TITLE 16 OCCUPATIONAL AND PROFESSIONAL LICENSING
CHAPTER 11 MIDWIVES
PART 2 CERTIFIED NURSE - MIDWIVES
16.11.2.1 ISSUING AGENCY:
New Mexico Department of Health.
[16.11.2.1 NMAC - Rp, 16.11.2.1 NMAC, 11/24/2020]
16.11.2.2 SCOPE: This rule applies to any person seeking to
practice or currently practicing as a certified nurse-midwife in the state of
New Mexico.
[16.11.2.2 NMAC - Rp, 16.11.2.2 NMAC, 11/24/2020]
16.11.2.3 STATUTORY AUTHORITY: This rule is authorized by Subsection E of
Section 9-7-6 NMSA 1978, Subsection S and Subsection V of Section 24-1-3 NMSA
1978 and Section 24-1-4.1 NMSA 1978.
[16.11.2.3 NMAC - Rp, 16.11.2.3 NMAC, 11/24/2020]
16.11.2.4 DURATION: Permanent.
[16.11.2.4 NMAC - Rp, 16.11.2.4 NMAC, 11/24/2020]
16.11.2.5 EFFECTIVE DATE: November 24, 2020 unless a later date is
cited at the end of a section.
[16.11.2.5 NMAC - Rp, 16.11.2.5 NMAC, 11/24/2020]
16.11.2.6 OBJECTIVE: This rule governs the licensure and practice
of certified nurse-midwives (CNMs) in New Mexico.
[16.11.2.6 NMAC - Rp, 16.11.2.6 NMAC, 11/24/2020]
16.11.2.7 DEFINITIONS:
A. Definitions
beginning with “A”:
(1) "ACNM" means the American college of nurse-midwives.
(2) “AMCB” means
American midwifery certification board.
(3) "Addiction" is a neurobehavioral syndrome
with genetic and environmental influences that results in psychological
dependence on the use of substances for their psychic effects. It is characterized by behaviors that include
one or more of the following: impaired control over drug use; compulsive use;
continued use despite harm; and craving.
Physical dependence and tolerance are normal physiological consequences
of extended opiate or opioid therapy for pain and should not by themselves be
considered addiction.
B. Definitions
beginning with “B”: "Board"
means the certified nurse-midwifery advisory board established
under these rules.
C. Definitions
beginning with “C”:
(1) "Certified
nurse-midwife (CNM)" means an
individual educated in the two disciplines of nursing and midwifery, who is
certified by the AMCB or its designee and who is licensed under this rule.
(2) "Chronic pain" means pain that
persists after reasonable efforts have been made to relieve the pain or its
cause and that continues, either continuously or episodically, for longer than
three consecutive months. For purposes
of this rule, chronic pain does not include pain associated with a terminal
condition or with a progressive disease that, in the normal course of
progression, may reasonably be expected to result in a terminal condition.
(3) "CNM
license" means a document issued by the department identifying a legal
privilege and authorization to practice within the scope of this rule.
(4) "Contact
hour" means 50-60 minutes of an organized learning experience relevant
to CNM practice, approved by one of the following:
(a) accreditation
council for continuing medical education (ACCME);
(b) ACNM;
(c) American college of obstetricians and
gynecologists (ACOG);
(d) American academy of physician
assistants (AAPA);
(e) American academy of nurse
practitioners (AANP);
(f) nurse
practitioners in women's health (NPWH); or
(g) other
clinician-level continuing education accrediting agencies approved by the
division.
(5) "Continuance"
means the adjournment or postponement of a trial or other proceeding to a
future date.
(6) "Controlled substance" means any drug or therapeutic agent
listed in Schedules I through V of Sections 30-31-6 to 30-3-10 NMSA 1978,
Controlled Substances Act, or rules adopted thereto, which is commonly
understood to include narcotics.
D. Definitions
beginning with “D”:
(1) "Dangerous
drug" means a prescription drug other
than a controlled substance that has been determined by law to be unsafe for
self-administration and is included in Sections 26-1-1 to 26-1-26 NMSA 1978,
New Mexico Drug, Device and Cosmetic Act, and in Sections 30-31-6 NMSA,
Controlled Substances Act.
