share.

Enforcement is through a private right of action: any aggrieved person may sue an electronic health network for violations and may seek actual damages, injunctive relief, reasonable attorney’s fees and costs, and other court-ordered relief; the bill specifies that it does not authorize actions against health care providers. The Act takes effect July 1, 2027 and includes severability language.

AT A GLANCE

This proposed rule would replace Illinois HFS family planning coverage provisions in 89 Ill. Adm. Code 140 with a “Family Planning Program” and presumptive eligibility model, and it would require written public comments within 45 days of Illinois Register publication.

FULL SUMMARY

The document contains a notice of proposed amendments to Illinois Department of Healthcare and Family Services (HFS) regulations in 89 Ill. Adm. Code 140 (Medical Payment). It would update the regulation’s family planning coverage framework by replacing the existing Sections 140.482, 140.483, and 140.484 with a “Family Planning Program” approach tied to Public Act 102-0665 (SB0967), and it would incorporate a “family planning presumptive eligibility” (SPA) concept modeled after Medicaid presumptive eligibility.

It also requests public comment during the first notice period: written comments must be submitted within 45 days after publication of the notice in the Illinois Register, with comments addressed to HFS (Chris Gange, Acting General Counsel) via HFS.Rules@illinois.gov. The notice does not include an automatic repeal date and does not replace an emergency rule currently in effect.

Operative regulatory changes are specifically proposed for Sections 140.9, 140.402, 140.413, 140.482, 140.483, and 140.484 (with 140.484 proposed for repeal and replacement of its content through the changes to 140.482/140.483). Consistent with the proposed replacement language, the document would (1) redefine covered family planning and related services and supplies and their allowable components, (2) update limitations governing sterilization consent/age and related family planning procedures, (3) impose new conditions for fertility preservation coverage (including prior approval and a limited list of services), and (4) align abortion payment with the limitations in Section 140.413.

Key substantive provisions shown in the replacement text include: copayment rules that exempt family planning services and supplies from copayments; expanded family planning coverage categories that include screenings and counseling, contraceptive devices/supplies/prescriptions, surgical sterilization procedures, abortion care, and fertility preservation; a sterilization consent/eligibility structure requiring federal Medicaid informed consent rules and signed/witnessed documentation plus timing windows (including special timing for premature delivery or emergency abdominal surgery) and an age and mental-competence requirement; and fertility preservation limited to medically necessary, prior-approved services for individuals of childbearing age (office visits, pelvic ultrasounds, sperm and oocyte cryopreservation/storage, medications/injectables, and laboratory testing).

AT A GLANCE

This bill requires health information exchanges to build by July 1, 2027 access limitations, segregation, and automated disabling features for abortion-care medical records to prevent out-of-state disclosure.

FULL SUMMARY

SB3771 establishes the Reproductive Health Records Privacy Act, which requires health information exchanges to build by July 1, 2027 capabilities, policies, and procedures (and related automated features) to: (1) limit user access privileges to systems containing medical information related to abortion care; (2) prevent disclosure, access, transfer, transmission, or processing of abortion-care-related medical information to persons and entities outside Illinois; (3) segregate abortion-care medical information from the rest of a patient’s record; and (4) automatically disable access to the segregated abortion-related information by out-of-state individuals and entities. The bill also requires that any compliance fees charged to health care providers be consistent with 45 CFR 171.302, and states the segregation/limitations requirements do not apply to a health care provider.

The bill creates enforcement and remedies for violations: any aggrieved person may sue for damages, an injunction, or other appropriate relief, with reasonable attorney’s fees and costs awarded to a successful plaintiff; the Illinois Attorney General may bring a civil action for injunctive or other equitable relief, and the court may impose a civil penalty up to $50,000 considering factors including good-faith compliance efforts, harm to patients, number/magnitude of violations, duration, and the defendant’s assets and net worth.

The bill changes the Medical Patient Rights Act by modifying Section 3. It adds/clarifies patient privacy and confidentiality protections for health care and patient information, including an express statement that medical information related to abortion care in a health information exchange may be segregated and that access to such information may be limited in accordance with the new Reproductive Health Records Privacy Act. It also clarifies related opt-out context for patients regarding availability of information on an HIE, and that physician or health care provider liability is not triggered by releases of information by other entities that may possess the patient’s information.

The bill includes definitions (notably for “abortion,” “health information exchange,” and “patient”), a severability clause, and a short title citing the new Act.

AT A GLANCE

This bill requires hospitals to notify patients of burial or cremation rights after a spontaneous fetal demise before 20 weeks and, if the patient elects in writing within 24 hours, removes the fetal death certificate requirement.

FULL SUMMARY

The bill amends Illinois’ Hospital Licensing Act and the Vital Records Act to align fetal-remains documentation requirements for fetal deaths occurring at less than 20 weeks’ gestation (and for abortions defined in the Reproductive Health Act) with a notification/permit-and-form process, rather than requiring a fetal death certificate.

Under the Hospital Licensing Act (new changes to Section 11.4), a hospital must notify the patient of the right to arrange burial or cremation for a fetus after a spontaneous fetal demise occurring during or after a gestation period of less than 20 completed weeks; if the patient elects in writing within 24 hours, no fetal death certificate is required, and disposition is governed by the rules applicable to fetal deaths at/after 20 weeks. The bill also adds that the Department of Public Health must develop forms for notification and elections under this section and that hospitals must provide the relevant form(s) to the patient. The bill further requires that, for a fetal death after less than 20 weeks’ gestation or for an abortion (as defined in the Reproductive Health Act), no fetal death certificate is required for disposition, and the Department must create a form for funeral directors/persons to obtain a permit for burial, entombment, or cremation, to be included as an appendix to existing rules; any form filed is to be sealed by the local registrar and a copy may not be retained by the funeral director.

Under the Vital Records Act, the bill amends Section 20 (fetal death; place of registration) to expand the circumstances treated as “fetal death” requiring registration after 20 completed weeks or when the patient elects in writing to arrange burial or cremation under Hospital Licensing Act Section 11.4. The bill also amends the funeral-director reporting/certification framework (Section 21) so that disposition permits are not tied to a fetal death certificate for fetal deaths occurring before 20 weeks (and for abortions), instead using the new Department-created permit form process for burial/entombment/cremation in those cases.

The document outlines amendments to the Illinois Insurance Code that specifically address medical liability insurance for obstetricians and gynecologists (OB-GYNs). These changes primarily impact medical liability insurance providers and OB-GYN practitioners, requiring insurance companies to evaluate premium rates based on the specific scope of practice for each insured OB-GYN.

One significant change is the classification of OB-GYNs who do not provide obstetric services, such as childbirth, as lower-risk providers. This classification is expected to result in reduced premium rates for these practitioners, potentially lowering their overall insurance costs.

The Department of Insurance is responsible for establishing guidelines to ensure fair and equitable medical malpractice premiums based on the risk profiles of OB-GYNs. These amendments aim to create a more balanced insurance landscape for medical professionals in this field.

AT A GLANCE

This bill requires every facility performing abortions to offer, before any abortion or related anesthesia or medication, a woman after 8 weeks’ gestation an opportunity to receive and view an active ultrasound image from a qualified person.

FULL SUMMARY

The bill creates the Ultrasound Opportunity Act and sets legislative findings and purposes. It requires, at any facility where abortions are performed, that the physician performing the abortion, the referring physician, or another qualified person working with either physician offer a woman seeking an abortion after 8 weeks of gestation the opportunity to receive and view an active ultrasound image of her unborn child before any part of the abortion is performed or induced and before any anesthesia or medication is administered in preparation for the abortion.

The bill defines “qualified person” as someone with documented evidence of completing a course in the operation of ultrasound equipment and compliance with other legal requirements for operating ultrasound equipment, and it defines “medical emergency” as a physician’s good-faith clinical judgment that immediate abortion is necessary to avert death or that delay will create serious risk of substantial and irreversible impairment of a major bodily function. The ultrasound must be performed by a qualified person or persons, must produce an image of a quality consistent with standard medical practice, and the facility must document the woman’s response, including the date and time of the offer and the woman’s signature attesting to her informed decision to accept or decline.

The Act includes an exception for medical emergencies based on the physician’s medical judgment in the specific case, and it provides a severability clause. The Act’s effectiveness is immediate.

AT A GLANCE

This bill defines “person” and “unborn child” to include any living human being from fertilization to natural death, applies homicide, assault, and wrongful-death enforcement as if born alive, and repeals specified offenses.

FULL SUMMARY

The bill establishes new statutory definitions governing criminal and civil treatment of unborn children, including that “person,” “individual,” and “another” cover any living human being from fertilization until natural death (including a preborn child). It defines “fertilization” as fusion of a human spermatozoon with a human ovum, and creates additional enforcement rules that apply when the “victim” is an unborn child (including that enforcement is subject to the same presumptions, defenses, justifications, immunities, and clemencies as would apply if the victim were a human being born alive). It further provides that the criminal provisions governing these concepts are in addition to other existing provisions relating to death of an unborn child, and supersede conflicting or inconsistent provisions to the extent of the conflict.

In the Criminal Code of 2012, the bill adds parallel definitions for the Homicide Article and the Assault and Battery subdivision, with exceptions that limit the criminal definitions’ application to unintentional deaths of unborn children resulting from: (1) life-saving procedures undertaken on a pregnant woman, when accompanied by reasonable steps (if available) to save the unborn child’s life; or (2) spontaneous miscarriage. It also specifies that when the victim is an unborn child, enforcement is treated the same as enforcement for the corresponding homicide/assault-and-battery of a person born alive, and supersedes conflicting inconsistent injury-of-unborn-child provisions.

The bill eliminates certain criminal offenses by repealing specified Criminal Code sections: 9-1.2, 9-2.1, 9-3.2, and 12-3.1.

In the Wrongful Death Act, the bill amends the Act’s definitions to make “person” include an unborn child and defines “unborn child” as an individual living human being at any stage of development from fertilization to birth; it also provides that the Act’s wrongful-death provisions are in addition to and supersede conflicting or inconsistent provisions relating to injury or death of an unborn child. It further repeals Wrongful Death Act Section 2.2 and includes severability, prospective-application (only for acts/neglect/default with any element occurring on or after the effective date), and an immediate effective date upon becoming law.

The Department of Public Health is in the process of recodifying the Pregnancy Termination Report Code under 77 Ill. Adm. Code 505. This review was conducted by the Administrative Code Division on November 21, 2025.

The recodification will involve changes to the subchapter headings related to vital records, specifically moving from Subchapter e to Subchapter f. Both subchapters are focused on vital records.

The document does not provide specific details regarding the monetary impacts on business industries or any implementation dates beyond the review date.

The document outlines significant amendments to the Illinois Parentage Act of 2015, aimed at enhancing the rights and protections of children regarding parentage, regardless of their parents' marital status, gender, or sexual orientation. Key changes include a public policy declaration affirming that every child has equal rights to parentage and support, a lowered burden of proof for challenging parentage, and the establishment of legal parentage through voluntary acknowledgment by various parties involved in a child's birth.

The amendments also clarify the implications of assisted reproduction and surrogacy, recognizing individuals who consent to assisted reproduction as parents and detailing the legal processes surrounding surrogacy agreements. Genetic testing regulations are updated to restrict challenges to parentage based on assisted reproduction and to streamline the process for establishing parentage through genetic testing. Additionally, a confirmatory adoption process is established for children born through assisted reproduction.

These changes are expected to impact various sectors, including legal services, healthcare, and child welfare agencies, leading to increased demand for legal counsel and potential adjustments in administrative procedures. The financial implications may include higher legal fees, costs associated with genetic testing, and adjustments in child support calculations.

Overall, the amendments reflect a progressive shift in Illinois law towards inclusivity and recognition of diverse family structures, ensuring that all children have equal rights to parentage and support.

The document outlines amendments to the Freedom of Information Act in Illinois, focusing on enhancing privacy protections across various sectors, particularly in health care and law enforcement. Key provisions include the protection of personal information for health care professionals, especially those providing abortion-related care, ensuring their confidentiality when interacting with governmental agencies or businesses.

In the realm of public health, records pertaining to sexually transmitted infections and reproductive health are exempt from disclosure, safeguarding sensitive health information. Law enforcement is also prioritized, with exemptions for officer identification information and records related to ongoing investigations, thereby maintaining the confidentiality of critical law enforcement data.

Educational institutions are required to protect student records and data, reinforcing the privacy of students and educational staff. Additionally, confidential business information and records related to financial acts are exempt from public disclosure, which may affect businesses operating in these sectors.

Overall, the amendments establish clear guidelines for the handling of sensitive information, emphasizing the importance of privacy across multiple industries while ensuring that personal information is adequately protected from public access.

The document outlines significant amendments to various Illinois laws, particularly focusing on healthcare practices and child welfare services. Changes to abortion laws establish stricter regulations for healthcare providers, including new definitions that impact the legality of abortions and the reinstatement of previous provisions affecting healthcare facilities and practitioners.

Amendments to the Children and Family Services Act aim to enhance services for homeless and neglected children, emphasizing family preservation and financial assistance for adoptive parents of children with disabilities. The changes also address the rights of children in the welfare system, including the establishment of interest-bearing accounts and requirements for background checks for foster and adoptive parents.

The Freedom of Information Act has been amended to introduce exemptions from public disclosure, particularly for sensitive information in healthcare, law enforcement, and education, balancing confidentiality with public access. Additionally, regulations concerning Health Maintenance Organizations (HMOs) focus on financial practices, ensuring enrollees are informed about potential refunds or premium adjustments.

Changes affecting healthcare professionals include enhanced regulatory oversight and the establishment of processes for investigating complaints against licensed medical professionals. Advanced practice registered nurses (APRNs) will gain full practice authority by 2028, allowing them to operate independently and prescribe medications under certain conditions, which is expected to streamline healthcare delivery.

The document also highlights modifications to the Health Care Right of Conscience Act and the Rights of Married Persons Act, clarifying the rights of healthcare providers and spouses regarding healthcare decisions. Collectively, these amendments reshape the landscape of healthcare practice and child welfare in Illinois, impacting operational practices and the delivery of services across various sectors.

The Ultrasound Opportunity Act establishes requirements for abortion facilities in Illinois, mandating that women seeking an abortion after 8 weeks of gestation must be offered the opportunity to receive and view an active ultrasound of their unborn child. This requirement aims to ensure that women have complete and accurate information about their pregnancy, thereby promoting informed consent.

The Act impacts healthcare facilities that provide abortion services, as they must comply with the new ultrasound requirements. This compliance may involve financial implications, including costs for hiring qualified personnel, maintaining ultrasound equipment, and documenting adherence to the law.

There is a provision in the Act that exempts facilities from these requirements in cases of medical emergencies, as determined by the physician's clinical judgment. Additionally, the provisions of the Act are severable, meaning that if any part is found to be invalid, the remaining sections will still be enforceable. The Act takes effect immediately upon becoming law.

The document outlines a new provision in the Criminal Code of Illinois that establishes the offense of coercing an abortion. This law addresses the use of force, intimidation, or manipulation to compel a woman to undergo an abortion against her will, categorizing it as a Class 3 felony.

The impacted business industries include healthcare providers, particularly those involved in reproductive health services, who may need to implement additional training and protocols to ensure compliance with the new law. Legal services may also experience increased demand as individuals seek advice regarding the implications of this legislation.

Monetary impacts could arise from potential legal liabilities for healthcare providers, as well as costs associated with compliance and training. Additionally, there may be broader societal costs related to enforcement and legal proceedings stemming from violations of this law.

The effective date of the changes is not specified in the provided text.

The legislation establishes that performing a partial-birth abortion, resulting in the death of a human fetus or infant, is classified as a Class 4 felony. It specifies conditions under which such an abortion may be legally performed, requiring the involvement of a physician and a documented referral from another physician, with both determining that the mother's life is at risk due to a physical condition.

Additionally, the law permits maternal grandparents of the fetus or infant to seek civil relief if the mother is under 18 at the time of the abortion. This relief can include monetary damages that amount to three times the cost of the procedure.

Importantly, the legislation ensures that women who undergo a partial-birth abortion cannot be prosecuted under related criminal codes.

The affected industries primarily include healthcare providers, particularly those in obstetrics and gynecology, as well as legal services related to civil actions stemming from violations of the law. The financial implications may involve increased legal costs for healthcare providers and potential liabilities from civil actions.

The document outlines a new law in Illinois regarding abortion practices, particularly focusing on the care of fetuses born alive during an abortion procedure. Physicians are mandated to employ methods that prioritize the life and health of a fetus if there is a reasonable chance of survival outside the womb. Additionally, an extra physician must be present during abortions involving viable fetuses to provide immediate medical care for any child born alive.

The law requires physicians to inform women about the availability of anesthetics or analgesics to alleviate potential pain for the fetus during the abortion process. Exceptions to these requirements are permitted in cases of medical emergencies or when the use of anesthetics may hinder the fetus's chances of survival.

Healthcare providers, especially those in obstetrics and gynecology, as well as medical facilities that perform abortions, will be significantly impacted by this law. Compliance with the new regulations may lead to increased operational costs due to the necessity for additional medical personnel and adherence to new reporting standards.

Overall, the law emphasizes the protection of fetuses born alive during abortion procedures and introduces new obligations for medical professionals in Illinois.

The Ultrasound Opportunity Act establishes specific requirements for facilities performing abortions in Illinois. Physicians or qualified personnel are mandated to offer women seeking an abortion after 8 weeks of gestation the opportunity to receive and view an active ultrasound of their unborn child prior to any abortion procedure or the administration of anesthesia or medication.

Following the ultrasound, a mandatory waiting period of 72 hours must elapse before any anesthesia or medication can be administered for the abortion. However, these requirements do not apply in cases where a medical emergency is determined by the physician's clinical judgment.

Facilities are required to document the woman's response to the ultrasound offer, including the date, time, and her signature to indicate her informed decision. This legislation may have implications for healthcare providers in the reproductive health sector, as well as ultrasound service providers and legal or counseling services related to abortion.

Additionally, the Act includes a severability clause, ensuring that if any part of the legislation is found invalid, the remaining provisions will still be enforceable. The specific effective date of these changes is not mentioned.

The Parental Notice of Abortion Act of 2025 mandates that parents or adult family members be notified before an abortion is performed on an unemancipated minor or an incompetent person. This requirement is based on the belief that parental consultation is crucial due to the potential serious and long-lasting consequences of abortion on minors.

Under the Act, physicians are required to provide at least 48 hours of actual notice to an adult family member prior to the procedure. There are exceptions to this requirement, including situations where the minor is accompanied by someone entitled to notice, if notice is waived in writing, in medical emergencies, or if the minor reports abuse.

