AB 55: Alternative birth centers: licensing and Medi-Cal reimbursement. - California

09/02/25 - Amended Senate → 09/11/25 - Enrolled · 5 edits · Sep 11, 2025

MODERATE

This diff represents the transition from the Amended Senate version to the final Enrolled version of AB 55, which governs licensing and Medi-Cal reimbursement for alternative birth centers. The changes are primarily technical cleanups: removal of duplicate text left over from the amendment markup process, correction of a numbering error in the hospital transfer policy subsections, and standard enrolled-bill formatting updates (removal of line numbers, addition of passage dates, and Governor receipt block). No new substantive policy was added or removed between these two versions.

TECHNICAL

Removed duplicate text in Section 1204.3(a)(1) where both an older 'pregnancy and postpartum services' version and the final 'perinatal services that are comprehensive in nature' version appeared side by side; the enrolled version retains only the final language.

Removed a duplicate subsection (A) in Section 1204.3(a)(4) that contained a cross-reference to Business and Professions Code sections 2746.54 and 2508, which was an artifact of the amendment process. The enrolled version retains only the final 'Have and implement a written policy for hospital transfer' language.

Corrected subsection numbering in the hospital transfer policy requirements from (i), (iii), (ii), (iv) to the proper sequential (i), (ii), (iii), (iv).

Fixed a typo in Section 1204.3(a)(4)(A)(iv) changing 'A requirement that that' to 'A requirement that.'

Updated the legislative counsel's digest to remove 'as amended' from the bill citation and removed the 'pregnancy and postpartum services' phrase, aligning the digest with the final enrolled text.

10/11/25 - Chaptered → AB55 · 3 edits

MINOR

No substantive policy changes occurred between these two versions. The diff reflects a transition from the formal chaptered document format (with 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL' header) to a website presentation of the same bill text. All legislative content, including the digest and all three sections amending the Health and Safety Code and Welfare and Institutions Code, is identical in both versions.

TECHNICAL

Removed the formal 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL' header and replaced it with website navigation elements (skip to content, home, accessibility, FAQ, feedback, sitemap, login).

Added web page UI elements including a quick search bar, version history list showing prior versions (Enrolled, Amended Senate, Amended Assembly, Introduced), and metadata such as 'Date Published: 10/13/2025 02:00 PM' and document identifier 'AB55:v93#DOCUMENTBill Start'.

Reformatted the identical bill text (digest, Section 1, Section 2, Section 3) from a fixed-width chaptered layout with page numbers into a flowing web page format with different line breaks and spacing.

09/11/25 - Enrolled → 10/11/25 - Chaptered · 2 edits · Oct 11, 2025

MINOR

This diff reflects the transition of AB 55 from its enrolled (pre-signature) form to its chaptered (enacted statute) form after the Governor approved it on October 11, 2025. The changes are entirely technical and formatting: addition of the chapter number (595), official state header, approval date, updated page numbering to match the compiled statutes, and a minor correction of a constitutional article citation from 'Article XIIIB' to 'Article XIII B.' No substantive policy language was altered.

TECHNICAL

Section 3 corrected the constitutional reference from 'Article XIIIB' to 'Article XIII B,' fixing the formatting of the article number in the no-reimbursement clause.

Added chapter number (Chapter 595), official state authentication header, and the Governor's approval date (October 11, 2025) to convert the document from enrolled bill format to enacted statute format.

05/29/25 - Amended Senate → 09/02/25 - Amended Senate · 5 edits · Sep 2, 2025

MODERATE

The September 2025 Senate amendment to AB 55 significantly expands the service and hospital transfer requirements for alternative birth centers. The bill now requires 'perinatal services that are comprehensive in nature' with specific referral obligations (counseling, food supplement programs, vitamins, breastfeeding), replaces the simple transfer plan with a governing-body-approved written policy containing four detailed elements including complication referral arrangements and hospital preregistration recommendations, and mandates that transfer time information be provided in writing with a signed patient acknowledgment at initial orientation. Senator McGuire was added as coauthor.

REQUIREMENT

The service requirement changed from 'pregnancy and postpartum services' to 'perinatal services that are comprehensive in nature,' adding explicit requirements for referrals to counseling, referrals on food supplement programs/vitamins/breastfeeding, and removing the word 'high' before 'standards of the midwifery and birth center model of care.'

The hospital transfer policy was substantially expanded from two elements to four: (1) new requirement for specific arrangements for referral of a complication to a physician and surgeon for consultation, with clarification that the midwife need not identify a specific physician; (2) new requirement for arrangements covering prenatal transfer, intrapartum/postpartum hospital transfer, emergency medical services access, and recommendations for preregistration at a hospital with obstetric emergency services; (3) the existing medical records and provider communication requirement; (4) the existing estimated transfer time disclosure, now expanded to require it be provided during initial orientation consultation, in writing, and included in the patient's medical file with a signed acknowledgment.