(2) "Department" means the New Mexico
department of health.
(3) "Division" means the public health division.
E. Definitions
beginning with “E”: “Electronic
professional licensing management system”
means the system by which licensees apply and submit an application for
midwifery license and keep up to date their online profile.
F. Definitions beginning
with “F”: [RESERVED]
G. Definitions
beginning with “G”: [RESERVED]
H. Definitions
beginning with “H”: [RESERVED]
I. Definitions
beginning with “I”: [RESERVED]
J. Definitions
beginning with “J”: [RESERVED]
K. Definitions
beginning with “K”: [RESERVED]
L. Definitions
beginning with “L”: “Lapsed license” means a license that a person has voluntarily lapsed, has
failed to renew as required, or the license of a person who failed to meet
stated obligations for renewal within a stated time.
M. Definitions
beginning with “M”: [RESERVED]
N. Definitions
beginning with “N”: “National practitioner data bank (NPDB)” means the web-based repository of reports containing
information on medical malpractice payments and certain adverse actions related
to health care practitioners, providers, and suppliers.
O. Definitions
beginning with “O”: “Opioid
antagonist” means a drug approved by the
federal food and drug administration that when administered negates or
neutralizes in whole or in part the pharmacological effects of an opioid
analgesic in the body; this includes naloxone and such other medications
approved by the board of pharmacy for the reversal of opioid analgesic
overdoses.
P. Definitions
beginning with “P”:
(1) "Pain"
means an unpleasant sensory and
emotional experience associated with inflammation or with actual or potential
tissue damage or described in terms of such inflammation and damage, which
could include acute, persistent, or chronic pain.
(2) "Peer review" means the assessment
and evaluation of CNM practice by other CNMs and other health care providers to
measure compliance with established institutional or legal standards. In the peer review process, a CNM’s practice
undergoes scrutiny for the purpose of professional self-regulation.
(3) "Physical dependence" means a state of
adaptation that is manifested by a drug-specific withdrawal syndrome that can
be produced by abrupt cessation, rapid dose reduction, decreasing blood level
of the drug, administration of an antagonist, or a combination of these.
(4) "Prescription monitoring program (PMP)" means
a centralized electronic system within the New Mexico board of pharmacy that
collects, monitors, and analyzes data submitted by dispensing practitioners and
pharmacies related to the prescribing and dispensing of controlled substances. The data are used to support efforts in education,
research, enforcement, and abuse prevention.
(5) "Primary care" means the provision of
integrated, accessible health care services by clinicians who are accountable
for addressing the large majority of presenting health care needs, developing
sustained partnerships with clients, and practicing within the context of
family and community.
Q. Definitions beginning with “Q”:
(1) "Quality assurance" means monitoring structural, procedural, and outcome
indicators as they relate to accepted standards.
(2) "Quality improvement" means modifying the
process for providing care in order to improve outcomes. Modifications are based upon the measurement
of parameters such as evidence-based best practices, patient satisfaction,
clinical outcomes, population specific care,
culturally appropriate care, appropriate use of technology and resources, and
access to care.
R. Definitions
beginning with “R”:
(1) “Reactivation” means the process of making current a license which has
been in abeyance as a result of failure to comply with the necessary renewal
requirements; this process does not involve disciplinary action at any juncture.
(2) “Reinstatement” means the process whereby a license which has been subject to
revocation or suspension, is returned to active status; this process always
involves disciplinary action.
S. Definitions
beginning with “S”: [RESERVED]
T Definitions
beginning with “T”:
(1) "Therapeutic purpose" means the use of pharmaceutical and non-pharmaceutical
treatments and the spectrum of available modalities that conforms substantially
to accepted guidelines.
(2) "Tolerance" means a state of adaptation in
which exposure to a drug induces changes that result in a diminution of one or
more of the drug’s effects over time.