Minors have the option to petition for a judicial waiver of the notice requirement, with the process designed to be confidential and expedited to ensure timely decisions. The Act emphasizes the importance of parental involvement while also providing a legal pathway for minors who may need to bypass the notification requirement.

While the Act does not specify the financial impacts on businesses such as healthcare providers and legal services, it is anticipated that compliance with the new requirements may lead to increased administrative costs and potential legal fees related to judicial waivers.

The Parental Notice of Abortion Act of 2025 establishes requirements for parental notification prior to performing an abortion on an unemancipated minor or an incompetent person. Physicians are mandated to provide at least 48 hours of actual notice to an adult family member before the procedure, with alternative options for notification if actual notice is not feasible.

There are specific exceptions to the notification requirement, including situations where the minor is accompanied by someone entitled to notice, if notice is waived in writing, in cases of medical emergencies, or if the minor reports being a victim of abuse. Additionally, minors or incompetent persons have the option to petition for a judicial waiver of the notice requirement through expedited and confidential court proceedings.

Consent from the minor is necessary for an abortion, except in medical emergencies. The Act imposes additional administrative responsibilities on healthcare providers in the reproductive health sector, which may lead to increased compliance costs and potential legal liabilities.

Overall, the Act aims to regulate the process surrounding abortions for minors and incompetent individuals while providing certain protections and options for both patients and healthcare providers.

The document outlines amendments to the Reproductive Health Act in Illinois, focusing on informed consent requirements for abortion procedures. Physicians are mandated to provide specific information to women seeking an abortion at least 24 hours prior to the procedure. This information includes details about the nature and risks of the procedure, the probable gestational age of the fetus as verified by an ultrasound, and the medical risks associated with carrying the pregnancy to term.

An ultrasound must be conducted by a qualified individual, and women are given the option to view the live images and receive an explanation. If a woman chooses not to view the ultrasound, she is required to complete a form acknowledging her decision. Additionally, certain informed consent requirements may be waived for women who present documentation indicating they are victims of rape, incest, domestic violence, or human trafficking.

Women seeking an abortion must also receive printed materials from the Department of Public Health, which include information on fetal development, alternatives to abortion, and medical assistance benefits. In cases of medical emergencies, physicians may proceed with an abortion without fulfilling the informed consent requirements if they obtain a corroborative medical opinion regarding the necessity of the procedure.

These amendments primarily impact healthcare providers involved in reproductive health services, as well as legal and counseling services related to domestic violence and reproductive rights. The document does not specify the monetary impacts of these changes.

AT A GLANCE

This bill requires required abortion-complication reporters to submit each report to ISDH, which must forward it to the Office of the Inspector General and publish quarterly summaries, with failure remaining a Class B misdemeanor.

FULL SUMMARY

SB 236 modifies Indiana’s abortion-related statutes by (1) revising definitions of “abortion” and “abortion inducing drug,” (2) expanding and revising the requirements for reporting abortion complications to the Indiana State Department of Health (ISDH), including directing ISDH to send those reports to the Office of the Inspector General, and (3) adding a new civil-liability framework for persons who manufacture, distribute, mail, transport, deliver, prescribe, or provide abortion inducing drugs.

Under the revised definitions, “abortion” is defined to include surgical abortions and abortion inducing drugs, and “abortion inducing drug” is defined as a prescribed or dispensed drug (including specified regimens and specified off-label use) prescribed with intent to terminate a clinically diagnosable pregnancy with knowledge that the termination will with reasonable likelihood cause death of the fetus; the definition excludes drugs prescribed for other medical reasons. The bill also revises the “abortion complication” concept for reporting purposes, specifying a defined list of physical or psychological conditions and adding categories such as allergic reaction to anesthesia or abortion inducing drugs, psychological complications (depression, suicidal ideation, anxiety, sleeping disorders), and “death,” along with other detailed reportable complications.

The bill amends the medical reporting regime for abortion complications: required reporters (certain licensed physicians, hospitals, and ambulatory outpatient surgical centers) must report each abortion complication to ISDH with specified patient and event information (including whether the abortion occurred in Indiana, whether medication was obtained by mail order or via an Internet website, and details about medications used in the pharmaceutical regimen, diagnosed complications, treatment, and follow-ups). ISDH must send each report it receives to the Office of the Inspector General, compile quarterly public summaries, submit annual aggregate data to the CDC for inclusion in the Vital Statistics Report, and ensure that reports do not include identifying information about the pregnant woman; failure to report remains a Class B misdemeanor.

A new chapter is added to IC 16-34 establishing restrictions on “abortion inducing drugs” and creating civil actions, including joint-and-several liability for wrongful death and personal injury to an unborn child or pregnant woman resulting from use of abortion inducing drugs, with additional civil actions for the mother or father of an unborn child and specific affirmative defenses. The bill also includes a qui tam mechanism allowing persons (other than barred categories) to bring actions against certain violators of the prohibition on abortion inducing drugs, while limiting who may sue and what claims are barred; it further restricts enforcement approaches by state/prosecutorial actors to wrongful death actions or qui tam actions, and adds multiple procedural and substantive limits (venue, choice-of-forum/fair forum provisions, limits on class actions, attorney-fee/cost rules, sovereign/governmental immunity protections, and constitutionally framed carve-outs). The bill’s effective date is July 1, 2026.

The bill amends Indiana Code Title 16 regarding reporting requirements for pregnancy terminations by specifying that abortion reports submitted by health care providers to the Indiana State Department of Health are confidential medical records not subject to public disclosure.

Specifically, it revises IC 16-34-2-5 (effective upon passage) to treat each provider’s report under the abortion reporting form as a “medical record” that is confidential and exempt from disclosure by the state department as a public record under IC 5-14-3-4(a)(9).

In addition to this confidentiality clarification, the amended section retains the existing structure requiring providers to complete and transmit the form within 30 days after each abortion, with a shorter three-day transmission requirement when the patient is under 16, and to face Class B misdemeanor penalties for failure to complete or timely transmit the form. The bill also maintains quarterly state department compilation of a public report using submitted statistics while ensuring the report contains no identifying information of pregnant women.

An emergency is declared for the act.

Governor Michael K. Braun of Indiana has issued an Executive Order that mandates strict enforcement of the state's abortion laws. This order requires health care providers to submit Terminated Pregnancy Reports (TPRs) to the Indiana Department of Health (IDOH) each time an abortion is performed, reflecting the state's preference for childbirth over abortion.

The new requirements will directly impact health care providers, particularly those involved in performing abortions, as well as state agencies responsible for health and legal oversight. Compliance with these laws may lead to increased operational costs for health care providers due to the need for adherence to new reporting requirements and potential legal fees from investigations.

The order stipulates that a report evaluating IDOH's historical operations and necessary changes must be submitted to the Governor by July 1, 2025. However, the enforcement of the abortion laws is to be implemented immediately.

Overall, the Executive Order aims to enhance the enforcement of Indiana's abortion laws and ensure that both state agencies and health care providers comply with these regulations.

AT A GLANCE

This bill requires physicians to conduct an in-person examination, including coercion or abuse screening and referral as needed, before performing an abortion.

FULL SUMMARY

House File 2788 establishes and revises several abortion-related legal standards in Iowa by changing statutory definitions, adding new informed-consent prerequisites, and creating new regulatory and civil-liability rules governing the dispensing of abortion-inducing drugs.

It amends abortion-related definitions. “Abortion” in Iowa Code section 146B.1 is clarified to mirror the pregnancy-termination definition and existing exceptions (e.g., miscarriage/spontaneous termination, removal after an incomplete/inevitable loss, and ectopic pregnancy) (Division I, Sections 1–2). “Abortion” as used in section 146E.1 is updated to track the definition in section 146B.1. The bill also amends the informed-consent statute by adding new terms (“health care provider,” “physician,” and a definition reference for “abortion”). Additionally, in Division IV it amends an induced-termination reporting provision to include the use of mifepristone or misoprostol as part of the “method” used, and it adds language addressing spontaneous terminations occurring after ingesting those drugs; it also amends the definition of “spontaneous termination of pregnancy” (miscarriage).

For informed consent, the bill adds new requirements before a physician performs an abortion: an in-person examination of the pregnant woman is required, including screening for indicia of coercion or abuse, with referral to an appropriate health care provider if necessary based on examination results (Division II, Section 3). For chemical abortion/abortion-inducing drugs, the bill creates a new section (146A.2) establishing prerequisites for physicians who are performing or attempting to perform a chemical abortion (Division II, Section 5). Those prerequisites include: obtaining the patient’s signature on the FDA patient agreement form for each authorized abortion-inducing drug; obtaining written confirmation that the patient has been informed of gestational-age-specific risks; specific risks (including hemorrhage, failure to remove all tissue, sepsis, sterility, and possible continuation of pregnancy); the FDA recommendation to follow up with a health care provider about 7–14 days after administration to confirm complete termination and evaluate bleeding; and that women using abortion-inducing drugs have suffered trauma from seeing remains of the unborn child. The physician must also advise how to access emergency surgical intervention for incomplete abortion, severe bleeding, or other medical complications. The requirements do not apply when the chemical abortion is performed in response to a medical emergency. The bill specifies that it cannot be construed to impose civil or criminal liability on the woman for a chemical abortion, and it subjects physician noncompliance to professional/board discipline (licensee discipline under Iowa’s licensing disciplinary chapters) and requires rulemaking by the board of medicine.

For dispensing abortion-inducing drugs, the bill creates a new “dispensing” chapter structure. It adds new definitions (146F.1), restricts dispensing (146F.2) to prohibit dispensing in Iowa unless the drug is dispensed in a health care setting directly to the woman prescribed the drug and the dispenser is authorized under the referenced licensing statute; there is an exception for dispensing in response to a medical emergency. It also creates a private civil cause of action (146F.4): a person who dispenses in violation of the dispensing restrictions is civilly liable to any “interested party” for all damages caused by the abortion-inducing drug; licensees disciplined under specified chapters are immune from liability under this section. Prevailing plaintiffs may recover court costs and reasonable attorney fees, and the woman’s identity and identifying characteristics must be redacted in pleadings and documents without a court order, with the court able to issue additional privacy-protective orders. Finally, licensees who fail to comply are subject to discipline under the referenced licensing disciplinary chapters, and the bill repeals Chapter 146C of the Iowa Code (Division IV, Section 13).

AT A GLANCE

This bill requires physicians to conduct an in-person examination, including screening for coercion or abuse, before performing an abortion.

FULL SUMMARY

The bill changes Iowa law governing abortion procedures by adding new requirements tied to abortion-inducing drugs and by revising definitions and reporting rules. It amends the Code definition of “abortion” to exclude spontaneous termination of pregnancy (miscarriage) when not all products of conception are expelled. It also adds an informed-consent requirement that, prior to performing an abortion, a physician must conduct an in-person examination of the pregnant woman, including screening for indicia of coercion or abuse, and refer the woman for appropriate treatment if necessary.

For chemical abortions, the bill creates new restrictions requiring additional steps before a physician prescribes or dispenses an abortion-inducing drug: the physician must obtain the patient’s signature on the FDA patient agreement form for each authorized drug; obtain written confirmation that the patient was informed of specified gestational risks, drug-specific risks, recommended follow-up to confirm complete termination, statements about trauma from seeing remains of the fetus, and the possible reversibility of effects (including that information is available on the department’s website); and advise how to access emergency surgical intervention for incomplete abortion, severe bleeding, or other complications. These requirements do not apply in medical emergencies, do not impose civil/criminal liability on the patient for having undergone the chemical abortion, and any physician noncompliance subjects the physician to licensee discipline. The bill also directs the Department of Health and Human Services (HHS) to publish online informational materials about possible reversal of chemical abortion effects and resources to that end.

The bill establishes a new regulatory framework for dispensing and reporting abortion-inducing drugs. It defines abortion-inducing drugs as mifepristone and misoprostol and defines “abortion-inducing drug complication” to include specified physical and psychological conditions (e.g., hemorrhage, failure to terminate, retained tissue, missed ectopic pregnancy, infection, and sepsis). It prohibits dispensing an abortion-inducing drug in Iowa unless the drug is dispensed in a health care setting directly to the prescribed woman and the dispenser is authorized under specified law; this restriction does not apply in medical emergencies. The bill requires hospitals, rural emergency hospitals, or attending physicians to file reports with HHS within 30 days of discharge or death when a woman presented with or was treated for an abortion-inducing drug complication; reports must be physician-signed, contain specified non-identifying clinical and administrative details (including age, residence, date of drug use, probable postfertilization age, provider/facility/referrer, and complication codes), and must not include identifiers that would make the woman identifiable. Reports are confidential and not subject to public disclosure. HHS must compile an anonymized, aggregated annual statistical report (by specified dates) and make anonymized aggregated data publicly available in downloadable form.

To provide enforcement and accountability, the bill creates a private civil cause of action allowing a person who dispensed an abortion-inducing drug in violation of the dispensing restrictions to be sued for all damages caused to an “interested party” (with specified rules on redacting the woman’s identity in filings and with court discretion to protect privacy). It also creates immunity for certain licensees (including licensed pharmacists or physicians) from civil liability under this cause of action and subjects licensees who fail to comply with the new chapter requirements to licensee discipline. Finally, it amends Iowa’s termination-of-pregnancy reporting requirement to require health care providers to report both whether mifepristone or misoprostol was used to induce a spontaneous termination and whether the patient ingested either drug within 14 days prior to the spontaneous termination of pregnancy.

AT A GLANCE

This bill amends Iowa’s criminal provisions by replacing the phrase “pregnant person female” in specified pregnancy-related sections, including feticide and related offenses under Iowa Code §§ 707.7, 707.8, and 708.2.

FULL SUMMARY

The bill makes targeted terminology updates across Iowa’s criminal provisions on pregnancy-related offenses by changing references from “pregnant person female” (as used in the bill text) while also adjusting the corresponding statutory cross-references. In practice, the operative changes are limited to replacing or standardizing the phrase “pregnant person female” within the affected sections.

It amends Iowa Code § 707.7 (feticide) by revising the wording in subsections 1, 2, 3, and 4. The offense definitions and felony classifications remain the same: intentionally terminating a human pregnancy after the end of the second trimester results in death of the fetus is a class “C” felony; attempting to intentionally terminate after the end of the second trimester without resulting in death of the fetus is a class “D” felony; terminating a human pregnancy while not licensed to practice medicine/surgery or osteopathic medicine/surgery is a class “C” felony; and the provision continues to exclude terminations performed by a licensed physician in the best clinical judgment to preserve the life or health of the pregnant person (including medical efforts to preserve the life of a viable fetus).

It amends Iowa Code § 707.8 by revising wording in subsections 1, 2, 3, 5, and 7, and also amends subsection 12, paragraphs a and b. The substantive offense structure and penalties are unchanged in the bill text: (1) termination without consent during a forcible felony is a class “B” felony; (2) termination without consent during commission of a felony or felonious assault is a class “C” felony; (3) termination (or attempt) without the knowledge and voluntary consent of the pregnant person is a class “C” felony (or class “D” felony for attempt); (5) procuring consent by force or intimidation is a class “C” felony; and (7) unintentionally terminating without knowledge and voluntary consent via an act likely to cause termination or serious injury is an aggravated misdemeanor. The definitional/exception language in subsection 12 likewise remains substantively the same, continuing to include: an act or omission by the pregnant person; and a termination or serious injury caused by an approved medical procedure by a licensed provider, irrespective of pregnancy duration, with or without the pregnant person’s voluntary consent when circumstances preclude consent.

Finally, it amends Iowa Code § 708.2 (subsection 4) to revise terminology by providing that a person who commits a violation of subsection 3 against another person the offender knows or reasonably should know is a pregnant person female is guilty of a class “D” felony.

The bill establishes a new Iowa statutory provision granting certain pregnant minors legal capacity to consent to pregnancy-related medical care when a parent, guardian, or legal custodian is not reasonably available.

It creates a new section, 135.196 (“Pregnancy care for minors”), providing that if a parent/guardian/legal custodian is not reasonably available, the minor may consent to prenatal care, intrapartum care, or postnatal care for the minor. Consent may be given to the listed health care providers: a physician, a physician’s designee, an advanced registered nurse practitioner, a physician assistant, a registered nurse, a licensed practical nurse, or an emergency medical care provider.

The bill also clarifies that this consent capacity does not relieve health care providers from the duty to obtain informed consent from the minor patient for the provision of such care.

The bill establishes the repeal of existing Iowa statutory chapters related to prohibiting abortions after detection of a fetal heartbeat through prescribed testing.

Specifically, Section 1 repeals Chapters 146C and 146E of the Iowa Code (Code 2026). The included legislative explanation states that these repealed chapters concern the prohibition on a physician performing an abortion after a fetal heartbeat is detected via testing required by statute.

No other operative provisions, substantive amendments to remaining sections, definitions, enforcement mechanisms, or effective dates are stated in the provided text.

AT A GLANCE

This bill requires physicians to obtain a patient’s signed FDA drug agreement and specified written risk confirmation before prescribing or dispensing abortion-inducing drugs, except in medical emergencies.

FULL SUMMARY

The bill establishes new requirements governing abortion informed consent, dispensing of abortion-inducing drugs, and reporting of drug-related complications.

It amends Iowa Code section 146B.1 to define “abortion” and exclude certain miscarriages (spontaneous terminations) from the definition when not all products of conception are expelled. It also amends section 146A.1 by adding an in-person physician examination requirement before performing an abortion, including screening for indicia of coercion or abuse, with referral to appropriate health care providers if necessary. The bill further adds definitions to section 146A.1 (including “abortion,” “health care provider,” and “physician”) aligned with definitions used elsewhere in the bill’s new provisions.

The bill creates new sections in Iowa Code: (1) section 146A.2, requiring additional procedural steps before a physician prescribes or dispenses abortion-inducing drugs in “chemical abortions,” including obtaining the woman’s signature on a U.S. FDA patient agreement form for each authorized drug, obtaining written confirmation that the woman was informed of specified gestational-age-specific and drug-specific risks (including possible continuation, failure to remove tissue, hemorrhage, sepsis/sterility), FDA-recommended follow-up timing (approximately 7–14 days), and additional statements about trauma and potential reversal, as well as advising how to access emergency surgical intervention for incomplete abortion, severe bleeding, or other complications. These requirements do not apply when the chemical abortion is performed in a medical emergency, and failure to comply subjects a physician to licensee discipline under chapter 148, with the board of medicine authorized to adopt rules. (2) section 146A.3, directing the Department of Health and Human Services to publish on its internet site notices and reversal-related information for chemical abortions.