The hospital transfer policy must now be approved by the governing body of the alternative birth center or primary care clinic, adding a governance accountability requirement not present in the prior version.

SCOPE

Senator McGuire was added as coauthor of the bill.

TECHNICAL

Terminology updated throughout from 'patient' to 'patients and clients' for inclusive language, and minor clarifications made to transfer timing language (removing 'or as soon as practicable' from the immediate records provision while retaining it for other records).

04/10/25 - Amended Assembly → 05/29/25 - Amended Senate · 4 edits · May 29, 2025

MODERATE

The Senate amendment to AB 55 strengthens hospital transfer requirements for alternative birth centers by renaming the 'written policy' a 'written plan,' adding a requirement that all patients and clients be informed of the estimated transfer time with a clear explanation of the overall emergency transfer plan including risk mitigation measures, and expanding the medical records transfer obligation to include any information not yet in the record. The bill also broadens language throughout from 'patients' to 'patients and clients' for inclusivity.

REQUIREMENT

The written hospital transfer document is renamed from a 'policy' to a 'plan' throughout the bill, signaling a shift toward a more structured, comprehensive approach.

A new requirement mandates that all patients and clients be informed of the estimated transfer time (expected duration from departure to arrival at the receiving hospital) and receive a clear explanation of the birth center's overall emergency transfer plan, including specified measures to mitigate risk associated with distance from the planned receiving hospital and to ensure safe transfer for both pregnant person and fetus or neonate.

The medical records transfer requirement is expanded: the midwife must now be identified as the one responsible for care immediately prior to transfer, must provide all records available at the time of transfer (not just prenatal records), must include any information not yet added to the medical record, and must send any remaining records as soon as practicable after transfer.

DEFINITION

Language throughout the bill is broadened from 'patients' to 'patients and clients' in multiple provisions, including the child passenger restraint information dissemination requirement and the receiving provider communication requirement.

02/25/25 - Amended Assembly → 04/10/25 - Amended Assembly · 4 edits · Apr 10, 2025

MODERATE

The April 10 amendment to AB 55 makes three substantive changes to alternative birth center requirements: it adds a new obligation to provide pregnancy and postpartum services (including psychosocial and nutritional assessments), removes the requirement that centers be located within 30 minutes of a hospital capable of cesarean delivery, and replaces the simple written transfer policy with a detailed transfer plan specifying record-sharing, provider communication, and patient notification requirements. The bill is now classified as imposing a state-mandated local program.

REQUIREMENT

Alternative birth centers must now provide pregnancy and postpartum services including psychosocial assessments, nutritional assessments, and overall health, childbirth, and parenting education, consistent with the midwifery and birth center model of care.

The requirement that an alternative birth center be located within 30 minutes (in time and distance) of a facility capable of managing obstetrical and neonatal emergencies, including cesarean section delivery, is deleted.

The hospital transfer requirement is expanded from a simple written policy to a detailed written plan that must include: (1) the midwife providing the hospital with the patient's medical records including prenatal records and speaking with the receiving provider about labor up to the point of transfer, and (2) the patient being given the estimated transfer time along with discussions of maternal and fetal or neonatal risks and benefits.

FISCAL

The state-mandated local program designation changes from 'no' to 'yes,' meaning the new requirements imposed on alternative birth centers will trigger state reimbursement obligations to local agencies under the California Constitution.

12/02/24 - Introduced → 02/25/25 - Amended Assembly · 3 edits · Feb 25, 2025

MINOR

The amended version of AB 55 replaces the strict geographic proximity requirement for alternative birth centers with a less restrictive written hospital transfer policy requirement. Originally, the bill required birth centers to be located within 30 minutes of a facility capable of managing obstetrical and neonatal emergencies including cesarean sections. The amendment removes that distance/time mandate and instead requires only a written policy for hospital transfer, consistent with existing midwifery practice standards. This significantly lowers the barrier for alternative birth centers to operate in areas without nearby hospitals.

REQUIREMENT

Replaced the requirement that alternative birth centers be located within 30 minutes of a facility capable of managing obstetrical and neonatal emergencies (including cesarean section delivery) with a requirement to have a written policy for hospital transfer, consistent with Business and Professions Code sections governing midwifery practice.

Removed the specific 30-minute proximity standard and the explicit reference to cesarean section delivery capability as a licensing condition for alternative birth centers under Health and Safety Code Section 1204.3.

SCOPE

The state-mandated local program designation changed from 'no' to 'yes' because the new written hospital transfer policy requirement imposes obligations on local agencies. However, a new Section 3 provides that no state reimbursement is required because the act creates a new crime or infraction.

Alternative birth centers: licensing and Medi-Cal reimbursement.

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