U. Definitions beginning
with “U”: [RESERVED]
V. Definitions
beginning with “V”: "Valid CNM-client relationship" means a professional relationship between the CNM and the
client for the purpose of maintaining the client’s well-being. At minimum, this relationship is an
interactive encounter between the CNM and client involving an appropriate
history and physical or mental examination; ordering labs or diagnostic tests
sufficient to make a diagnosis; and providing, prescribing, or recommending
treatment, or referring to other health care providers. A patient record must be generated by the
encounter. The relationship includes:
(1) the CNM has
sufficient information to ensure that a dangerous drug or controlled substance
is indicated and necessary for treatment of a condition when the CNM prescribes
a dangerous drug or controlled substance;
(2) the CNM has
sufficient information to ensure that a dangerous drug or controlled substance
is not contraindicated for the individual;
(3) the CNM
provides a client with appropriate information on the proper dosage, route,
frequency, and duration of a drug treatment;
(4) the CNM
informs the client of possible untoward effects and side effects of a proposed
treatment;
(5) the CNM
provides care for a client in the event of an untoward effect or a side effect
that requires care;
(6) the CNM
provides for client education regarding a condition and the condition’s
treatment to enhance client compliance with plan of care;
(7) the CNM
provides for appropriate follow-up care, including further testing, treatment
and education, as appropriate; and
(8) the CNM
documents, at minimum, the indication, drug, and dosage of any prescribed drugs
in a health record for the individual
W. Definitions
beginning with “W”: [RESERVED]
X. Definitions
beginning with “X”: [RESERVED]
Y. Definitions
beginning with “Y”: [RESERVED]
Z. Definitions
beginning with “Z”: [RESERVED]
[16.11.2.7 NMAC - Rp, 16.11.2.7 NMAC, 11/24/2020]
16.11.2.8 DOCUMENTS INCORPORATED BY REFERENCE ARE THE LATEST
EDITIONS OF:
A. ACNM “core competencies for basic
midwifery practice”.
B. ACNM “standards for the practice of
midwifery”.
C. ACNM handbook: “the home birth
practice manual”.
[16.11.2.8 NMAC - Rp, 16.11.2.8 NMAC, 11/24/2020]
16.11.2.9 LICENSURE:
A. Licensure requirements: A CNM practicing in New Mexico shall hold a
license that meets the New Mexico board of nursing’s requirement to practice as
a registered nurse in New Mexico and shall hold current certification by AMCB
or its designee. The department may deny
licensure, including renewal, reinstatement, or reactivation of licensure, to a
CNM whose midwifery or nursing license has been subject to disciplinary action
in any jurisdiction. If denied due to
disciplinary action, re-application will only be considered after a minimum of
one year from date of initial denial, and the re-application must be
accompanied by full disclosure and complete record of previous actions. A CNM license is not transferable.
B. Initial
licensure:
(1) An applicant
for licensure to practice as a CNM in New Mexico shall submit to the department via the electronic professional licensing management system:
(a) a completed
application;
(b) proof of holding a valid license that meets the New Mexico
board of nursing’s requirement to practice as a registered nurse in New Mexico;
(c) proof of current certification by AMCB or its designee;
(d) the fee
designated in Subsection E of 16.11.2.9 NMAC.
(2) An initial CNM license may be issued
at any time upon submission and verification of the materials required in
Paragraph (1) of this subsection and shall expire on the expiration date of the
registered nurse license recognized by the New Mexico board of nursing. A CNM
license shall be valid for a maximum of two years.
(3) If a license is denied due to
disciplinary action on initial application, the applicant may reapply after one
year and upon meeting all the requirements under Subsection B of 16.11.2.9
NMAC.
(4) Any final action denying a license to
an applicant is an event reportable to the NPDB.
C. Licensure renewal:
(1) A CNM's renewed license shall expire
on the expiration date of the registered nurse license recognized by the New
Mexico board of nursing.