The bill also creates a new reporting and liability framework for abortion-inducing drugs in Iowa Code chapter 146F. It defines “abortion-inducing drug” (mifepristone, misoprostol, and certain FDA-approved other drugs used with intent to terminate pregnancy, including off-label use with such intent) and defines “abortion-inducing drug complication” broadly to include physical and psychological conditions identified by a health care provider as possible results, including specific examples such as hemorrhage, failure to terminate, retained tissue/incomplete abortion, missed ectopic pregnancy, infection, and sepsis. It prohibits dispensing abortion-inducing drugs in Iowa unless dispensed in a health care setting directly to the woman and by a person authorized under Iowa Code section 147.107, with a medical-emergency exception. Hospitals/rural emergency hospitals/attending physicians must file a confidential report with the department within 30 days of discharge or death after treating or the woman presenting with an abortion-inducing drug complication; reports must use required content fields (woman’s age, residence state/county, date drug was used, probable postfertilization age, identifying information about the performing/referring physician and facility, and the specific complications plus corresponding ICD codes as applicable) while not including the woman’s name or other identifying information. The department must produce an annual, anonymized, downloadable public statistical report and ensure anonymization prevents disclosure of the reporting provider and the woman’s identity. The bill further creates a private civil cause of action with strict liability against persons who dispense in violation of the chapter: “interested parties” (including the woman or her personal representative) may recover all damages caused, plus statutory damages of $50,000, court costs, and reasonable attorney fees. It also amends section 144.29A to expand termination-of-pregnancy reporting requirements: providers diagnosing or inducing a spontaneous termination must disclose whether mifepristone or misoprostol was used, and whether the patient ingested either drug within 14 days before the spontaneous termination.

AT A GLANCE

This bill prohibits any person from knowingly using, administering, or aiding elective-abortion drugs, instruments, devices, or procedures on a pregnant woman with intent to terminate a clinically diagnosed pregnancy, and subjects violators to Board of Medicine discipline.

FULL SUMMARY

The bill establishes a new framework in Iowa for regulating “elective abortion,” including definitions, a prohibition on certain conduct, and administrative enforcement. It defines “elective abortion” as using, prescribing, administering, procuring, or selling any instrument/medicine/drug/device/means with the purpose of terminating a clinically diagnosed pregnancy with knowledge that the termination will with reasonable likelihood cause the death of an unborn child, while expressly excluding specified situations (e.g., certain fertility treatments, acts intended to save the life or preserve the health of an unborn child, miscarriage, ectopic pregnancy treatment, medical treatment for medical emergencies, and non-intended outcomes of treatment by a licensed physician).

The bill creates new Code section 146F.2 prohibiting a person from knowingly using/employing/administering a drug/instrument/device/means/procedure on a pregnant woman with the specific intent to cause an elective abortion, and from knowingly aiding or abetting such conduct. It also subjects licensees required to be licensed under section 147.2 who violate the chapter to licensee discipline, and directs the Board of Medicine to adopt rules to administer and enforce the new prohibition.

The bill changes Iowa’s feticide law by amending section 707.7 (Code 2026) and removing the existing requirement that the pregnant person’s knowledge and voluntary consent after the end of the second trimester be an element of the offenses. Under the amended section, intentionally terminating a human pregnancy resulting in the death of an unborn child constitutes feticide as a class “A” felony; attempted feticide involving death not resulting is a class “B” felony. The amended section also revises the penalty structure for other categories (including intentional serious injury and unintended death or serious injury), preserves specified exceptions (medical procedures necessary to preserve the life/health of the pregnant woman or fetus under physician’s reasonable medical judgment; legally justified/excused acts including self-defense; and no prosecution of the pregnant woman for death/serious injury/attempt involving her unborn child), and authorizes prosecution by the attorney general. The bill repeals section 707.8.

The bill includes an effective date provision taking effect upon enactment. It also provides a nonoperative “Explanation” section describing its intent to define elective abortion, create the new 146F.2 prohibition, combine and restructure the feticide-related crimes by adjusting elements and penalties, allow attorney general prosecution of the amended feticide provision, and repeal 707.8.

AT A GLANCE

This bill requires physicians to conduct an in-person examination and coercion or abuse screening before performing an abortion, and to refer the woman to appropriate providers based on results.

FULL SUMMARY

The bill establishes new requirements governing abortions, with emphasis on informed consent before an abortion and restrictions, reporting, and civil enforcement relating to “abortion-inducing drugs.” Prior to performing an abortion, a physician must conduct an in-person examination of the pregnant woman, including screening for indicia of coercion or abuse, and refer the woman to an appropriate health care provider if necessary based on the results. It also expands the definitional framework for key terms used in the informed-consent provisions.

Before prescribing or dispensing an abortion-inducing drug, the bill requires a physician to (1) obtain the woman’s signature on a required FDA patient agreement form for each drug, (2) obtain written confirmation that the woman was informed of gestational age–specific risks and specified risks of the particular drug(s), FDA-recommended follow-up timing, trauma-related information about viewing remains in a chemical abortion process, the possibility of reversal with time sensitivity, and where reversal information is available on the department’s internet site, and (3) advise how to access emergency surgical intervention for incomplete abortion, severe bleeding, or other complications. These requirements do not apply when the chemical abortion is performed in a medical emergency. A physician’s failure to comply is subject to licensee discipline, the board of medicine must adopt rules to administer the division, and the department must publish specified reversal notice and resources on its internet site.

The bill creates new chapter provisions restricting dispensing of abortion-inducing drugs: a person may not dispense such a drug unless it is dispensed in a health care setting directly to the woman prescribed the drug and the dispenser is authorized under specified law, with a medical-emergency exception. It also creates a reporting regime: within 30 days after discharge or death following treatment for an abortion-inducing drug complication, hospitals/rural emergency hospitals/attending physicians must file a report with the department in a prescribed form that identifies the woman’s age (not name), her state and county of residence, date the drug was used, probable postfertilization age, relevant physician/facility/referring information, and the specific complications with the most recent WHO ICD code. Reports must be confidential and not subject to public disclosure, and the department must produce an anonymized annual statistical report available to the public in downloadable form; the anonymization must prevent disclosure of the reporting facility/physician and the woman’s identity.

The bill further establishes a private cause of action with strict liability against anyone who dispenses an abortion-inducing drug in violation of the chapter, allowing recovery of all damages caused by the drug, plus statutory damages of $50,000, court costs, and reasonable attorney fees for prevailing plaintiffs. It requires redaction of identifying characteristics of the woman from pleadings and documents without a court order, permits additional court orders to protect identity and privacy, and states the section does not impose civil or criminal liability on the woman. Finally, it amends existing abortion-related reporting/definition provisions to require disclosure to include whether mifepristone or misoprostol was used to induce a spontaneous termination, requires reporting whether mifepristone or misoprostol was ingested within 14 days prior, and excludes spontaneous termination from “abortion” for purposes of certain reporting and penalties under the abortion chapter.

AT A GLANCE

This bill amends the Iowa Constitution to require that the state not deny or interfere with an individual’s reproductive freedom, permitting abortion regulations only after fetal viability.

FULL SUMMARY

This joint resolution proposes an amendment to the Iowa Constitution creating a new “Right to reproductive care” section in Article I.

The proposed constitutional section affirms and recognizes “reproductive freedom” as a fundamental individual right. It requires that the state “shall not deny or interfere” with an individual’s reproductive freedom, and states that private decisions concerning reproductive freedom shall not be infringed. It further provides that any denial, burdening, or infringement of the right may occur only if justified by a compelling state interest achieved by the least restrictive means.

The proposal defines “reproductive freedom” broadly to include prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care. It also creates an abortion-care exception: the state may regulate abortion care after “fetal viability,” but “under no circumstance” may the state prohibit an abortion that, in the professional judgment of an attending health care professional, is medically indicated to protect the life or the pregnant person’s physical or mental health. “Fetal viability” is defined as the point in pregnancy when there is a significant likelihood of sustained fetal survival outside the uterus without extraordinary medical measures, based on the attending professional’s judgment and the particular facts.

It directs that, if adopted, the proposed constitutional amendment be referred to the next general assembly for adoption, and then be published as required by law for three consecutive months before the next election of members; the included explanation also describes submission to the electorate for ratification after the next general assembly’s adoption.

The document outlines regulations in Iowa regarding parental notification prior to an abortion for a pregnant minor. Effective July 1, 2025, these rules require a licensed physician to notify a parent of the minor's intent to terminate a pregnancy, unless a judicial waiver is obtained or specific conditions are met.

The notification must include the minor's name, the intent to terminate the pregnancy, and the name, address, and relationship of the person being notified. The physician is responsible for maintaining the original notification form in the minor's medical record and providing a copy to the minor.

If the minor chooses to notify a grandparent instead of a parent, similar notification procedures apply. This includes a declaration regarding potential civil action against the grandparent for accepting the notification and provisions for the grandparent to refuse acceptance.

These regulations primarily impact the healthcare industry, particularly providers of abortion services, who will need to implement the notification procedures and ensure proper documentation. Overall, the rules aim to enhance parental involvement in the decision-making process concerning abortions for minors.

The document outlines new regulations affecting various aspects of medical practice, particularly in pain management, medical spas, telemedicine, and the use of medical cannabidiol and abortion procedures. It emphasizes the importance of ethical standards and patient safety in the prescribing and dispensing of medications, particularly opioids, while promoting nonopioid therapies and safeguards against substance abuse.

Key provisions include the requirement for physicians to conduct thorough evaluations and document treatment plans before prescribing opioids, as well as the necessity for participation in prescription monitoring programs. Additionally, all prescriptions must be transmitted electronically, and physicians are mandated to complete continuing medical education in medical aesthetic services annually.

The regulations also address the practice of chelation therapy, automated dispensing systems, and the responsibilities of medical directors at medical spas, ensuring proper supervision and training of nonphysician staff. Telemedicine practices are governed by guidelines that require adherence to evidence-based protocols and patient privacy standards.

Furthermore, the document outlines specific requirements for the medical use of cannabidiol, including the need for written certification and restrictions on financial relationships with manufacturers. It also details prerequisites for performing abortions, emphasizing the importance of documentation and compliance with established medical ethics.

Overall, these regulations aim to enhance the quality of care provided by healthcare professionals while ensuring that practices align with ethical standards and patient safety considerations.

The document outlines a legislative proposal in Iowa regarding medication abortions, introducing several new requirements for healthcare facilities and providers. Healthcare settings where medication abortions are performed must display signs informing patients about the potential ineffectiveness of these abortions and the possibility of reversing their effects. This requirement may impact the operations of clinics and hospitals that provide reproductive health services.

Physicians are mandated to obtain written certification from patients, confirming that they have been informed of the risks associated with medication abortions and the possibility of reversal. This could lead to increased administrative burdens for healthcare providers and may affect the overall patient experience.

Additionally, after dispensing abortion-inducing drugs, physicians must provide written discharge instructions that reiterate the information about the potential for reversal. This requirement may necessitate additional resources and time for healthcare providers.

Furthermore, regulations stipulate that mifepristone, a drug used in medication abortions, can only be dispensed directly to patients in a healthcare setting, which may affect pharmacies and healthcare providers involved in the dispensing process.

Overall, the implementation of these provisions is likely to influence the reproductive health industry, potentially increasing costs related to compliance and patient education.

The document outlines a legislative proposal in Iowa concerning medication abortions, introducing several new requirements for healthcare facilities and providers involved in administering abortion-inducing drugs. One key requirement mandates that healthcare facilities, including private offices and hospitals, post conspicuous signs informing patients about the potential ineffectiveness of medication abortions and the possibility of reversing their effects. This could lead to increased operational costs for these facilities.

Additionally, physicians are required to obtain written certification from patients, confirming that they have been informed of the risks associated with medication abortions and the possibility of reversal. This requirement may impose additional administrative burdens on healthcare providers.

The Department of Health and Human Services is tasked with publishing informational materials to educate women about the possibility of reversing medication abortions, which may incur costs related to the development and distribution of these resources.

Furthermore, the proposal includes regulations that prohibit the dispensing of mifepristone outside of a healthcare setting, potentially impacting pharmacies and other entities involved in the distribution of abortion-inducing drugs.

Overall, the implementation of these regulations is likely to significantly affect the operations of healthcare providers and facilities involved in medication abortions in Iowa.

The document outlines significant legal changes in Iowa regarding abortion and related actions, primarily through the Iowa Human Life Protection Act. The act prohibits elective abortions and criminalizes the distribution of abortion-inducing drugs, with enforcement mechanisms limited to private individuals who can bring qui tam actions on behalf of the state. This shift places substantial liability on individuals and entities involved in abortion services, including healthcare providers and pharmaceutical companies.

Key provisions include strict liability for wrongful death and personal injuries associated with abortion-inducing drugs, while pregnant women and those who have undergone abortions are protected from lawsuits. The act also grants immunity to the state and its subdivisions in legal challenges against its provisions, ensuring that certain entities cannot be held liable for actions taken in compliance with the law.

Internet service providers are required to block access to information related to elective abortions and are granted immunity for compliance. Publicly owned institutions must implement measures to restrict access to such content, while local governments are empowered to regulate or prohibit elective abortions within their jurisdictions.

The act establishes a framework for legal actions and defenses, emphasizing the role of private individuals in enforcing the law and the potential financial implications for those involved in abortion-related services. Overall, the changes reflect a strong legislative intent to restrict abortion access in Iowa, with significant ramifications for various industries.

The Iowa Board of Medicine is proposing to rescind and replace Chapter 13 of the Iowa Administrative Code, which outlines the "Standards of Practice and Principles of Medical Ethics." This rulemaking aims to update the standards of practice and medical ethics for healthcare providers, licensees, and employers in Iowa, focusing on areas such as office practices, recordkeeping, physician behavior, and patient-physician relationships, particularly in emergency medical services.

The proposed regulations will significantly impact various sectors within the healthcare industry, including healthcare providers specializing in hospice, palliative, and pain management, as well as the pharmaceutical industry and medical spas. The guidelines emphasize the importance of effective pain management practices, the responsible dispensing of controlled substances, and the qualifications and responsibilities of medical directors in medical spas.

Additionally, the regulations address telemedicine practices, establishing guidelines for technology compliance, patient disclosure, and prescribing protocols. These measures aim to enhance patient safety and ensure that telemedicine services maintain the same standards of care as in-person consultations. The document also highlights the need for ongoing education and training for practitioners involved in medical aesthetic services and chronic pain management.

Furthermore, the regulations cover the treatment of tick-borne diseases and the prescription of medical cannabidiol, detailing the standards of practice for physicians in these areas. The emphasis on thorough documentation and patient evaluations is intended to ensure quality care and compliance with established medical standards.

Lastly, the document outlines regulations regarding abortion services, focusing on the requirements for physicians to assess exceptions under fetal heartbeat laws. These regulations are expected to influence operational practices within the healthcare industry, particularly for those providing abortion services, by necessitating additional documentation and compliance measures.

The Department of Health and Human Services is proposing a rulemaking to rescind and adopt a new Chapter 89 regarding parental notification for a minor's intent to terminate a pregnancy through abortion. This initiative is authorized under Iowa Code chapter 135L and aims to enhance compliance with its provisions.

A public comment period is open until 4:30 p.m. on January 17, 2025, allowing interested individuals to provide feedback. Additionally, public hearings are scheduled for January 15, 2025, and January 17, 2025, both conducted via Microsoft Teams.

The proposed rulemaking is noted to have no fiscal impact on the State of Iowa, nor has any impact on jobs been identified as a result of these changes. The new rules will outline the procedures for notifying a parent or grandparent of a pregnant minor prior to an abortion, including requirements for notification forms and documentation.

The Public Health Department has proposed rulemaking concerning the notification procedures for parents or grandparents of pregnant minors prior to an abortion, as required by Iowa Code chapter 135L. This initiative aims to clarify and structure the procedural requirements for medical providers involved in these notifications.

The proposed rulemaking identifies medical providers as both bearing and benefiting from the costs associated with the notification procedures. However, no quantitative monetary impact has been identified, as the analysis indicates that there are no substantive changes to existing rules. While the Department incurs personnel costs to implement these procedures, there is no anticipated effect on state revenues.

A public hearing to gather comments on the proposed rulemaking is scheduled for November 6, 2024, from 2 to 3 p.m. Written or oral comments must be submitted to the Department of Health and Human Services by 4:30 p.m. on the same day.

AT A GLANCE

This bill requires abortion providers, except in medical emergencies, to give patients KDHE-form written notices and obtain signed 24-hour informed-consent certifications before performing procedures.

FULL SUMMARY

The bill establishes additional procedural, notice, and reporting requirements governing abortion under Kansas’s “woman’s-right-to-know” framework. It expands required disclosures before abortion by adding detailed physician/procedure information, counseling and resources contact information (including perinatal hospice and national perinatal assistance), multiple ultrasound/heartbeat offer-and-documentation duties, certification and reporting obligations to the Department of Health and Environment (KDHE), and enhanced facility/posting and website-link requirements for informed-consent materials. It also adds parallel, medication-abortion-specific requirements tied to use of mifepristone (RU-486/mifeprex), including specific patient-facing notices, sign-posting rules, informed-consent communication and reversal-information duties, publication of multilingual materials by KDHE, criminal penalties, administrative fines, and express private rights of action with anonymity protections.

The bill changes K.S.A. 65-6709 (the informed-consent statute) by revising the conditions for “voluntary and informed consent.” Among other updates, it requires (except in a medical emergency) a 24-hour written notice on a KDHE-provided white-paper form in black 12-point Times New Roman type (hardcopy or electronic) containing: detailed physician qualification/disciplines/malpractice/privileges information; descriptions of the proposed abortion method; risk information and alternatives; gestational-age-related statutory viability language; probable anatomical/physiological characteristics; contact information for medically challenging pregnancy counseling, perinatal hospice, and national free assistance resources; medical risks of carrying to term; and, if the patient is Rh negative, information on anti-Rh immune globulin therapy, consequences of refusal, and likely cost. It adds additional written advisories at least 24 hours before abortion regarding benefits for prenatal/childbirth/neonatal care, availability of printed and online informational materials and specified alternatives/adoption/ultrasound details, father support liability (with a rape exception), the patient’s right to withdraw consent prior to uterine invasion, and fetal pain-structure messaging by no later than 20 weeks from fertilization.

