al-al-6a61127328262978bed3c347: 540-X-8-.26 — Limitations Upon Utilization Of Certified Nurse Midwives

APA-1 TRANSMITTAL SHEET FOR NOTICE OF INTENDED ACTION Control: 540 Department or Agency: ALABAMA BOARD OF MEDICAL EXAMINERS 540-X-8-.26 Rule No.: Rule Title: Limitations Upon Utilization Of Certified Nurse Midwives Intended Action Amend Would the absence of the proposed rule significantly harm or endanger the public health, welfare, or safety? Yes power and the protection of the public health, safety, or welfare? Yes that could adequately protect the public? of regulation available No Does the proposed rule have the effect of directly or indirectly No increasing the costs of any goods or services involved? To what degree?: N/A that might result from the absence of the proposed rule?the harm NA Are all facets of the rule-making process designed solely for the protection of the public?ave, as their primary effect, the Yes Does the proposed action relate to or affect in any manner any matter of the proposed rule?is a party to concerning the subject No Does the proposed rule have an economic impact? No If the proposed rule has an economic impact, the proposed rule is required to be accompanied by a fiscal note prepared in accordance with subsection (f) of Section 41-22-23, Code of Alabama 1975. Certification of Authorized Official I certify that the attached proposed rule has been proposed in full compliance conforms to all applicable filing requirements of the Administrative Procedureit Division of the Legislative Services Agency. Signature of certifying officer D William M Perkins & F IL E E C ’D 26 Date Thursday, August 20, 2026 A UG 20,2 0 Y C A G E N C L AT I E S V LE G I APA-2 ALABAMA BOARD OF MEDICAL EXAMINERS NOTICE OF INTENDED ACTION AGENCY NAME: Alabama Board of Medical Examiners 540-X-8-.26 Limitations Upon Utilization Of RULE NO. & TITLE: Certified Nurse Midwives INTENDED ACTION: Amend SUBSTANCE OF PROPOSED ACTION: Following a recommendation from the Alabama Joint Committee for Advanced Practice Nursing, the Board removed the requirement for physicians to perform six (6) consecutive months of Quality Assurance review for all Advanced Practice Providers (APP) with whom they collaborate when adding a new collaboration if the collaborations extend past four (4) FTE collaborations (equivalent to 160 hours). TIME, PLACE AND MANNER OF PRESENTING VIEWS: All interested persons may submit data, views, or arguments concerning the proposed new rule(s) and regulation(s) in writing to: Effie Hawthorne, Office of the General Counsel, Alabama State Board of Medical Examiners, Post Office Box 946, Montgomery, Alabama 36101-0946, by mail or email (publiccomment@albme.gov), until and including Monday, October 5, 2026. Persons wishing to submit data, views, or comments in person should contact Effie Hawthorne by telephone (334-242-4116) during the comment period. Copies of proposed rules may be obtained at the Board’s website: www.albme.gov. FINAL DATE FOR COMMENT AND COMPLETION OF NOTICE: Monday, October 5, 2026 CONTACT PERSON AT AGENCY: Effie Hawthorne Phone: 334-833-0171 Email: ehawthorne@albme.gov Wi iam M. Perkins William M Perkins (Signature of officer authorized to promulgate and adopt rules or his or her deputy) 540-X-8-.26 Limitations Upon Utilization Of Certified Nurse Midwives. (1) A physician may enter into a collaborative agreement with certified nurse midwives not exceeding a cumulative three hundred and sixty (360) hours (nine FTEs) per week. The physician shall not collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions). "One full- time equivalent" (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call. (a) A physician collaborating with more than four FTEs per week shall engage in documented quality assurance review with each CNM every month for six (6) months following the commencement of a collaborative practice with a new CNM. (b) A physician shall disclose to the Board of Medical Examiners the existence of all collaborative and supervisory agreements to which the physician is a party, including collaborative and supervisory agreements in other states, and shall not be eligible to collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions), inclusive of collaborative and supervisory agreements existing in other states. Agreements with an individual certified registered nurse practitioner, certified nurse midwife, and/or assistant to physician in multiple states shall only be counted once for purposes of calculating the total number of full-time equivalent positions. (2) Employees of the Alabama Department of Public Health and county board of health are specifically exempt from the requirements of paragraph (1) of this rule. (3) A physician in collaborative practice may request approval for additional full-time certified nurse midwife positions by the Joint Committee, with consideration given to the following factors to ensure that an acceptable standard of care is rendered: (a) Availability of the physician (b) Practice settings and staffing needs for extended hours of service (c) Risk to patients 8-.26-1 (d) Educational preparation, specialty and experience of the parties in the collaborative practice (e) Complexity and risk of procedures to be performed (4) A physician in collaboration with CRNP, CNM or supervising Physician Assistant personnel totaling 360 hours per week (nine (9) FTEs) may request a transitional allowance increasing the total weekly hours for the purpose of orientation of the incoming CNM. The transitional allowance shall not exceed 45 days. The physician shall request the transitional allowance in writing and specify the starting date for this FTE allowance. Author: Alabama Board of Medical Examiners Statutory Authority: Code of Ala. 1975, §§34-21-87, 34-24-53. History: New Rule: Filed June 20, 1996; effective July 26, 1996. Amended: Filed August 25, 2003; effective September 29, 2003. Amended: Filed July 2, 2015; effective August 6, 2015. Amended: Published April 30, 2021; effective June 14, 2021. Amended: Published ______; effective ______. 8-.26-2