(2) An applicant for licensure renewal
shall submit to the department via
the electronic professional licensing management system:
(a) a completed
application electronically submitted by the fifth day of the month of the
expiration of the CNM license;
(b) proof of
holding a valid license that meets the requirement of the New Mexico board of
nursing to practice as a registered nurse in New Mexico for the period the
renewed CNM license will cover;
(c) proof of
current certification by AMCB or its designee;
(d) proof of
having met the continuing education and quality management requirements in
Paragraphs (3) and (4) of this subsection; and
(e) the fee
designated in Subsection E of this section;
(f) an
additional fee designated in Subsection E of this section for applications
electronically submitted after the fifth day of the month after the license is
expiring.
(3) Continuing education: CNMs must complete a minimum of 30 contact
hours during the two years preceding license renewal.
(a) 15 of the contact hours shall be pharmacology-related. As part of the pharmacology-related contact
hours, a CNM who holds a CNM license shall submit with the first license
renewal application proof of completing a minimum of five contact hours on any
of the following topics:
(i) the CNM
rule as it applies to management of chronic pain,
(ii) the
pharmacology and risks of controlled substances,
(iii) the problems
of abuse and addiction, or
(iv) state and
federal regulations for the prescription of controlled substances.
(b) With each subsequent license renewal
application, a CNM shall submit proof of completing a minimum of two contact
hours on the above topics.
(c) The following options, subject to
audit and approval by the department, may be accepted in place of continuing
education contact hours, except for the pharmacology-related contact hours requirement:
(i) preparation and presentation of a
nurse-midwifery topic that has received contact hour approval by any of the
organizations listed in Subsection H of 16.11.2.7 NMAC, will count for twice
the number of contact hours for which the presentation is approved; the same
presentation cannot be credited more than once;
(ii) sole or primary authorship of one
nurse-midwifery related article published in a department-approved professional
medical or midwifery journal may be accepted in place of 10 contact hours per
licensure period;
(iii) completion of a formal university or college course
directly related to nurse-midwifery practice; each university or college unit
shall be credited as 15 hours of continuing education; and
(iv) acting
as primary preceptor for a nurse-midwifery or certified midwifery student; each
10 hours of precepting shall be credited as one
continuing education hour; verification shall be provided by an accreditation
commission for midwifery education (ACME) accredited nurse-midwifery education
program; acting as primary preceptor for a licensed
midwifery student upon verification of out of hospital setting practice by the
CNM, prior to preceptor relationship This option shall not be accepted
in place of pharmacology-related contact hours.
(4) Quality management: documentation of participation during the
preceding two years in a system of quality management meeting the approval of
the department is required for license renewal.
Quality management includes peer review, quality assurance and quality
improvement as defined in Subsection S of 16.11.2.7 NMAC,
Subsection W of 16.11.2.7 NMAC, and Subsection X of 16.11.2.7 NMAC.
(5) If license renewal is denied, the
applicant may request an administrative hearing under the terms set forth by
Paragraph (5) of Subsection C of 16.11.2.11 NMAC.
D. Reactivation
of a CNM license:
(1) A
lapsed license occurs on the first day of the following month following the
expiration date of the current license if license not renewed on time, and a
CNM must apply for reactivation of the license, paying all added fees before
being allowed to practice. A CNM may not
work with a lapsed license or disciplinary action will be taken.
(2) The
requirements for reactivation of a CNM license that has voluntarily lapsed in
status or for an applicant that is returning to New Mexico are the same as
those for license renewal, listed in Paragraph (2) of Subsection C of 16.11.2.9
NMAC, except the applicant must pay the additional fee
for reactivation pursuant to Subsection F of 16.12.2.9 NMAC.
(3) The
license will be reactivated with the original license number.
E. Reinstatement of a CNM license:
(1) The
requirements for reinstatement of a revoked or suspended CNM license are the
same as those for license renewal, listed in Paragraph (2) of Subsection C of 16.11.2.9
NMAC, except that the fee is higher than a renewal, as designated in Subsection
F of 16.11.2.9 NMAC.
(2) The
license will be reinstated with the original license number.