It also adds a private meeting requirement at least 30 minutes before the procedure and requires KDHE-provided informational materials to be given at least 24 hours before, with answers provided in the patient’s own language if asked. It adds a written patient certification requirement (on a KDHE form) that the required information was provided and that the patient met with the performing physician, plus monthly physician reporting of the number of certifications received to KDHE and annual public availability of certification counts. The bill introduces ultrasound-related duties (offer to view the image, offer a physical picture, written certification time-stamped, and signed acceptance/rejection placed in the medical file with retention rules) and heart-monitor duties (offer to listen to the fetal heartbeat, written certification time-stamped, signed acceptance/rejection, and retention rules). It further requires conspicuous facility posting with a KDHE “Notice” text (including patient rights and resource/payment statements) and requires website facilities to post an easily identifiable link to the KDHE informed-consent materials; it includes definitions for “human being” (including unborn during embryonic and fetal ages from fertilization to full gestation) and “medically challenging pregnancy” (severe anomaly or condition invariably fatal).

The bill changes K.S.A. 2025 Supp. 65-6716 by replacing it with medication-abortion rules specifically for providers prescribing/dispensing/administering mifepristone. It requires conspicuous signage for all such settings (and pharmacies) with a KDHE “medication abortions using mifepristone” notice addressing effectiveness, possible reversal if the second pill/tablet hasn’t been taken, and availability of immediate help resources; it specifies sign placement by setting (waiting rooms/consultation rooms; admission areas; pharmacy drive-through/prescription areas). It imposes pre-medication consent requirements: except in a medical emergency, physicians must inform the patient in writing using KDHE forms and also by telephone or in person at least 24 hours before a medication abortion that uses mifepristone, including the possibility of reversal and where reversal information is available, and after initial mifepristone administration must provide a legible written notice with the same content. In medical emergencies, it limits required emergency disclosure to medical indications supporting the judgment and excludes psychological/emotional conditions. KDHE must publish within 90 days multilingual (English and languages spoken by at least 2% of the population) comprehensible materials about reversing mifepristone medication-abortion effects and resources to obtain timely assistance, in print and online. The bill sets class A misdemeanor penalties for a first violation and a severity level 10 person felony for second/subsequent violations; creates KDHE fine authority of $10,000 per sign-posting failure with daily separate violations (excluding medication abortions necessary to prevent the pregnant woman’s death); authorizes civil damages suits by the woman, the father, and specified grandparents in limited circumstances, subject to a two-year limitations period keyed to discovery or related criminal case conclusion; provides for attorney fees and costs for prevailing parties (with a bad-faith/frivolous loser fee-shifting provision); and includes anonymity-preservation procedures (sealing/exclusion and pseudonym use) when the woman does not consent to public disclosure. The bill repeals the existing K.S.A. 65-6709 and K.S.A. 2025 Supp. 65-6716 text and makes the act effective upon publication in the statute book.

Recent legislation in Kansas significantly alters reproductive health services by imposing strict prohibitions on abortion procedures and allowing civil enforcement actions against violators. The law enables individuals to sue for damages related to abortion services, while also restricting the manufacture and distribution of abortifacient drugs. Amendments clarify the legal framework surrounding wrongful life and wrongful birth claims, ensuring that no new causes of action are created while maintaining existing claims related to maternal health.

Additionally, the legislation mandates that billing for anatomic pathology services can only occur if personally rendered or directly supervised by licensed professionals, aiming to enhance transparency and uphold ethical standards in healthcare practices.

The law introduces various tax credits and exemptions to support community services, education, and healthcare sectors. Tax credits for contributions to community colleges and technical institutions incentivize funding for educational resources, while sales tax exemptions are provided for specific nonprofit organizations and healthcare entities, particularly those serving underserved populations.

Exemptions also extend to organizations involved in animal welfare, military support, and services for individuals with developmental disabilities. Contractors working on projects for these nonprofits can purchase materials without incurring sales tax, further alleviating financial burdens associated with operational costs.

Overall, these legislative changes reflect a comprehensive approach to regulating healthcare practices, enhancing financial support for education, and imposing stricter controls on reproductive health services, thereby significantly impacting various sectors within Kansas.

The proposed legislation in Kansas seeks to prohibit abortion, categorizing unlawful performance of an abortion and destruction of a fertilized embryo as severity level 1 person felonies. It aims to align state law with constitutional protections, asserting that unborn persons deserve the same legal rights as those who are born. The act includes provisions that any conflicting federal law or court decision is void and that judges attempting to invalidate the act may face impeachment. Exceptions are made for procedures necessary to save the life or health of an unborn child or to address miscarriages.

Amendments to Kansas statutes clarify criminal liability related to conspiracy and solicitation, particularly for serious offenses, and specify that the term "person" in wrongful death actions includes unborn children. These changes may impact various sectors, including healthcare and legal industries, while also addressing wrongful death actions by prohibiting claims for wrongful life or wrongful birth. Additionally, regulations emphasize ethical conduct in medical practices, prohibiting the use of experimental therapies without informed consent and restricting the distribution of anabolic steroids for non-medical purposes.

The legislation introduces tax credits for contributions to educational institutions and community services, aiming to enhance funding for these sectors. Tax credits are available for contributions made to community colleges and postsecondary institutions, with specific limits set for various tax years. Exemptions from sales tax are provided for certain purchases related to construction, healthcare, and agriculture, impacting various business industries.

Furthermore, the document addresses the use of fetal tissue in medical practices, prohibiting its use without informed consent and restricting abortion services in certain medical facilities. Tax credits for research and development activities are also introduced, excluding expenditures related to abortion. Overall, these legislative changes aim to reshape the legal and financial landscape surrounding reproductive rights, healthcare practices, and educational funding in Kansas.

The document outlines various exemptions from sales tax for nonprofit organizations and specific activities, primarily benefiting charitable entities across multiple sectors. Key exemptions include those for educational materials, agricultural supplies, and services provided by advertising agencies and public broadcasting stations. Nonprofit organizations, including zoos, museums, and historical societies, are eligible for tax exemptions on tangible personal property and services used for their charitable purposes, significantly impacting their financial operations and supporting their missions in education, health, and community services.

AT A GLANCE

This bill prospectively extends criminal and wrongful-death liability by defining an “unborn child” as covering fertilization through birth and treating it as a “person/human being” in specified statutes.

FULL SUMMARY

The bill establishes a new criminal-liability framework for certain deaths of unborn children and a modified wrongful-death civil cause of action tied to abortion-related circumstances. It creates the “abolish abortion Kansas act” label for changes to K.S.A. 21-5419 (known as “Alexa’s law”), expands the definition of who qualifies as an “unborn child” and treats an unborn child as a “person/human being” for specified criminal statutes, and adds priority/dominance language if other state law conflicts.

Substantively, it amends K.S.A. 21-5419 by: (1) redefining “Fertilization” and “unborn child” (to cover the period from fertilization to birth); (2) altering the statute’s exclusion list—removing the previous exceptions as reflected by striking/renaming within the reproduced text to carve out only specified circumstances (life-saving procedures on the pregnant woman with reasonable steps to save the unborn child, and certain medical/procedural scenarios at the request of the pregnant woman or legal guardian, and lawful administration/dispensation of prescribed medication; the reproduced text also references “lawful dispensation… medication” and removes/changes other listed items such as a “spontaneous miscarriage” exception marker); (3) expanding application by stating that in certain listed criminal statutes, “person” and “human being” also mean an unborn child; (4) requiring that enforcement follow the same due-process presumptions/defenses/justifications/immunities/clemencies that would apply if the victim had been born alive; and (5) providing severability and a “prevail if conflict” rule.

It also amends K.S.A. 60-1901 (wrongful death) by adding unborn children to the statutory definition of “person” for article 19 of chapter 60, defining “unborn child” similarly (from fertilization to birth), and narrowing the wrongful-death claim exclusions for deaths of unborn children caused by certain abortion-related circumstances. The bill further adds a severability clause mirroring the criminal-law severability language.

The amendments apply prospectively only and do not apply to conduct committed before July 1, 2026. The bill repeals K.S.A. 21-5419 and K.S.A. 60-1901 (the existing versions as codified) and takes effect upon publication in the Kansas statute book. It additionally includes a provision stating the amendments to K.S.A. 21-5419 and 60-1901 will be known as the “abolish abortion Kansas act” and the Alexa’s law designation applies to K.S.A. 21-5419.

The proposed changes to abortion laws in Kansas aim to significantly alter the legal landscape surrounding abortion and related medical practices. The new legislation will criminalize all abortions, eliminating previous exceptions that allowed for wrongful death claims in cases involving the death of an unborn child due to abortion.

The amendments to existing laws will redefine key legal terms and remove certain defenses previously available in murder and wrongful death cases. This shift is expected to increase legal risks for medical professionals and facilities that provide abortion services, as they will face heightened scrutiny and potential liabilities.

The repeal of existing legal provisions will lead to substantial changes in how abortion and wrongful death cases are managed in the state. As a result, healthcare providers, legal practitioners, and individuals involved in abortion-related matters will need to navigate a more complex legal environment.

Overall, the proposed act is poised to have profound implications for the healthcare system and the legal framework surrounding abortion in Kansas, potentially reshaping medical practices and legal proceedings in the state.

The document outlines a legislative act that requires healthcare providers in Kansas to report specific complications arising from abortions to the Kansas Department of Health and Environment. This reporting will include various complications, both physical and psychological, along with relevant patient demographics and details of the abortion procedures.

Healthcare providers will need to implement new reporting procedures to comply with the act, which aims to enhance the collection of data related to abortion complications. The Kansas Department of Health and Environment is tasked with developing a reporting process and will compile quarterly public reports summarizing the collected data.

Additionally, the department is responsible for submitting annual data to the United States Centers for Disease Control and Prevention. This initiative is expected to impact healthcare providers, particularly those involved in abortion services, as they adapt to the new requirements.

AT A GLANCE

This bill prohibits abortion providers from performing or inducing an abortion after a fetal heartbeat is detected except under specified medical-emergency, lethal-fetal-anomaly, ectopic, miscarriage, or rape-incest exceptions.

FULL SUMMARY

The bill makes multiple changes to Kentucky’s abortion statutes (KRS 311.710–311.820 and related provisions) primarily by (1) revising definitional language for “abortion,” and medical/emergency-related terms; (2) narrowing and restructuring when abortion may be performed; (3) tightening consent/ultrasound and minor-consent procedures; and (4) expanding/clarifying reporting and enforcement, including changes to civil and criminal exposure and repeal of a spousal-notice provision.

It amends KRS 311.720 to redefine “abortion” so that the definition focuses on intent to terminate a “pregnancy” rather than a “clinically diagnosable” pregnancy and removes/reshapes the prior phrasing tied to knowledge that the termination will with reasonable likelihood cause the death of the unborn child by specified means; it also adjusts related definitional carve-outs. It amends KRS 311.723 to prohibit abortion actions requiring separating the pregnant woman from her unborn child, while enumerating exceptions that include procedures intended to save the life or preserve the health of an unborn child; specific miscarriage-sepsis/hemorrhage emergencies; removal of a dead child under documented conditions; ectopic/molar pregnancy treatment; procedures for removal of an unborn child with a lethal fetal anomaly; and specified rape/incest pregnancies (gestational age 22 weeks or less) along with a medical-emergency clause requiring reasonable efforts to preserve both mother and unborn child. It also amends KRS 311.725 (consent requirements) to keep the 24-hour consent/printed-materials framework but modifies certain content (including restrictions on abortions based on sex/race/national origin/Down syndrome or disability except lethal fetal anomaly) and updates related cabinet-published materials provisions, ultrasound and heartbeat informed-consent requirements in KRS 311.727, and minor abortion consent and court self-consent procedures in KRS 311.732 (including notice exceptions, anonymity requirements, expedited confidential hearings with a 72-hour ruling deadline framework, and detailed evidence categories for court review).

It amends fetal-heartbeat-based restrictions and related enforcement across KRS 311.7701, 311.7706, 311.772, 311.780, 311.781, 311.782, and 311.783. Key changes include: revising/clarifying definitions tied to lethal fetal anomaly, “medical emergency/medically necessary,” fetal heartbeat/gestational-age determinations, and “unborn child” framing; making the prohibition on intentionally performing or inducing abortion when a fetal heartbeat is detected subject to specific enumerated exceptions (including procedures to prevent death/serious irreversible major bodily function impairment, lethal fetal anomaly, ectopic/extrauterine pregnancy, missed/incomplete miscarriage, and rape/incest when gestational age is 22 weeks or less), with added requirements for written physician findings and recordkeeping, including documentation of gestational-age determination for rape/incest cases. It also amends viability limits (KRS 311.780) to allow abortion after viability only for medically necessary reasons preserving the woman’s life/health or for lethal fetal anomaly, and adjusts reporting/record-entry requirements and license discipline provisions for violations (including suspension/revocation authority changes in multiple amended sections). The bill further amends KRS 311.800 to prohibit abortions in publicly owned hospitals except as provided for lethal fetal anomaly and other statutory exceptions, and expands protections against coercion/discipline for refusal to participate based on moral, religious, or professional objections.

It amends KRS 213.101 reporting requirements for abortions to the Vital Statistics Branch, including changing the reporting deadline from “three (3) days” to “fifteen (15) days” after month-end and revising what must be reported: the report must still include patient demographic and procedural/reason data, but the bill’s amendments reorganize and update required categories (including probable gestational/post-fertilization ages and methods used to confirm, pre-existing complications, viability and medical reasons, pathological examination, follow-up efforts/results, Rh-negative testing and prevention information, billing/ICD-10 and cost details, and whether sexually transmitted disease testing occurred), while the report must not include patient name or identifiers that would allow patient identification. It also makes changes to enforcement/penalties in KRS 311.990 and elsewhere, and repeals KRS 311.735 (spousal notice provisions). The bill is titled/used as the “Compassionate Care Act” and includes a repeal of KRS 311.735; no new effective date is stated in the provided text excerpts aside from specific “immediately upon” provisions tied to constitutional triggers in amended KRS 311.772.

AT A GLANCE

This bill requires Kentucky courts to apply the same homicide and assault doctrines to prosecutions where an unborn child is the victim, while excluding unintentional deaths caused by specified life-saving medical procedures.

FULL SUMMARY

The bill establishes a framework in Kentucky criminal law treating prosecutions involving an unborn-child victim under KRS Chapter 507 (criminal homicide) and KRS Chapter 508 (assault) as subject to the same general legal principles that apply to comparable crimes against a person born alive. It also creates definitions for “unborn child” (from fertilization until live birth) and “spontaneous miscarriage,” and it limits application by excluding from coverage the unintentional death of an unborn child resulting from specified life-saving medical procedures on a pregnant woman (when accompanied by reasonable steps, if available, to save the unborn child) or a spontaneous miscarriage.

Under the bill’s new KRS Chapter 507 section, if a victim is an unborn child, the enforcement standard incorporates homicide doctrines such as presumptions, defenses, justifications, and laws of parties, along with immunities and clemencies. Under new KRS Chapter 508 sections, the chapter is made to similarly treat prosecutions where an unborn child is the victim as governed by the same principles that would apply to assault on a person born alive. The bill amends KRS 507.010 to expressly include unborn children within the definition of “person” and “human being,” while also adjusting the chapter’s definitional structure by adding the “person”/“human being” unborn-child inclusion and defining “unborn child” (fertilization through live birth) and “spontaneous miscarriage” (natural or accidental termination of a pregnancy with expulsion of the unborn child).

The bill creates related definitions applicable across specified assault and homicide-related statutes (KRS 508.010, 508.020, 508.025, 508.030, 508.032, 508.040) and referenced sections of the Act, ensuring that “person,” “spontaneous miscarriage,” and “unborn child” align with its definitions. It also creates a new concurrent jurisdiction rule giving the Attorney General concurrent jurisdiction with Commonwealth’s and county attorneys to investigate and prosecute offenses under KRS Chapter 507 and the specified KRS 508 sections when the victim is an unborn child.

It amends KRS 439.265 (shock probation) by updating cross-references to ensure the provision’s scope and references operate consistently with the Act’s unborn-child victim definitions, and it repeals listed KRS sections that concern fetal homicide and related exceptions (KRS 507A.010 through 507A.060, including definitions, degrees of fetal homicide, and prohibition on death sentence). The changes apply prospectively to conduct occurring on or after the Act’s effective date, and existing provisions on prenatal homicide or assault or regulating abortion/abortion facilities are maintained but become superseded to the extent they conflict or are inconsistent with the Act’s new homicide/assault and jurisdiction provisions. The bill is cited as the “Prenatal Equal Protection Act.”

AT A GLANCE

This bill requires Kentucky’s cabinet to place abortion-inducing drugs, as defined in KRS 311.7731, on Schedule IV.

FULL SUMMARY

The bill changes Kentucky criminal and civil law to restrict and penalize the intentional use and distribution of pharmaceuticals intended to cause or hasten death, with a particular focus on abortion-inducing drugs and “aid in dying” approaches. It requires Kentucky’s cabinet to place abortion-inducing drugs (as defined by KRS 311.7731) onto Schedule IV. It also increases and clarifies criminal liability related to controlled-substance trafficking and possession by adding abortion-inducing drugs and by creating new offenses for importing abortion-inducing drugs and for “medically assisted aid in dying.”

It amends KRS 218A.1413 (trafficking in a controlled substance in the second degree) to include unlawful trafficking, prescribing, distributing, supplying, selling, or trafficking “in any quantity” of an abortion-inducing drug as a separate trafficking basis, carrying Class D felony penalties for first offenses and a higher penalty for subsequent offenses (with the subsection (c)/(d) penalty framework retained for the abortion-inducing-drug category). It amends KRS 218A.1415 (possession of a controlled substance in the first degree) to treat possession of an abortion-inducing drug as possession in the first degree, while preserving limits on incarceration and the availability of deferred prosecution/presumptive probation, except that deferred prosecution is not preferred (and presumptive probation does not apply) when the controlled substance is an abortion-inducing drug; it also maintains an explicit protection that the section cannot be construed to convict a pregnant woman for personal-use possession. The bill further amends KRS 216.302 (assisted suicide) to define the offense terms more plainly for knowingly causing or attempting suicide by force/duress and for assisting suicide with the purpose of assisting, classifying assisted suicide as a Class B felony.

It creates new offenses in KRS Chapter 218A and KRS Chapter 216: (1) a new “importing an abortion-inducing drug” offense—Class D felony for knowingly and unlawfully transporting any quantity into Kentucky with intent to sell or distribute—barred from pretrial diversion and subject to a requirement that the defendant serve at least 85% of the sentence before parole/release; and (2) a new “medically assisted aid in dying” offense—Class B felony—covering prescribing/dispensing/providing/administering/assisting drugs intended to cause or hasten the death of another person, participating in such use, or coercing/encouraging/pressuring a request for such drugs. The new “medically assisted aid in dying” section contains specific carve-outs stating it does not prohibit appropriate pain management that does not intentionally shorten life, withholding/withdrawing futile or disproportionate extraordinary/disproportionate treatment while continuing basic care, providing palliative/hospice/spiritual support, or complying with a scope-of-treatment order or a living will directive. It also creates a civil damages mechanism within that chapter by authorizing damages for deaths resulting from violations, prosecuted by the deceased’s personal representative, with damages including funeral expenses, estate administration costs, recovery costs (including attorney’s fees and expert witness services), punitive damages, and other allowed damages.