F. Fees: the department shall charge applicants the
following fees for licensure services:
(1) two hundred dollars ($200) for
initial licensure;
(2) one hundred dollars ($100) for
license renewal;
(3) one hundred and fifty dollars
($150.00) late fee for renewing a license when the complete application is not
electronically submitted by the fifth calendar day of the month of the current
license’s expiration date or for voluntary lapse of a license; this fee is in
addition to the renewal fee;
(4) one hundred and fifty dollars
($150.00) for reinstatement of a revoked or suspended
license, or reactivation of a lapsed license; this fee is in addition to
the renewal fee;
(5) twenty-five dollars ($25.00) for
verifying licenses by FAX or letter;
(6) thirty dollars ($30.00) for a hard
copy of a license certificate (8 ½” x 11” size).
G. Change of address or other
contact information: a CNM shall submit
a change of any contact information to the department’s electronic professional
licensing management system within 30 days of the change.
[16.11.2.9 NMAC - Rp, 16.11.2.9 NMAC, 11/24/2020]
16.11.2.10 PRACTICE OF THE CERTIFIED NURSE-MIDWIFE:
A. Scope of practice: Practice by CNMs encompasses independently
providing a full range of primary health care services for women from
adolescence to beyond menopause. These
services include primary care; gynecologic and family planning services;
pre-conception care; care during pregnancy, childbirth, and the postpartum
period; care of the normal newborn; and treatment of clients for sexually
transmitted infections. Midwives provide
initial and ongoing comprehensive assessment, diagnosis, and treatment. They conduct physical examinations;
independently prescribe, distribute, and administer dangerous drugs, devices,
and contraceptive methods, and controlled substances in Schedules II through V
of Sections 30-31-1 NMSA 1978, Controlled Substances Act; admit, manage, and discharge clients; order
and interpret laboratory and diagnostic tests; and order the use of medical
devices. Midwifery care also includes
health promotion, disease prevention, and individualized wellness education and
counseling. These services are provided
in partnership with clients/patients in diverse settings such as ambulatory
care clinics, private offices, community and public health systems, homes,
hospitals, and birth centers. A CNM
practices within a health care system that provides for consultation,
collaborative management, or referral as indicated by the health status of the
client. A CNM practices in accordance
with the ACNM "standards for the practice of midwifery". A CNM who expands beyond the ACNM "core
competencies" to incorporate new procedures that improve care for their
clients/patients shall comply with the guidelines set out in the ACNM
"standards for the practice of midwifery", standard VIII. Practice guidelines for home births should be
informed by the most recent edition of the "ACNM home birth practice
manual."
B. Prescriptive authority:
(1) Dangerous drugs: A CNM who prescribes, distributes, or
administers a dangerous drug or device shall do so in accordance with Section
26-1 NMSA 1978, New Mexico Drug, Device and Cosmetic Act.
(2) Controlled substances:
(a) A CNM shall not prescribe nor
distribute controlled substances in Schedule I of Section 26-1 1978 NMSA, Controlled
Substances Act.
(b) A CNM shall not prescribe,
distribute, or administer controlled substances in Schedules II-V of the
Controlled Substances Act unless the CNM is registered with the New Mexico
board of pharmacy and the United States drug enforcement administration (DEA)
to prescribe, distribute, and administer controlled substances.
(c) A CNM who prescribes, distributes, or
administers a controlled substance in Schedules II-V of Section 26-1 NMSA 1978,
Controlled Substances Act, shall do so in accordance with the Controlled
Substances Act.
(d) An individual employed as a CNM by
the United States military, the United States veterans administration, or the
United States public health service, and operating in the official capacity of
that employment, who is prescribing, distributing or administering controlled
substances under that facility’s United States drug enforcement administration
registration is exempt from the Subparagraphs (a), (b) and (c) of Paragraph (2)
of this subsection.
(e) A CNM may prescribe, provide samples
of, and dispense any dangerous drug to a patient if, at the time of the
prescription, the CNM has a valid CNM-client relationship with the patient, as
defined in 16.12.2.7 NMAC.
(3) Prescriptions: A CNM may prescribe by
telephone, by written prescription, by e-mail, or through an electronic health
record (EHR) system. Controlled
substances may only be prescribed by written or electronic prescription. A CNM prescription shall have the CNM's name,
office address, and telephone number printed on it. In the event that a CNM is writing a
prescription printed with the names of more than one CNM, the name of the CNM
writing the individual prescription shall be indicated. The name and address of the client, the date
of the prescription, the name and quantity of the drug prescribed, and
directions for use shall be included on a prescription.