The bill adds an enforcement-and-notice framework in two other areas. First, it amends KRS 216.308 to require that the licensing agency revoke a healthcare professional’s license/certification upon receipt of proof of a criminal conviction/plea for felony violations of the new “Section 5 or 6” offenses (or a contempt judgment for violating an injunction under KRS 216.306). Second, it creates a new civil cause of action in KRS Chapter 411 allowing specified plaintiffs (including the pregnant woman, spouse, minor’s parent/legal guardian, next friend/guardian, or estate) to sue any person/entity that mails/sends abortion-inducing drugs into Kentucky or intentionally places them in Kentucky’s stream of commerce with substantial likelihood of in-state use, or knowingly prescribes to a person in Kentucky regardless of prescriber location—authorizing compensatory and punitive damages, court costs, and reasonable attorney’s fees, with joint-and-several liability and court discretion to award injunctive/equitable relief. Third, it creates a new KRS Chapter 216B section defining “chemical abortion,” expanding the meaning of “complication/abortion complication” to include specified adverse events from abortion-inducing drugs (including failures to terminate requiring additional procedures, hemorrhage, uterine injury, allergic/anesthesia complications, excessive pain/nausea, emotional complications, and other FDA MedWatch-defined adverse events), and requiring healthcare providers who believe a patient has experienced such a complication to provide a mandated written notice describing potential private causes of action and emergency-care rights; it further requires physicians and certain facilities to make the statement available and tasks the cabinet with publishing the written statement on its website in downloadable form (page 9–11).

AT A GLANCE

This bill requires prosecutors to enforce, for crimes with an unborn-child victim, Kentucky’s homicide and assault rules using the same principles as comparable crimes against persons born alive, subject to specified life-saving and miscarriage exceptions.

FULL SUMMARY

The bill establishes new rules treating the “victim” of certain criminal prosecutions as an unborn child for purposes of criminal-law analysis under Kentucky’s homicide and assault-related chapters. It creates new provisions in KRS Chapter 507 and KRS Chapter 508 requiring that, unless otherwise specified, prosecutions in which the victim is an unborn child are enforced using the same legal principles that would apply to comparable crimes involving a person born alive, including presumptions, defenses, justifications, laws of parties, immunities, and clemencies. It also creates a carve-out that excludes coverage for unintentional death of an unborn child resulting from life-saving procedures on a pregnant woman (accompanied by reasonable steps, if available, to save the life of the unborn child) or from a spontaneous miscarriage.

For definitional alignment, the bill amends KRS 507.010 to include “Person” and “human being” as including an unborn child, defines “Spontaneous miscarriage” as natural or accidental termination of a pregnancy with expulsion of the unborn child, and defines “Unborn child” as an individual from fertilization until live birth. It also creates new definitions within KRS Chapter 508 (covering KRS 508.010, 508.020, 508.025, 508.030, 508.032, and 508.040) to mirror those same categories (including “Person” and “Unborn child”) and adds a new enforcement rule for prosecutions under those statutes when the victim is an unborn child, tying enforcement to the assault laws applicable to persons born alive. In addition, it creates concurrent prosecutorial jurisdiction for the Attorney General to investigate and prosecute the specified offenses when the victim is an unborn child.

The bill amends Kentucky’s abortion statutes and related court/jurisdiction rules affecting minors. It amends KRS 311.732 to revise the “abortion” definition and changes restrictions on performing an abortion on a minor by requiring specified informed written consent from the minor and one parent/legal guardian (with a requirement that the consenting parent make a reasonable attempt to notify the other parent at least 48 hours prior, subject to notice exceptions for certain protective orders and specified prior criminal/diversion circumstances). It preserves and details an option for minors to petition a circuit or district court for an order allowing self-consent to an abortion, with anonymous/expedited/confidential proceedings, a required hearing with evidence-focused factors (including maturity and ability to understand medical risks and consequences), defined evidentiary standards for granting or denying relief, and provisions for confidential appeal, attorney/guardian-ad-litem support, waiver of fees if indigent, and emergency-medical-exception procedures (including documentation and follow-up notice to a parent/legal guardian after an emergency abortion). It also amends KRS 402.205 concerning minors’ permission to marry by inserting/retaining more detailed conditions and related procedures and clarifies that granting such permission removes the disabilities of minority.

Finally, the bill makes additional criminal-law administration changes: it amends KRS 439.265 (probation/shock probation suspension procedures) in ways that include removing specific prior statutory restrictions tied to certain fetal homicide provisions by deleting references to KRS 507A.010/507A.040/507A.050 (the stricken KRS 507A provisions relate to fetal homicide). It also creates/retains sex-offender presentence evaluation requirements when sentencing sex crimes and modifies applicability through references to probation suspension. The bill expressly repeals the KRS 507A fetal homicide provisions (including definitions/exceptions and degrees of fetal homicide, plus a death-sentence prohibition in that chapter). A general effective-date clause limits the new changes to conduct occurring on or after the act’s effective date, and it states that existing prenatal homicide/assault/abortion provisions are superseded to the extent they conflict with the new sections.

AT A GLANCE

This bill establishes a constitutional right to reproductive freedom that bars the Commonwealth from denying, burdening, or infringing pregnancy-related decisions without a compelling health interest shown by the least restrictive means.

FULL SUMMARY

The bill proposes adding a new constitutional section to the Kentucky Constitution establishing a fundamental individual right to “reproductive freedom.” The proposed right covers decisions about all matters relating to pregnancy, including prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care.

Under the proposed section, the Commonwealth may not deny, burden, or infringe the reproductive freedom right unless it is justified by a compelling state interest achieved by the least restrictive means. The bill permits regulation of abortion care only after fetal viability, and in no circumstance may the Commonwealth prohibit an abortion that, based on the professional judgment of an attending health care professional, is medically indicated to protect the life or the physical or mental health of the pregnant person. The bill also requires non-discrimination: the Commonwealth may not discriminate in the protection or enforcement of the fundamental right.

The proposed section further prohibits adverse governmental action against individuals based on actual, potential, perceived, or alleged pregnancy outcomes (including miscarriage, stillbirth, or abortion). It also prohibits penalizing or prosecuting a person for aiding or assisting a pregnant person in exercising the right to reproductive freedom when the pregnant person provides voluntary consent.

The bill defines “compelling” to mean only an interest limited to protecting the health of a person seeking care, consistent with accepted clinical standards of practice and evidence-based medicine, and without infringing on autonomous decision-making. It defines “fetal viability” as the point in pregnancy when, in the professional judgment of an attending health care professional and based on the particular facts of the case, there is a significant likelihood the fetus will sustain survival outside the uterus without extraordinary medical measures. The proposed constitutional change must be submitted to Kentucky voters for ratification or rejection, with specified requirements for publication of the ballot question and certification of the question to county clerks for placement on ballots.

AT A GLANCE

This bill establishes legal protections from civil, criminal, and administrative liability for persons and entities that assist with obtaining abortion services, including lawful out-of-state services for Kentucky residents.

FULL SUMMARY

The bill creates a new section within KRS 311.710 to 311.820 establishing broad legal protections for individuals and entities who assist with obtaining an abortion service, including services provided lawfully outside Kentucky to patients who reside in Kentucky.

It defines “abortion service” to include (1) an abortion and (2) related health care or other services provided in conjunction with an abortion, and it broadly defines “seeking, obtaining, providing, or facilitating” to cover a wide range of actions, including information review/research, expressing interest, offering or providing financial assistance, providing/disseminating information, arranging or providing transportation, recommending/referring/arranging/assisting any service related to obtaining an abortion, providing any health care not prohibited for a pregnancy, and attempting such actions. The bill provides that certain actors—explicitly including persons, physicians, health care providers, abortion referral or counseling agencies, employers, and other individuals/entities—are protected from civil liability, criminal liability, or administrative investigations for protected acts to aid or encourage someone connected to seeking, obtaining, providing, or facilitating an abortion service.

The protections include specific coverage for termination of a pregnancy resulting from a patient’s use of an abortion-inducing drug when the drug is received outside Kentucky for the patient’s personal and sole use and ingested outside Kentucky. The bill also restricts disclosure and sale of medical or other records created regarding protected actions, prohibiting their use for investigating/tracking/identifying protected actors or for civil, criminal, or administrative investigations related to obtaining or facilitating an abortion service. Licensed professionals are protected from disciplinary action (including suspension, revocation, denial/limitation/restriction tied to protected conduct), and businesses/organizations are protected from denial of licenses or monetary fines based solely on protected actions. Public agencies and their employees/agents are prohibited from implementing or enforcing regulations or policies that prevent or restrict cross-state travel for lawful abortion services or penalize assistance for such travel, and the bill clarifies that protected actions do not, by themselves, constitute violations of specified Kentucky criminal provisions (KRS 529.100 or 529.110).

The bill creates a civil enforcement mechanism: any person harmed by a violation of the protected subsections may sue for actual and punitive damages, court costs, and reasonable attorney’s fees, with suit filed in either the county where the violation occurred or the county where the plaintiff resides. Those found liable are jointly and severally liable for damages arising from the same violation, and the Commonwealth waives immunity for equitable and declaratory relief and for monetary damages, costs, or attorney’s fees under this subsection. The bill includes a limitation that it does not create a right to performance of an abortion in Kentucky if otherwise prohibited by Kentucky law.

AT A GLANCE

This bill establishes a fundamental reproductive privacy right in KRS Chapter 311, prohibiting the state from denying, interfering with, or discriminating against individuals who choose or refuse contraception, sterilization, or abortion.

FULL SUMMARY

The bill establishes broad “reproductive privacy” protections in a new section of KRS Chapter 311, including a stated fundamental right for individuals to choose or refuse contraception or sterilization, and to choose or refuse to bear a child or obtain an abortion prior to fetal viability or to protect the life or health of the pregnant person. It directs that the state may not deny or interfere with these rights through regulation or the provision of benefits, facilities, services, or information, and it prohibits discrimination in enforcement or protection of these rights based on specified characteristics (including sex, race/ethnicity, disability, gender identity, age, religion, and sexual orientation). Enforcement is provided through an action for injunctive relief and damages against charged state or local officials.

The bill also creates or reenacts multiple abortion-related statutory provisions in KRS Chapter 311, redefining terms and resetting viability standards: it repeats and reenacts the post-viability prohibition (with an exception to preserve the life or health of the pregnant person) and reenacts related requirements that physicians determine the fetus’s probable gestational age, including inquiry/testing obligations and a restriction on performing abortions after 15 weeks’ probable gestational age without specified determinations and record documentation. It further creates a cabinet inspection duty for abortion facilities’ medical records to ensure compliance with KRS 213.101 reporting, and it reenacts limitations on governmental discrimination/coercion for accepting or refusing abortion. Additionally, the bill amends KRS 311.820 to define “abortion referral or counseling agency” and prohibits agencies from charging or accepting any fee/kickback/compensation from abortion providers for referrals.

Significant changes are made to Kentucky’s abortion reporting framework. KRS 213.101 is amended to adjust reporting timing (from “three (3) days” to “fifteen (15) days,” reflected in the bill text as changes to deadlines), and to revise/expand the content of required abortion reports. The amended report must include numerous patient and clinical details while prohibiting the report from containing information that would identify the patient (e.g., name and direct identifiers). The bill also requires annual public statistical reporting by the Vital Statistics Branch while ensuring information cannot reasonably lead to identification of a person upon whom an abortion was performed or attempted. It also provides that the Vital Statistics Branch shall promulgate administrative regulations to assist compliance.

Beyond abortion/privacy provisions, the bill makes a set of technical statutory amendments across health and other areas. It updates the scope of “medical care” in KRS 205.510 (including how abortions are treated in that definition), amends multiple licensing and disciplinary provisions for medical professionals (e.g., definitions and procedures in KRS 311.550 onward, and related references), adjusts assault statutes to incorporate “freestanding birthing center” contexts and modifies assault classifications, revises KRS 39A.180 and education/juvenile-justice related provisions, updates regional community services allocations (KRS 210.370), and revises provisions related to perinatal palliative care (KRS 216.2975) and freestanding birthing center licensing standards (KRS 216B.198). Effective timing is specified only at the end of the bill: Section 10 takes effect January 1, 2027.

AT A GLANCE

This bill defines “sex” as a person’s biological sex at birth and requires state agencies and courts to replace “gender” and “gender identity” in statutory and reporting language.

FULL SUMMARY

The bill establishes a statewide “sex” terminology framework in Louisiana law and related reporting/administrative contexts, replacing “gender” references for personally identifiable information and for legal definitions while directing multiple state entities to maintain diversity considerations and disaggregated data using “sex” (and related population characteristics).

Operatively, it amends numerous statutes and civil/procedural provisions to replace “gender” with “sex” (including rules of construction that words used in one gender sex apply to others, and related cross-gender/number applicability rules). It also codifies a definition of “sex” as an individual’s biological sex (male or female) as observed or clinically certified at birth, and prohibits use of “gender identity” and other subjective terms as synonyms/substitutes for “sex.” The bill further requires demographic reporting and data collection frameworks across several programs (workforce demographics, juvenile discipline and solitary confinement reporting, traffic stop and impaired driver tracking data elements, charter and student outcome reporting, and other programmatic reporting), with disaggregation that explicitly includes “gender sex”/“sex” alongside race, ethnicity, age, disability, and other categories.

It changes governance/diversity requirements for boards, commissions, and councils by updating language to require due consideration of state demographics including “gender sex” alongside geography and race, and by making similar “race and gender sex” representativeness requirements for membership. It also makes targeted technical changes to multiple program rules (e.g., criminal justice reform reporting and education/tutoring evidence reporting) to ensure reported metrics are disaggregated by sex/gender-sex terminology.

Finally, the bill includes extensive procedural forms/ordering language for Louisiana Code of Criminal Procedure expungement provisions (motions for expungement, interim expungement, and orders of expungement), adjusting the included form fields and labels to use “gender sex.” It authorizes the Louisiana State Law Institute to change law-wide references from “gender” to “sex” as it pertains to personally identifiable information, and names the act the “Restoring Biological Truth Act.”

AT A GLANCE

This bill requires gestational carrier agencies to obtain LDH licensure and maintain independently administered escrow accounts before collecting any fees for Louisiana matching or coordinating services.

FULL SUMMARY

The bill establishes a comprehensive Louisiana “Family Building and Maternal Health Protection Act” governing gestational carrier agreements and compensated arrangements, including eligibility and required documentation, agreement content and enforceability, mandatory counseling, medical decision-making rules, prohibitions on pregnancy termination requirements, parentage procedures, confidentiality, and dispute/fee provisions. It creates a separate licensing and consumer-protection framework for “gestational carrier agencies” and related matching/coordinating services, operated by the Louisiana Department of Health (LDH), including mandatory escrow, financial controls, disclosure requirements, screening standards, recordkeeping, audits, complaint handling, administrative sanctions, and civil/criminal penalties.

Key requirements for agreements include: parties must execute written notary-attested agreements and satisfy mandatory counseling (at least two sessions per party, at least 30 days apart, with defined counseling topics; a written report/certification is required and appended to the agreement); gestational carriers must meet eligibility criteria (including age, prior live birth, medical clearance, mandatory counseling completion, independent legal advice, and restrictions on primary Medicaid/public-assistance coverage unless pregnancy/postpartum coverage is independently provided); intended parents must meet financial capacity thresholds (with waiver/declared ability to meet obligations via assets/insurance; waiver review requires independent financial documentation, while escrow pre-funding remains required). The bill also requires a three-contract architecture for agency-facilitated arrangements (parents–agency enrollment agreement, carrier–agency engagement agreement, and an agency-coordinated operative agreement), specifies conflict rules among them, mandates that certain compensation conditions are void (no base-compensation conditioning/forfeiture based on birth outcome, carrier health/appearance/genetics/number of children, refusal to selective reduction/termination, or surrender of the child), and sets guidance benchmarks for total compensation (not minimum/maximum by law) while treating materially below-benchmark compensation as a potential coercion/free-consent factor.

For parentage and vital records, the bill provides that intended parents are legal parents upon birth under compliant arrangements and that the gestational carrier (and spouse) is not a legal parent; it authorizes LDH administrative processes including an “Administrative Pre-Parentage Certification” transmitted electronically to enable vital records listing of intended parents absent a contrary court order. A compliance-certificate process is created for agency-facilitated agreements submitted through LDH portals, with LDH limited review to facial/statutory-document completeness and compliance checklists (not merits of medical judgment or factual disputes). The bill preserves district-court jurisdiction over judicial parentage determinations and provides that compliance certification/pre-parentage certification do not adjudicate parentage.

Agency regulation changes the market by requiring LDH licensure for matching/coordinating services tied to Louisiana covered arrangements, with exemptions for attorneys acting solely as counsel, licensed healthcare providers performing only clinical services, and licensed mental health professionals performing only evaluations/counseling. Licensed agencies must perform extensive background checks and disqualifying-screen safeguards (including registry checks; sex offender registration is an absolute disqualifier; protective order checks require independent attorney opinion for non-disqualification), must keep client/escrow funds in independent segregated interest-bearing escrow accounts administered by independent escrow agents, and must provide detailed mandatory disclosure packets (fees, refund policy, referral-fee relationships, conflict rules, contract enforceability constraints, and complaint/cause-of-action information) before collecting fees. Enforcement includes routine and for-cause audits, complaint procedures with confidentiality protections, public registries of agencies and enforcement actions, administrative sanctions (reprimand to revocation) and emergency suspension for imminent risk, civil penalties scaled by violation severity/frequency (including enhanced penalties for misappropriation and unlicensed operation), restitution authority, creation of a “Gestational Carrier Consumer Protection Fund,” and a private right of action for gestational carriers and intended parents for misrepresentation, escrow violations, and unlicensed operation, including potential actual/ consequential/punitive damages and attorney’s fees. It also prohibits certain prohibited acts (including inducing participation through fraud/undue influence; conditioning compensation on unlawful relinquishment/outcomes; and materially misleading advertising) and creates criminal offenses for unlicensed operation, fraud/misrepresentation in unlicensed operation (felony), and escrow misappropriation/conversion (felony), plus misdemeanor penalties for certain intentional violations causing harm.

The act amends existing Louisiana Title 9 provisions addressing gestational carrier contracts (re-enacting Chapter 1-C of Title 9, §§9:2718–2720.15) and related public-record exceptions (R.S. 44:4.1(B)(27)), and adds new Title 9 gestational-carrier provisions §§9:2720.16–9:2720.23. It also enacts Chapter 2-B in Title 40 (R.S. 40:101–127) establishing LDH’s gestational carrier agency licensing/consumer-protection functions. Effective date is August 1, 2026, with existing agreements executed before that date governed by prior law unless parties elect otherwise in writing before a parentage order.

The Department of Health's Health Standards Section in Louisiana is proposing amendments to the licensing standards for free-standing birth centers (FSBCs). These changes aim to expand the services offered by FSBCs, allowing them to provide prenatal and postpartum care for clients with a history of cesarean sections or uterine surgeries, as well as care for clients aged under 16 or over 40, under certain conditions.

The financial impact of the proposed rule on FSBCs is uncertain for the fiscal years 2026, 2027, and 2028. While FSBCs that choose to offer the expanded services may experience increased revenues, they could also face additional costs related to staffing and changes in staffing qualifications. The overall fiscal implications remain indeterminable due to the unknown number of FSBCs that will implement these changes.

The amendments are expected to enhance access to care at FSBCs for specific patient populations. However, the precise monetary impacts and the extent of changes in staffing requirements are not yet clear.

The document outlines significant legislative changes proposed by the 132nd Maine Legislature regarding abortion and related reproductive health laws. The proposed amendments aim to repeal existing laws that currently authorize abortion, which could have profound implications for healthcare providers and the accessibility of reproductive health services in the state.

Key changes include the expansion of definitions related to "human being" and "person," which may lead to legal ramifications for medical practitioners involved in abortion services. Additionally, the legislation seeks to repeal certain crimes related to domestic violence against pregnant individuals, potentially affecting legal and law enforcement practices.

New reporting requirements for miscarriages are introduced, placing additional administrative responsibilities on healthcare professionals. The emphasis on patient confidentiality in the context of abortion and miscarriage reporting may necessitate adjustments in how healthcare facilities manage sensitive information.

Overall, these proposed changes represent a significant shift in reproductive health policy in Maine, with potential legal and economic consequences for various stakeholders, including healthcare providers and legal professionals. The broader community may also feel the impact of these amendments as they reshape the landscape of reproductive health services in the state.

The document outlines significant amendments to abortion laws in Maine, set to take effect on February 25, 2025. One of the key changes is the introduction of new reporting requirements for healthcare professionals, who must report each abortion performed to the Department of Health and Human Services within a specified timeframe. These reports will include demographic information about the patient and details regarding the abortion procedure.

Additionally, the amendments emphasize that only licensed healthcare professionals may perform abortions, with stricter criteria for procedures conducted after viability. Abortions will only be permitted in cases where they are medically necessary to protect the life or health of the mother or in instances of lethal fetal anomalies.

The changes are expected to have a significant impact on the healthcare industry, particularly for facilities and professionals involved in reproductive health services. Compliance with the new reporting requirements may require additional administrative resources and training for healthcare providers.

While specific monetary impacts are not detailed, the potential for increased legal liabilities and the costs associated with compliance and reporting could financially affect healthcare providers. Overall, these amendments indicate a shift in the regulatory landscape surrounding abortion services in Maine, influencing both healthcare providers and patients.

This legislative document introduces new regulations concerning the provision and disposal of abortion drugs in Maine, set to take effect on March 4, 2025. Health care providers are required to conduct physical examinations of patients and be present during chemical abortions. Additionally, they must schedule a follow-up visit within seven days after the administration of the abortion drug and provide patients with a catch kit and a medical waste bag for the proper disposal of medical waste.

Manufacturers of abortion drugs are tasked with ensuring the proper disposal of these drugs and any associated pathological waste. They are also responsible for minimizing the release of endocrine disruptors that may result from improper disposal practices.

These regulatory changes aim to enhance the safety and accountability of healthcare providers and pharmaceutical manufacturers involved in the provision and manufacturing of abortion drugs. By imposing stricter operational requirements, the legislation seeks to protect public health and the environment.

AT A GLANCE

This bill requires hospitals with emergency departments to provide stabilizing examination and treatment, including medically necessary termination, or to transfer a patient who presents an emergency pregnancy–related medical condition.

FULL SUMMARY

The bill establishes new hospital requirements for patients presenting to an emergency department with an “emergency pregnancy–related medical condition.” It defines the term and “stabilize,” limits coverage to hospitals with emergency departments, and requires that once a hospital determines a patient has such a condition, the hospital must either (1) provide further examination and treatment necessary to stabilize the condition, explicitly including termination when medically necessary to stabilize the patient, using available staff and facilities; or (2) transfer the patient to another medical facility.

The bill requires the hospital to allow termination at the hospital when the patient’s treating health care practitioner determines termination is medically necessary to stabilize the patient. It also provides that a hospital is treated as meeting the requirements if the patient or the patient’s representative refuses consent to further examination and treatment or to transfer, after the hospital offers those options and informs the patient/representative of risks and benefits; the hospital must take reasonable steps to secure written informed consent to that refusal.

If the patient is not stabilized, the bill prohibits transfer unless the transfer is consistent with 42 U.S.C. § 1395dd. It prohibits adverse action by a hospital against a treating health care provider who refuses to authorize transfer of an unstabilized patient with an emergency pregnancy–related medical condition, against a treating provider whose treatment is consistent with applicable medical standards of care necessary (in clinical judgment) to stabilize, and against a hospital employee who reports a violation. The bill creates civil penalty liability for negligent violations (up to $50,000 per violation for hospitals with 100+ beds; up to $25,000 per violation for hospitals with fewer than 100 beds) and directs the Department to stay a final decision on a potential violation if there is an ongoing federal investigation under 42 U.S.C. § 1395dd about the same incident; it also addresses coordination of overlapping federal fines (offset and potential refund when a federal fine is imposed after the state fine).

The bill changes existing Maryland law governing licensed hospitals’ obligations regarding artificial insemination, sterilization, and termination of pregnancy by adding an exception for the new emergency pregnancy–related medical condition statute: a hospital (and related governance persons) may not be required to allow or refer for such procedures except as provided in the newly created § 19–342.1. Finally, it sets an effective date of October 1, 2026.

AT A GLANCE

This bill requires hospitals with emergency departments to screen for emergency pregnancy–related medical conditions and either stabilize the patient, including medically necessary termination, or transfer consistent with EMTALA.

FULL SUMMARY

The bill creates new State requirements for hospitals with emergency departments to screen and manage patients presenting with emergency pregnancy–related medical conditions, and it revises existing hospital refusal/authorization limitations for pregnancy-related procedures.

It establishes a new Health–General § 19–342.1 defining “emergency pregnancy–related medical condition” and “stabilize,” and directing that § 19–342.1 applies only to hospitals with emergency departments. If a hospital determines a patient has an emergency pregnancy–related medical condition, the hospital must either (1) provide further examination and treatment necessary to stabilize the condition, including termination of a pregnancy when the termination is medically necessary to stabilize the patient, or (2) transfer the patient to another medical facility. The hospital must allow termination at the hospital when the patient’s treating health care practitioner determines it is medically necessary to stabilize the patient. If the patient (or representative) refuses consent to further examination/treatment or transfer after being informed of the risks and benefits, the hospital is treated as having met the § 19–342.1 requirements; the hospital must take reasonable steps to secure written informed consent to the refusal.

The bill restricts transfer of an unstabilized patient by stating a hospital may not transfer unless the transfer is done consistent with 42 U.S.C. § 1395dd (the federal EMTALA framework). It also prohibits adverse employment or credentialing action against certain providers or employees: a hospital may not penalize a treating provider for refusing to authorize transfer of an unstabilized patient with an emergency pregnancy–related medical condition, for providing treatment consistent with the medical standards of care necessary (in the provider’s clinical judgment) to stabilize the patient, or a hospital may not take adverse action against a hospital employee who reports a violation. It provides civil penalty exposure for negligent violations, capped at $50,000 per violation for hospitals with 100+ beds and $25,000 per violation for hospitals with fewer than 100 beds. The bill adds Department of Health oversight on enforcement in relation to federal EMTALA investigations: the Department must stay a final decision if there is an ongoing federal investigation of the same incident; if the federal investigation results in a fine for the same incident, the Department must subtract the federal fine from the maximum potential State fine; and if a federal fine is imposed within 2 years after a State fine, the Department must refund the hospital an amount equal to the federal fine (subject to not exceeding the State fine).

Separately, it amends Health–General § 20–214(b) by changing the scope of the existing permission/obligation prohibition: the provision no longer uses “permit” and instead requires hospitals to “allow” only as it relates to the listed pregnancy-related procedures (artificial insemination, sterilization, or termination of pregnancy) and prohibits orders requiring referral for those procedures, except as provided in the new § 19–342.1. The refusal to allow or to refer may not be grounds for civil liability or disciplinary/recriminatory action. The Act takes effect October 1, 2026.

The bill adds a new informed-consent requirement in the Maryland Health–General statute for abortion procedures performed by a “qualified provider.” It requires that, before performing a procedure to terminate a pregnancy, the qualified provider must (1) inform the patient of the nature of the proposed procedure and the potential risks associated with it, including specified risks (depression, infection, hemorrhage, breast cancer, danger to subsequent pregnancies, infertility, and regret); and (2) obtain the patient’s signed, written informed consent.

The bill also requires recordkeeping: the qualified provider must place a copy of the signed, written informed consent in the patient’s medical record.

The bill directs that the new informed-consent provisions be added as Article—Health—General § 20–201 within the existing “Part I. Abortion Services” subtitle, using the existing definition of “qualified provider” in § 20–207.

The act takes effect October 1, 2026.

AT A GLANCE

This bill bars a qualified provider from performing or inducing an abortion until 24 hours after the woman receives required transabdominal ultrasound imaging, and until 2 hours if she lives 100 miles away.

FULL SUMMARY

The bill creates an abortion “ultrasound and waiting period” framework in Maryland by adding a new Health-General section (§ 20–210) and revising an existing subtitle provision (§ 20–209).

A qualified provider generally may not perform or induce an abortion within 24 hours after the woman receives required transabdominal ultrasound imaging; additionally, if the woman resides at least 100 miles from the facility where the abortion will be performed, the provider may not perform or induce the abortion within 2 hours after the woman receives the transabdominal ultrasound. The new section also includes an exception for women seeking abortion who are alleged victims of rape or incest (as defined by reference to Maryland’s Criminal Law), but only if the rape or incest incident is reported to law enforcement. It provides that the ultrasound may be used in a medically appropriate way consistent with the standard of care, even aside from the specifically required imaging procedures.

The bill establishes detailed procedural requirements for the transabdominal ultrasound: the ultrasound must be performed by a medical professional trained in sonography and working under a qualified provider’s supervision; the gestational age must be determined when possible (via standardized fetal measurement or, when only the gestational sac is visible, via sac measurement); if gestational age cannot be determined, the professional must verbally offer other ultrasound imaging to determine gestational age. The ultrasound image must include specific content if viewable (fetal dimensions and an accurate portrayal of external members and internal organs), a printed copy must be made to document measurements, and the professional must verbally offer options during the ultrasound including viewing the image, receiving a printed copy, and hearing the fetal heartbeat (consistent with the standard of care). The woman must sign a written certification confirming the offered options and, if applicable, confirming the distance condition.

The new section states that the woman is not required to accept anything offered during the transabdominal ultrasound (including the offered gestational-age determination options and the viewing/print/heartbeat offers). The facility performing the abortion must retain the printed ultrasound image for the longer of 7 years or the period required by federal or state law. A qualified provider who violates the new waiting-period section is subject to a penalty of up to $2,500. Separately, the bill revises § 20–209 to clarify that the provider’s good-faith, best-clinical-judgment liability protections are conditioned on compliance with § 20–210 (i.e., the safe harbor in § 20–209 applies only when the decision is made in accordance with accepted clinical practice and the new ultrasound/wait-time requirements). The act takes effect October 1, 2026.

AT A GLANCE

This bill requires that an abortion in Maryland be performed only by a licensed physician who first determines and documents whether a detectable fetal heartbeat exists.

FULL SUMMARY

The bill establishes a new abortion regulatory and enforcement framework in Maryland focused on “fetal heartbeat” and a physician-only requirement. It repeals existing abortion-procedure subtitle parts in Article – Health – General (including Parts II–IV referenced in the bill) and replaces them by adding a new set of sections (20–201 through 20–212) to define key terms, require that abortion be performed by a licensed physician, restrict when and how a physician may knowingly perform or induce an abortion based on a detectable fetal heartbeat, require specific written documentation and medical-record entries for certain emergency and health-related circumstances, and impose extensive procedural requirements tied to informed consent and sonography. The bill also sets sovereign/governmental/official immunity provisions related to challenges to the subtitle and creates a liability-enforcement structure primarily through private civil actions.

Operationally, the bill requires that an abortion be performed by a “physician” (defined as a person licensed to practice medicine under Title 14 of the Health Occupations Article). A physician may not knowingly perform or induce an abortion before the physician determines whether the baby has a detectable fetal heartbeat, and may not do so if a detectable heartbeat is determined, except for specified medical-emergency circumstances and other carve-outs (including when testing does not detect a heartbeat and when a medical emergency prevents compliance with the pre-determination requirement, provided additional subtitle requirements are followed). The bill specifies how fetal heartbeat determinations must be made under “standard medical practice,” including selecting appropriate detection methods based on estimated gestational age and recording required details in the patient’s medical record.

Enforcement is structured around exclusively private civil actions: the State and state/local government actors are barred from taking or threatening enforcement actions to enforce the heartbeat and documentation requirements, while “any person” (excluding state/local officers or employees and certain individual plaintiffs barred by the bill’s conditions) may bring civil actions. If a claimant prevails, the court must award injunctive relief, statutory damages of not less than $10,000 per covered abortion (including per abortion aided/abetted), plus costs and attorney’s fees; there is also a limited limitation on repeat awards after a defendant previously paid full statutory damages for the same abortion or the same aiding/abetting conduct. The bill imposes a 4-year statute of limitations, prohibits certain defenses (including ignorance of law and reliance on overruled/unbinding decisions), creates a specific affirmative defense for reasonable belief after reasonable investigation that the physician complied or would comply, and bars state/official intervention in these suits (though amicus briefs are allowed). It also restricts where such actions may be filed (venue rules by county) and prohibits transfer without written consent of all parties.

The bill adds additional procedural and related provisions: it requires that an abortion in the state may not be performed or induced unless voluntary and informed consent is obtained, and it enumerates detailed counseling/disclosure items (including specified medical risks, gestational-age information, risks of carrying to term, father-assistance disclosure, and pregnancy-prevention counseling/referrals). It requires pre-abortion sonography in many cases, including display of sonogram images, disclosure of results in lay terms, and audibility of fetal heartbeat if present; it also includes conditions and a certification/election form process that addresses, among other things, waiver of certain waiting requirements for patients living at least 100 miles from the nearest qualified facility. The bill further grants broad immunity protections to the State and certain officials/officers/employees in actions challenging the subtitle; reallocates fee liability in suits seeking to stop enforcement of abortion laws (joint and several liability for costs and attorney’s fees of the prevailing party under defined “declaratory/injunctive relief” circumstances); and provides severability and other general construction rules for abortion regulations (including severability of unconstitutional applications and rules about repeal and political-subdivision regulation). The bill takes effect October 1, 2026.

AT A GLANCE

This bill requires covered Massachusetts hospitals to provide emergency health services, including stabilizing abortion when medically necessary, to any person presenting with specified emergencies without delay.

FULL SUMMARY

The bill establishes expanded and clarified obligations for abortion-related care within Massachusetts law, focused on emergency hospital treatment and later consent/counseling and facility/provider requirements.

It amends Chapter 111 (General Laws) by adding a new Section 51M requiring hospitals licensed with an emergency care department to provide emergency health services to any person presenting in active labor or with specified injuries/acute medical conditions that may cause death or severe harm, expressly including certain pregnancy-related emergencies (including ectopic pregnancy, complications of pregnancy loss, risks to future fertility, previable premature rupture of membranes, and emergent hypertensive disorders such as preeclampsia). “Emergency health services” are defined broadly to include screening, stabilizing treatment, processes for refusals to consent, transfer procedures, nondiscrimination, no delay in examination or treatment, and whistleblower protections; stabilizing treatment includes abortion when abortion is necessary to resolve the patient’s injury or acute medical condition. The bill requires each covered hospital to submit an annual (by September 1) report to the Department of Public Health describing policies and processes consistent with the new section, and creates enforcement and remedies: civil penalties up to $50,000 per violation, license revocation for gross/flagrant/repetitive violations, a damages right for individuals harmed by direct violation, and a requirement that the department promulgate regulations to implement the section.

It amends Chapter 112 (General Laws) Section 12F by changing the phrasing of a health-related threshold from “have come in contact with” to “be at risk of contracting,” and adds “prevention” after “diagnosis.” It amends Section 12I to limit conscientious objection by providing that no conscientious objection is valid when an abortion is required to preserve the life of a pregnant person and no medical staff other than the objector are available to perform or support the abortion. It adds definitions in Section 12K (including “abortion-related care,” “provider,” and “provider facility”), and throughout Sections 12L, 12M, 12N, and 12N½ it replaces “physician”/other clinician-specific terms with “provider” and expands references to cover “abortion-related care.” It repeals Section 12O and further removes restrictive language in Sections 12P and 12Q.

The bill replaces existing Section 12R with new abortion consent and related protections (Sections 12R, 12R.1, and 12R.2, plus a new 12R.3). Under Section 12R, a provider must obtain a pregnant person’s written informed consent in a multilingual form prescribed by the Department of Public Health, and the patient must execute the consent form prior to receiving an abortion; exceptions allow performing without an executed informed consent form in emergencies where abortion is required to preserve the health of the pregnant person, and allow proxy execution when the pregnant person is incapacitated due to a vegetative state and a legally valid health care proxy exists. The bill prohibits an age-based invalidation of a pregnant person’s signature, bars any waiting period between consent execution and the abortion, and requires providers to retain executed consent forms as medical records. Consent form and related documents are confidential and may be released only to specified persons (patient, properly consented proxy/other legally authorized person, or the provider), or by written patient consent or proper judicial order. Under Section 12R.1, it prohibits requiring patients to delay beyond standard/operational necessity after consent, to undergo or view an ultrasound inconsistent with standard of care, to appear more frequently/longer than standard of care, or to receive medically inaccurate/unnecessary/misleading counseling. It also restricts facility burdens: provider facilities are not required to affiliate with or be located within a specified distance of a hospital; not required to construct/maintain medically unnecessary physical structures/spaces; not required to hire only providers with admitting privileges; and not required to comply with other medically unnecessary physical/operational standards. Provider facilities must comply with ambulatory-surgery clinic licensure requirements only if they operate as a free-standing ambulatory surgical center. Enforcement is assigned to the Attorney General, while preserving a private right of action with a 10-year statute of limitations. Under Section 12R.2, the Department of Public Health must publish and periodically update a listing of provider facilities opting into a public list and must run a culturally competent, linguistically diverse education campaign about “crisis pregnancy centers”/pregnancy resource centers and the availability of licensed medical/family planning services across the Commonwealth; the Department of Veterans Services must provide veterans (and their families) information on available abortion services and support, including financial assistance under Chapter 118E. Under Section 12R.3, a health care professional working in a school-based health center must keep reproductive health care information/services confidential, including contraceptive counseling and abortion-related information or care.

AT A GLANCE

This bill requires covered Massachusetts insurers and payors to accept a single written provider verification or certification for gender-affirming care for people with gender dysphoria unless it clearly fails minimum guideline requirements.

FULL SUMMARY

The bill creates new statutory limits on how Massachusetts regulators and payors review documentation for access to gender-affirming care for individuals with gender dysphoria. It directs each covered entity to accept a written verification/certification from a health care provider (including a qualified mental health care professional) for accessing gender-affirming care, unless the documentation “clearly” fails to meet minimum requirements under established clinical guidelines.

Specifically, it adds new provisions to multiple Massachusetts insurance/health-care statutes—MassHealth-related coverage rules in Chapter 32A (new §17T), MassHealth/health benefit administration rules in Chapter 118E (new §10R), and four private-market insurance/insurer frameworks in Chapters 175 (new §47VV), 176A (new §8WW), 176B (new §4WW), and 176G (new §4OO). In each section, the covered entity must not reject provider documentation unless it clearly does not satisfy minimum clinical-guideline requirements, and must not require more than one written verification/certification stating that the care is required to treat gender dysphoria.

Each added section also defines “qualified mental health care professional” to mean a mental health professional meeting minimum credentials, training, and standards of care for working with gender-dysphoric adults and adolescents developed by the World Professional Association for Transgender Health (unless the context requires otherwise). The net effect is to standardize documentation acceptance and reduce administrative barriers across state insurance and health-plan categories by prohibiting additional or duplicative verification beyond what one qualifying provider supplies.

AT A GLANCE

This bill requires Massachusetts insurers that cover gender-affirming health care to also cover defined “detransition-related treatment,” with the Group Insurance Commission limiting cost-sharing to no greater than for any other benefit.

FULL SUMMARY

The bill establishes a required insurance benefit in Massachusetts for “detransition-related treatment,” a defined category of medical, psychological, or psychiatric care (including mental-health treatment, medical interventions, and surgeries) intended to stop, reverse, or help an individual cope with effects of prior gender-affirming health care services.

It adds this coverage requirement across multiple state-regulated insurance/health benefit systems covering gender-affirming health care under Chapter 9A, by inserting new sections into Chapter 32A (Group Insurance Commission coverage), Chapter 118E (Massachusetts Medicaid-related managed care/contracted insurers and related administrators), Chapter 175 (individual and group insurance policies), Chapter 176A (individual and group hospital service plans), Chapter 176B (individual and group medical service agreements/subscription certificates), and Chapter 176G (health maintenance organization contracts). For each, the bill requires that if a plan/contract/certificate covers gender-affirming health care, it must also provide coverage for detransition-related treatment.

For the Group Insurance Commission specifically, the bill also states that the required detransition-related treatment benefits shall not be subject to any greater deductible, coinsurance, copayments, or out-of-pocket limits than any other benefit provided by the commission.

The operative changes take the form of multiple new statutory sections inserted after specified existing sections; no other substantive provisions are included in the provided text beyond these coverage mandates and the cross-cutting definition.

AT A GLANCE

This bill requires providers to obtain written informed consent before performing an abortion, keep the signed form in the patient’s file, and destroy it seven years after the abortion date.

FULL SUMMARY

The bill establishes additional definitions in Massachusetts General Laws chapter 112, section 12K, including “abortion-related care” (a medically appropriate complementary service), “provider” (a licensed health care professional acting within scope who may lawfully perform abortions or provide abortion-related care), and “provider facility” (a structure where such services are performed/provided).

It replaces the existing chapter 112, section 12R by striking out that section and inserting new provisions governing abortion consent and confidentiality for patients. The new section requires written informed consent before an abortion is performed; the Department of Public Health must prescribe a consent form. The patient must sign the consent form in advance of the scheduled abortion time, except for emergencies requiring immediate action; the bill specifies that signing must not impose any waiting period between signing and receiving the abortion. The provider must maintain the signed consent in the patient’s file and destroy it seven years after the abortion date. The bill makes the consent form and other related documents (including court transcripts/written findings or conclusions) confidential and restricts release to the patient (or with the patient’s written informed consent) or by proper judicial order, with permitted disclosures to the treating provider and any person whose consent is obtained under the section or other applicable law.

The bill also changes minor consent rules for abortion and confidentiality protections for minors by amending section 12F of chapter 112. First, it revises the statement beginning “Any minor may give consent to …” by replacing “his medical or dental care” with “their medical care, including abortion, or dental care,” thereby expressly including abortion within what a minor may consent to. Second, it amends section 12F by striking the word “abortion” from the third paragraph, removing that phrase as written in that location.

AT A GLANCE

This bill requires abortion facilities in Massachusetts to conspicuously post bilingual coercion-warning and consent notices and to verbally inform patients of them before an abortion.

FULL SUMMARY

The bill creates a new offense-and-remedy framework in Massachusetts by adding Section 12½S to Chapter 112 of the General Laws, establishing requirements intended to protect patients from coerced abortion.

It defines “Abortion” to mean the knowing destruction of an unborn child’s life or the intentional expulsion or removal of an unborn child from the womb, except for the principal purpose of producing a live birth or removing a dead fetus. It requires any private office, freestanding ambulatory surgical center, hospital, clinic, or other facility where abortions are performed to conspicuously post a mandated notice sign in specified patient-visible locations; the sign must be in English and Spanish, with legible lettering at least three quarters of an inch in boldfaced type. The notice states that coercion to obtain an abortion is unlawful; that the facility cannot perform an abortion without freely given and voluntary consent; that performing an abortion against the patient’s will is unlawful; and that the patient has the right to contact law enforcement for protection from actual or threatened abuse or violence. Posting locations depend on facility type: private offices/ambulatory surgical centers/clinics must post in each abortion patient waiting room and consultation room; hospitals or other facilities must post in each admission area used by abortion patients.

The attending physician must also verbally inform the pregnant female of the notice content in private, not in the presence of certain accompanying persons (e.g., boyfriend, husband, family member, friend, or other accompanying person). The pregnant female must certify in writing, before the abortion, that she was informed by the attending physician; a copy must be kept in her file for seven years. For minors, the copy must be kept for at least seven years or for two years after reaching the age of majority, whichever is longer.

Facilities face a $10,000 fine for knowing, reckless, or negligent failure to post the required sign. The bill provides for daily separate violations for each day (during business hours when patients or prospective patients are present) that an abortion (except one necessary to prevent the death of the pregnant female) is performed while the sign is not posted. It also creates a private right of civil action: an individual may sue to recover damages for emotional distress and other damages allowed by law for failure to post the sign, and may sue for failure to provide the required verbal notice; venue is in superior court either where the conduct occurred or where the defendant has its principal place of business. The civil remedies do not displace sanctions that may apply under other law.

AT A GLANCE

This bill requires every licensed Massachusetts hospital with an emergency care department to provide emergency health services, including stabilizing abortion treatment when needed, to any eligible person presenting for care.

FULL SUMMARY

The bill creates new hospital and provider obligations to expand access to abortion and abortion-related care in Massachusetts. It amends Chapter 111 of the General Laws by inserting a new Section 51M requiring every licensed hospital with an emergency care department to provide emergency health services—including screening, necessary stabilizing treatment, consent/refusal procedures, appropriate transfers, and nondiscrimination—to any person presenting in active labor or with specified serious injuries or acute medical conditions; it explicitly provides that stabilizing treatment includes abortion when needed to resolve the patient’s injury or acute condition. The bill also requires annual (by September 1) reporting to the Department of Public Health on hospital policies/procedures for compliance, and authorizes enforcement including civil penalties up to $50,000 per violation, license revocation for gross/flagrant/repetitive violations, a private right of action for individuals harmed by a violation, and Department rulemaking.

The bill amends Massachusetts’ abortion consent and provider-related statutes in Chapter 112, including by changing references from “physician” (and related clinician titles in certain provisions) to “provider” and by adding definitions for “Abortion-related care,” “Provider,” and “Provider facility.” It adds that no conscientious objection may be valid when an abortion is required to preserve the life of a pregnant person and no non-objecting medical staff are available to perform or support the abortion. It adds “prevention” to the list of matters in Section 12F and modifies Section 12F by changing “have come in contact with” to “be at risk of contracting.” Several provisions are removed or revised, including repeal of Section 12O and striking out of particular sentences/requirements elsewhere (notably within Section 12P and Section 12Q).

It replaces Section 12R with new requirements for informed consent and introduces new constraints on required preconditions to care. Under new Section 12R, a provider must obtain a pregnant person’s written informed consent on a commissioner-prescribed multilingual form before an abortion, with exceptions for emergencies where abortion is required to preserve the pregnant person’s health and for certain incapacitation scenarios where a legally valid health care proxy executes the form. The bill bars any waiting period between executing the consent form and performing the abortion, requires confidentiality for the consent form and related documents (with limited disclosure permitted by patient consent, applicable law, or a proper judicial order), requires retention of executed consent forms consistent with medical recordkeeping, and states that a pregnant person’s age does not invalidate a signature on the consent form.

Under new Section 12R.1, the bill prohibits requiring pregnant persons to wait beyond the standard of care/operationally necessary time after executing the consent form, prohibits requiring ultrasounds inconsistent with standard of care or requiring the patient to view/receive results of an ultrasound beyond standard of care, limits requirements that would force more frequent/longer visits than standard of care, and bars counseling/information that is medically inaccurate, medically unnecessary, or misleading. It also restricts clinic/facility regulatory obligations by prohibiting provider facilities from being required to affiliate with or be within a specified distance of a hospital, from constructing/maintaining medically unnecessary facilities, from requiring only providers with hospital admitting privileges, and from complying with other medically unnecessary physical/operational standards; licensure compliance requirements are limited to clinics providing ambulatory surgery only if the provider facility operates as a free-standing ambulatory surgical center. Enforcement is assigned to the Attorney General (with a private right of action preserved) and actions must be commenced within 10 years after the cause of action accrues. The bill further requires the Department of Public Health to publish and annually update a website/print listing of provider facilities opting into a listing, mandates culturally competent multilingual public education about “crisis pregnancy centers”/pregnancy resource centers (including noting lack of licensed medical services and availability of licensed services across the Commonwealth), requires the Department of Veterans Services—consulting with Public Health—to provide information to veterans about abortion services and related financial assistance, and adds a confidentiality requirement for reproductive health care information/services provided in school-based health centers (including abortion-related information or care).

AT A GLANCE

This bill establishes new Massachusetts crimes for homicide, manslaughter, assault, and battery that apply when, without lawful justification, a defendant kills or injures an unborn child.

FULL SUMMARY

The bill establishes a new Massachusetts criminal law framework for crimes committed against “unborn child[ren]” (defined as the human life developing from conception until death) through insertion of a new Chapter 265A (“Unborn Victims of Violence Act”) into the General Laws.

It creates new homicide, manslaughter, assault, and battery offenses when a defendant, “without lawful justification,” causes the death or specified injuries to an unborn child, with offense degrees and penalties keyed to intent, malice, and the type of resulting harm. It specifies relevant terms for “bodily injury” (including serious impairment or conditions substantially imperiling the unborn child’s health or welfare) and “serious bodily injury” (permanent disfigurement, protracted loss/impairment, or substantial risk of death, including a birth before 37 weeks with a low birth weight; excluding birth inducement for bona fide medical purposes). It also provides that “any person” does not include the pregnant woman whose unborn child is killed or injured, and defines “unborn child,” “any person,” and “without lethal justification.”

Key offenses and penalties include: first-degree murder of an unborn child (life imprisonment, not eligible for parole under section 133A of chapter 127, with eligibility-for-parole rules if committed between ages 14 and 17); second-degree murder of an unborn child (life imprisonment with parole eligibility after the term of years set by the court); voluntary and involuntary manslaughter of an unborn child (up to 20 years plus specified fines/jail or house-of-correction terms); assault upon an unborn child (up to 2.5 years in a house of correction or up to a $1,000 fine when fear of immediate bodily harm or fear of the unborn child’s death is intended, or when bodily injury is inflicted or attempted and the child is subsequently born alive); battery upon an unborn child (serious bodily injury plus intentional/knowing, consent-less touching of a pregnant woman, with penalties up to a maximum of five years in state prison, plus alternative house-of-correction time and fines); and separate punishment provisions for assault and battery causing “bodily injury” (up to 5 years and/or fines) versus “serious bodily injury” (up to 15 years and/or fines).

The bill includes two exceptions: it does not apply to acts causing the death of an unborn child when committed during a legal abortion to which the pregnant woman consented, or to acts committed per usual and customary standards of medical practice during diagnostic testing or therapeutic treatment. It also states that prosecution or conviction under this Act does not bar conviction or punishment for other crimes committed by the defendant as part of the same conduct.

AT A GLANCE

This bill prohibits a physician from performing or inducing an abortion or causing an intentional miscarriage after the second trimester unless the procedure occurs in a hospital and required physicians certify that continuation is likely to result in the female’s death.

FULL SUMMARY

The bill establishes additional statutory conditions governing abortions and intentional miscarriages after the second trimester, and it requires specific life-preserving measures for a fetus that is born alive.

It amends Massachusetts General Laws ch. 112, § 12N (“Protecting women’s health”) to prohibit—“notwithstanding section 12L”—a physician from performing or inducing an abortion or causing a miscarriage on any female after the second trimester unless (a) the procedure is performed in a hospital and (b) the physician and two consulting physicians certify, and record that, in their medical opinion (based on best clinical judgment) continuation of the pregnancy is likely to result in the death of the female. The section also preserves medically necessary care for the mother after a miscarriage occurring before 20 weeks and for stillbirth or fetal death occurring after 20 weeks.

It amends ch. 112, § 12O (“Preserving the life of a fetus born alive after miscarriage or abortion”) to require, when an abortion is performed or an intentional miscarriage is caused pursuant to § 12N, that the hospital provide all life-saving measures and equipment as defined by the Department of Public Health, and that the physician employ all such life-saving measures and equipment to preserve the life and health of the fetus born alive if there is any clearly visible, audible, or otherwise discernible evidence of viability.

AT A GLANCE

This bill requires providers to obtain a minor’s written informed consent, on a commissioner-prescribed form, before performing an abortion, and prohibits disclosure of consent materials except as authorized.

FULL SUMMARY

The bill establishes additional definitions in Massachusetts General Laws chapter 112, section 12K for terms used in the state’s abortion-access framework, including “abortion-related care,” “provider” (a licensed health care professional acting within scope of practice who may perform abortions or provide abortion-related care), and “provider facility” (a structure where such services are performed or provided).

It further changes the existing statutory scheme for minors’ abortion consent and related requirements by replacing section 12R of chapter 112 with new text covering informed consent procedures. Under the replaced provisions, an abortion may not be performed without first obtaining the patient’s written informed consent using a form prescribed by the commissioner of public health. The patient must sign in advance of the scheduled time for the abortion, except in emergencies requiring immediate action; however, signing in advance is not to impose a waiting period between signing and obtaining the abortion. The provider who performs the abortion must maintain the signed consent in their files and destroy it seven years after the abortion date. The bill also specifies that the consent form and other related written materials and court transcripts/findings/conclusions remain confidential and are not released except with the patient’s written informed consent, via a proper judicial order, or to specified recipients (including the patient, the treating clinicians, and others whose consent is obtained under the section or other applicable state/federal law).

In addition, the bill modifies minors’ general consent language in chapter 112, section 12F: (1) it amends the second paragraph to clarify that any minor may give consent to “their medical care,” explicitly including abortion, or dental care; and (2) it amends the third paragraph to delete the word “abortion” from the stated phrase “abortion or” (per the text shown), thereby narrowing the remaining wording to omit “abortion” in that specific clause.

AT A GLANCE

This bill requires the Massachusetts Department of Public Health, consulting with Reproductive Equity Now, Inc., to identify within 50 miles areas lacking abortion or birth-care access and publish the legislative report.

FULL SUMMARY

The document contains a Massachusetts Department of Public Health (DPH) “Abortion Desert and Maternity Care Desert Legislative Report,” issued pursuant to Chapter 127 of the Acts of 2022, Section 43. It summarizes geographic access (using straight-line distances) across Massachusetts for both abortion services and maternity-care services, and it provides recommendations intended to facilitate access in areas identified as having reduced availability of specific service subtypes.

The report’s legislative mandate (reflected in the report’s opening pages) requires DPH—consulting with Reproductive Equity Now, Inc.—to identify areas where pregnant people lack access to abortion (as defined in Massachusetts General Laws ch. 112, §12K) or birth care within a 50-mile radius, and to recommend ways to improve access; the report is to be made publicly available on DPH’s website. The report states it also adds supplementary analyses at 25 miles and uses a broader, health-equity-centered lens by examining access to service subtypes rather than only overall “desert” thresholds.

Substantively, the report characterizes Massachusetts as having no “overall” abortion deserts under the 50-mile definition (i.e., essentially all residents have some abortion provider access within 50 miles), but it finds notable geographic gaps for specific abortion categories: hospital-based abortion, procedural abortion, and abortion for pregnancies at 21+ weeks gestation. It reports that most municipalities remain within 25 miles for abortion overall, yet certain areas—particularly Cape Cod and the Islands and parts of Western and Northern Massachusetts—show reduced access for these more specific abortion services. The report also finds racial/ethnic disparities in geographic access, with Non-Hispanic American Indian/Alaska Native populations reporting the lowest access in several abortion categories (including higher shares without access to hospital-based abortion within both 25 and 50 miles, and substantially higher shares without access to abortion at 21+ weeks).

On maternity care, the report similarly states there are no “overall” 50-mile maternity deserts, but it identifies major access limitations for specific maternity-care elements: it highlights the scarcity of freestanding birth centers (reporting only one currently available in Northampton after closures, with much of the state beyond 25 miles and Eastern Massachusetts—including Cape Cod and the Islands—beyond 50 miles) and the limited distribution of Level III neonatal care (with many non-metro areas beyond 25 miles). It further assesses access to hospitals offering vaginal birth after cesarean (VBAC) and concludes access remains important for equity despite high overall proximity, and it reviews midwife-attended birth access while noting constraints related to licensure, hospital/insurance practice restrictions, and integration policies. Methodologically, the report relies on multiple data sources (DPH registry reports and facility listings, Reproductive Equity Now’s provider guide, Leapfrog ratings, and UMass population estimates) and uses straight-line radius mapping; it includes a limitations section emphasizing that geography alone does not capture barriers such as insurance acceptance, appointment/provider capacity, transportation realities, language/cultural competency, doula availability, and other social determinants.

AT A GLANCE

This bill requires businesses that electronically store or maintain covered medical information to limit access and disable out-of-state access unless patients provide express written consent, by July 1, 2026.

FULL SUMMARY

The bill strengthens Massachusetts protections for legally protected reproductive health care activity and gender-affirming health care activity by limiting state and local cooperation with out-of-state or federal investigations and by restricting sharing of personally identifiable health and prescription data.

Key changes begin with public-record and privacy provisions: (1) Massachusetts adds to the list of protected personal information (in the public disclosure framework) the home address, personal email, telephone number, and other personal information of individuals engaged in providing, facilitating, or promoting reproductive or gender-affirming health care services. (2) It restricts the Department of Public Health’s controlled-substance program and related data disclosure: controlled-substance labels may, at provider request, use the name of the prescribing/dispensing health care practice instead of the individual practitioner; the electronic prescription monitoring program excludes medications specifically prescribed for reproductive or gender-affirming health care services unless the department determines reporting is necessary to protect public health; and the department is barred (except as required by federal law) from providing disaggregated or individually identifiable prescription drug monitoring data to specified law-enforcement and other actors in investigations of reproductive or gender-affirming services lawful in Massachusetts.

The bill also creates limits on law-enforcement and information sharing. It bars state/local officers, employees, or agents acting under color of law from cooperating with or assisting federal or other jurisdictions’ law enforcement (and from expending resources) in investigations into legally protected health care activity that would be lawful if performed entirely in Massachusetts; it provides that evidence of involvement in such health care activity generally cannot be offered as proof of wrongdoing, with an exception for proceedings sounding in tort/contract brought by the patient (or legal representative). Parallel restrictions apply to the state civil service (prohibiting civil service employees from furnishing information to or cooperating with law enforcement in contravention of the new health-care protection provisions). For out-of-state demands, it adds a new prohibition on Massachusetts businesses that provide electronic communication or remote computing services from complying with out-of-state warrants/subpoenas or other legal process seeking records, information, or assistance for investigations or enforcement of another state’s laws imposing liability for legally protected health care activity lawful in Massachusetts, unless accompanied by a perjury attestation that the process does not seek such documents/testimony; false attestations carry a statutory penalty up to $50,000 per violation and expose the submitter to Massachusetts jurisdiction. The attorney general is authorized to sue for injunctive/equitable relief to enforce multiple provisions.

Additional provisions expand privacy and anti-retaliation protections across health information systems and professional contexts. The bill creates new requirements for “businesses” that electronically store/maintain medical information related to abortion/abortion-related care, miscarriage management, in vitro fertilization, and gender-affirming care: they must restrict user access to patient-authorized persons; prevent disclosure/access/transfer/transmission/processing to persons/entities outside Massachusetts absent the patient’s express written consent that specifically authorizes disclosure to named outside persons/entities; and automatically disable access by out-of-state individuals/entities to segregated information unless such express written consent is provided. It directs the public health department to promulgate a consent form for licensed providers. It adds limits on state public health data collection and dissemination: the commissioner may not collect/maintain/use or disclose disaggregated or individually identifiable abortion surveillance data, and similarly restricts collection and disclosure of individually identifiable gender-affirming health care data; it also declares that names, home addresses, personal email addresses, and telephone numbers of individuals engaged in these activities are not public records. Professional licensing boards are barred from disciplining health professionals for providing or assisting in reproductive or gender-affirming care if lawful and consistent with the standard of conduct if done entirely in Massachusetts, and they may not publicly disseminate certain out-of-state criminal/disciplinary/malpractice outcomes tied to such care; boards also may not take adverse action based on such out-of-state actions. The bill further bars insurance companies from discriminating against nonprofit charitable organizations (including 501(c)(3) organizations) in setting risk classification or premiums for liability insurance based on the organizations’ offering of reproductive or gender-affirming care or exposure to abusive litigation. In the family law and legal services context, it prevents courts from treating out-of-state removal or bans on gender-affirming care as a basis to alter Massachusetts custody/visitation or to find abuse/neglect/maltreatment unless the conduct would qualify under Massachusetts law, and it prohibits attorney discipline in Massachusetts when the sole reason is that the attorney advised or represented clients involved in reproductive or gender-affirming care that is unlawful in another state or subject to another state’s liability laws—so long as the attorney’s conduct complies with Massachusetts law and professional responsibility rules. A compliance deadline is set for implementing the new prescription-monitoring label/data protection rule: the businesses must implement specified changes no later than July 1, 2026.

AT A GLANCE

This bill prohibits Massachusetts state and local agencies from cooperating with law enforcement or spending resources on investigations of legally protected reproductive or gender-affirming health care unless required by federal law.

FULL SUMMARY

The bill expands Massachusetts “shield” protections for reproductive health care and gender-affirming health care activities (as defined by reference to General Laws ch. 12, § 11I1/2) by adding requirements limiting access to, disclosure of, or use of identifying information by state/local actors and by regulated entities, primarily in response to out-of-state or federal inquiries or investigations. It (1) adds detailed personal identifying information of individuals engaged in providing/facilitating/promoting these services to a confidentiality-related clause in ch. 4, § 7, cl. 26, and (2) adds new restrictions in ch. 12, § 11I1/2 that prohibit state/local agencies and officials (except as required by federal law) from cooperating with law enforcement and from expending resources in investigations/inquiries into legally protected health care activity that would be lawful if conducted entirely in Massachusetts; it also creates evidentiary protection against using evidence of out-of-state provision as proof of wrongdoing, subject to carve-outs for tort/contract actions brought by the patient or their representative.

It further strengthens enforcement and information-control mechanisms: the bill authorizes the Attorney General to seek injunctive/equitable relief to enforce the new health-care-privacy and noncooperation rules (ch. 12, § 11I1/2). It also adds civil-suit enforcement provisions for a new ch. 93 § 115 requiring certain providers of electronic communications services and remote computing services operating in Massachusetts not to comply with subpoenas/warrants/legal process seeking records/information/assistance related to legally protected health care activity—unless the legal process includes an attestation (under penalty of perjury) that it does not seek documents/information/testimony for enforcing another state’s law imposing liability for lawful-in-Massachusetts protected activity; false attestations trigger statutory penalties and subject the attester to Massachusetts court jurisdiction. In addition, it amends the Health Information Exchange rules for the state’s center (ch. 12C, § 12, by replacing subsection (b) and adding/adjusting access/disclosure limitations) and the connector privacy rules (ch. 176Q, § 19) to restrict disclosure of identifying data in response to out-of-state/federal inquiries, while permitting limited access for treatment, payment, and health care operations/exchange functions; recipients are barred from using identifiable/de-identified information to investigate or impose liability on patients.

The bill adjusts multiple health-care regulatory and data-reporting regimes: it updates controlled substance packaging and labeling rules (ch. 94C, §§ 21 and 22) so that, at a provider’s request and subject to federal-law limits, labels for controlled substances prescribed for reproductive health care or gender-affirming health care may use the health care practice name instead of the practitioner name; it adds a controlled-substance prescription monitoring exclusion (ch. 94C, § 24A) unless the department determines reporting is necessary to protect public health; and it bars the department from providing disaggregated or individually identifiable prescription drug monitoring data to law enforcement or private citizens/entities for investigations into reproductive or gender-affirming care where such care would be lawful in Massachusetts. It also adds protections against public health surveillance data collection/use/disclosure: the commissioner of public health may not collect/maintain/use disaggregated surveillance data or individually identifiable surveillance data on abortions (ch. 112, § 12Q), and may not collect/use/disclose or disseminate disaggregated or individually identifiable surveillance data on gender-affirming health care (new § 12Q1/2); specified identifiers for individuals engaged in providing/facilitating/promoting these services are excluded from being “public records” under ch. 66.

Finally, the bill adds multiple substantive protections across professional licensing, child welfare/custody, insurance, and emergency-care access, plus an implementation study: (1) it provides that no board of registration may impose discipline for providing/assisting reproductive or gender-affirming health care when the services were or would have been lawful and consistent with professional standards in Massachusetts, and it limits public dissemination and adverse licensing actions based on out-of-state criminal/disciplinary/malpractice events tied to such services (ch. 112, § 61 additions); (2) it prevents child removal/custody determinations based on allowing a child to seek/receive gender-affirming health care under out-of-state laws or out-of-state liability theories, unless the conduct independently constitutes abuse or neglect under Massachusetts law, and it requires courts to consider likely disruption/cessation of gender-affirming care when custody/visitation is being decided (amending ch. 119, § 26(d) and adding parallel provisions to chs. 208, 209A, 209B, and 209C); (3) it prohibits attorneys licensed in Massachusetts from being disciplined solely for advising/representing clients regarding reproductive or gender-affirming health care matters where the “sole basis” for discipline is another state’s unlawfulness/liability exposure (ch. 221, new § 42A); (4) it prohibits discrimination by insurers against § 501(c)(3) exempt organizations on the basis of offering reproductive health care or gender-affirming health care, engaging in legally protected health care activity, or being subject to abusive litigation (ch. 175, new § 193V); and (5) it creates an emergency-services requirement for acute-care hospitals (ch. 111, new § 51I/4) requiring screening and stabilizing treatment for patients with emergency medical conditions (including enumerated conditions and explicitly including abortion when necessary to resolve injury/emergency medical condition), with AG enforcement and civil penalties. The bill also requires the commissioner of public health to convene a technical advisory group to review implementation of the new data-interoperability/consent-related hospital information section (ch. 111, § 70I), make recommendations by July 1, 2026, and explore technical standardization, consent-burden mitigation, interoperability limitations, and penalty minimization.

AT A GLANCE

This bill prohibits Massachusetts agencies and covered entities from collecting, maintaining, using, disclosing, or disseminating disaggregated or individually identifiable abortion surveillance data and specified gender-affirming health care data tied to protected activities.

FULL SUMMARY

The bill further limits Massachusetts and local entities’ and officials’ cooperation with federal or out-of-state law enforcement regarding “legally-protected health care activity,” including reproductive health care and gender-affirming health care, except as required by federal law, and strengthens privacy protections for personal and health information connected to those services. It adds/updates restrictions on collecting, using, disclosing, or disseminating identifiable and disaggregated surveillance and prescription-drug-monitoring data in those contexts, provides attorney general enforcement authority, and creates new civil action and injunctive-relief mechanisms with civil penalties for certain violations.

It amends Massachusetts public record and health data-sharing frameworks by (1) expanding what “personal information” about individuals engaged in these protected health care activities is protected from disclosure in certain government contexts; (2) prohibiting state agencies (including the Department of Public Health and other covered entities) from collecting, maintaining, using, disclosing, or disseminating disaggregated or individually identifiable abortion surveillance data, and from collecting/using individually identifiable gender-affirming health care data or disaggregated/identifiable surveillance data; and (3) restricting the Prescription Monitoring Program and the Health Safety and Environment / health data center/connector types of systems (as defined in their respective statutes) from disclosing identifying or disaggregated data in response to out-of-state or federal inquiries/investigations tied to protected reproductive or gender-affirming services, with limited carveouts for uses unrelated to those services.

The bill adds new substantive protections for health system and recordkeeping operations: acute-care hospitals must provide emergency medical services to any patient presenting with an injury or emergency medical condition and must implement policies addressing screening, stabilizing treatment, nondiscrimination, transfer procedures, and whistleblower protections (with AG enforcement and up to a $10,000 civil penalty per violation); businesses that electronically store or maintain medical information related to abortion/abortion-related services, in vitro fertilization, and gender-affirming health care must implement patient-authorized access controls and prevent disclosure/access/transmission/processing of segregated medical information outside Massachusetts without express written patient consent (with an AG enforcement authority and up to $5,000 civil penalty per violation, and a payment/treatment/operations safe harbor).

It also expands cross-sector protections: civil service employees are prohibited from furnishing information or cooperating with law enforcement in contravention of the added health privacy limits; pharmacists’ labeling rules allow, at provider request, use of the prescribing health care practice name (not practitioner name) for prescriptions for reproductive or gender-affirming care, with a prohibition on pharmacy benefit managers recouping funds for omission of the prescriber name; it creates a new limits-on-processes rule for businesses providing electronic communication services/remote computing services, generally barring compliance with subpoenas/warrants/legal process seeking records/information/assistance related to protected health care activity unless accompanied by an attestation that the process does not seek information for enforcement of another state’s criminal/civil law (with penalties for false attestations); it adds insurer non-discrimination rules for 501(c)(3) organizations offering or engaging in legally-protected reproductive or gender-affirming health care activity or subject to abusive litigation.

Finally, it strengthens family law and professional discipline safeguards by preventing Massachusetts courts and boards of registration from treating certain out-of-state actions involving gender-affirming health care (including removal of a child based on receiving gender-affirming care or bans on provision) as a basis for findings of abuse/neglect/maltreatment or adverse custody/visitation outcomes unless the underlying conduct would independently constitute abuse/neglect/maltreatment under Massachusetts law; courts must consider likely disruption or cessation of gender-affirming health care due to the out-of-state law when deciding custody/visitation changes. It also protects attorneys from discipline for advising/representing clients in matters related to reproductive or gender-affirming health care where the only discipline basis is another state’s unlawfulness or potential liability, subject to compliance with Massachusetts rules of professional conduct.

AT A GLANCE

This executive order requires Massachusetts executive-branch agencies to issue and follow guidance ensuring hospitals and licensed providers provide emergency abortion care to prevent loss of life or serious harm and to comply with EMTALA.

FULL SUMMARY

The executive order establishes a state-wide policy and enforcement directives aimed at preserving access to emergency abortion care and other emergency reproductive health services in Massachusetts, emphasizing that such care must be available to prevent loss of life or serious harm.

It requires the executive branch to reaffirm specific Massachusetts legal protections relating to abortion access and shield-law protections (including protections against state governmental interference, limits and after-24-week exceptions for abortion for medical reasons, and protection for providers and patients from certain out-of-state legal actions). It also directs all executive branch agencies to continue acknowledging Massachusetts law governing acute hospitals’ obligations not to refuse admission and treatment based on method of payment and to provide prompt life-saving treatment in emergencies without discrimination on economic status/source of payment.

The Commissioner of Public Health must issue guidance to hospitals (as a condition of licensure) and to licensed health care providers. Hospital guidance must require compliance with applicable state and federal hospital statutes and regulations, explicitly including EMTALA and related federal regulations, and must state that failure to provide required abortion care to prevent loss of life or serious health harm is a violation of EMTALA and related state laws/regulations that could lead to refusal to renew or revocation of a hospital license. Provider guidance must require professionals to ensure treatment of emergency medical conditions consistent with federal and state law—including when necessary to avoid loss of life or serious health harm—and must state that failure to ensure emergency treatment may violate recognized standards of practice and may support discipline under specified professional discipline regulations.

The Division of Insurance must issue bulletins to commercial health insurers/HMOs/Blue Cross and Blue Shield and to medical malpractice insurers identifying expectations about coverage for abortion, abortion-related care, medication abortion services, and malpractice coverage for providers who may deliver reproductive or gender-affirming care. The order takes effect immediately and remains in effect until amended, superseded, or revoked by a subsequent executive order.

AT A GLANCE

This bill exempts freestanding abortion clinics, as defined, from Michigan’s certificate-of-need requirement.

FULL SUMMARY

The bill amends Michigan’s Public Health Code fee and licensing provisions by modifying definitions and the department’s annual assessment schedule for health facility and agency licenses and certificates of need, and by adding a new certificate-of-need exemption for certain freestanding abortion clinics.

Key changes to the existing fee/assessment framework include: (1) revised cross-references and structuring of definitions in Part 201 (e.g., the numbering of “freestanding abortion clinic” and “freestanding birth center” definitions), (2) updates to the health facility/agency license and assessment fee schedule under the department’s annual fee authority—explicitly listing $500 facility/agency fees for multiple provider types (including freestanding surgical outpatient facilities, homes for the aged, hospice agencies/residences, freestanding birth centers, and freestanding abortion clinics) and bed-based components for certain facility categories, plus an initial licensure application fee and various certificate of need-related fees; and (3) modifications to provisions within the “quality assurance assessment” section governing nursing homes and hospital long-term care units and hospitals, including the scope, use of proceeds, state/federal matching rules, limitations on when assessments can be collected/used, and specific conditions tied to Medicaid reimbursement.

The bill also adds Part 207A (“Freestanding Abortion Clinics”), creating a licensure regime and operational requirements for facilities performing elective abortions other than hospitals or freestanding surgical outpatient facilities. It defines “freestanding abortion clinic” and “elective abortion,” establishes licensing requirements and prohibits using the term without licensure, assigns responsibility to clinic owners/operators/governing bodies, and requires written policies, staffing/credentialing, patient-rights protections (informed consent and the right to refuse treatment), referrals/consultation/transfer processes, availability of follow-up care, emergency coverage staffing with basic life support certification, and limits on abortion-related practices (including anesthesia conditions and an elective abortion gestational threshold of more than 22 weeks and 0 days, plus rule-based limiting factors).

The bill directs the department to promulgate implementing rules (including standards of practice and additional limiting factors), prohibits enforcement of the new part (including the licensure requirement) until 1 year after the effective date of the amendatory act adding Part 207A, and clarifies that the new part does not create new third-party reimbursement or mandated workers’ compensation benefits for services at freestanding abortion clinics. Finally, it adds a specific exemption from the certificate-of-need requirement: a freestanding abortion clinic (as defined in the new Part 207A) is not required to obtain a certificate of need.

The proposed amendment to the Public Health Code in Michigan mandates that health care professionals submit written reports to the department for each patient who experiences physical complications or death as a result of an abortion. This regulation primarily affects urgent care facilities and emergency departments, which will need to adhere to the new reporting requirements.

The department is responsible for compiling aggregate data from these reports to be included in the annual statistical report on abortion. To protect patient confidentiality, individual reports will be kept for five years and will not contain identifying information on the standardized reporting form.

These changes will be implemented only if specific legislative measures are enacted into law.