(4) Labeling: When distributing a drug, a CNM shall label
it with the client's name and date of birth; the date; instructions for use;
and the CNM’s name, address, and telephone number.
C. Guidelines for management of
chronic pain or other conditions with controlled substances: The treatment of chronic pain or other
conditions with various modalities, including controlled substances such as
opiates and opioids, is a legitimate practice when done in the usual course of
CNM practice. The goal when treating
chronic pain is to reduce or eliminate pain and also to avoid development of or
contribution to addiction, drug abuse, and overdosing. Effective dosages should be prescribed, with
both under- and over-prescribing to be avoided, using patient protection as a
guiding principle. The CNM should
provide control of the patient’s pain for its duration, while effectively
addressing other aspects of the patient’s functioning, including physical,
psychological, social, and work-related factors. A CNM may treat clients/patients with
addiction, physical dependence, or tolerance who have legitimate pain, however
such clients/patients require very close monitoring and precise documentation.
(1) If, in a CNM’s professional opinion,
a patient is seeking pain medication for reasons that are not medically
justified, the CNM is not required to prescribe controlled substances for the
patient.
(2) When prescribing, dispensing, or
administering controlled substances for management of chronic pain, a CNM
shall:
(a) obtain a PMP report for the patient
covering the preceding 12 months from the New Mexico board of pharmacy and any
other state’s report that is applicable and available;
(b) complete a history and physical
examination and include an evaluation of the patient’s psychological and pain
status, any previous history of significant pain, past history of alternate
treatments for pain, potential for substance abuse, coexisting disease or
medical conditions, and the presence of medical indications or
contra-indications related to controlled substances;
(c) be familiar with and employ screening
tools, as well as the spectrum of available modalities for therapeutic
purposes, in the evaluation and management of pain, and consider an integrative
approach to pain management in collaboration with other care providers,
including but not limited to acupuncturists, chiropractors, doctors of oriental
medicine, exercise physiologists, massage therapists, pharmacists, physical
therapists, psychiatrists, or psychologists;
(d) develop a written individual
treatment plan taking age, gender, and culture into consideration, with stated
objectives by which treatment can be evaluated, such as degree of pain relief,
improved physical and psychological function, or other accepted measures, and
include any need for further testing, consultation, referral, or use of other
treatment modalities as appropriate;
(e) discuss the
risks and benefits of using controlled substances with the patient or legal
guardian and document this discussion in the medical record;
(f) make a written agreement with the
patient or legal guardian outlining patient responsibilities, including a
provision stating that the chronic pain patient will receive all chronic pain
management prescriptions from one practitioner and one pharmacy whenever
possible;
(g) maintain complete and accurate
records of care provided and drugs prescribed, including the indications for
use, the name of the drug, quantity, prescribed dosage, and number of refills
authorized;
(h) when indicated by the patient’s
condition, consult with health care professionals who are experienced in the
area of the chronic pain or other conditions, though not necessarily
specialists in pain control, both early in the course of long-term treatment
and at least every six months;
(i) when
treating clients/patients with drug addiction or physical dependence, use drug
screening prior to and during the course of treatment to identify the drugs the
patient is consuming and compare the screening results with clients’/patients’
self-reports (this should be included in the written agreement, see
Subparagraph (f) above);
(j) note possible
indications of drug abuse by a patient and take appropriate steps to further
investigate and to avoid contributing to drug abuse; such steps may include
termination of treatment. Information about some of the indications may be
available only through PMP reports. The following list of possible indications
of drug abuse is non-exhaustive:
(i) receiving
controlled substances from multiple prescribers;
(ii) receiving
controlled substances for more than 12 consecutive weeks;
(iii) receiving more than one controlled substance analgesic;
(iv) receiving a new prescription
for any long-acting controlled substance analgesic formulation, including oral
or transdermal dosage forms or methadone;
(v) overutilization,
including but not limited to early refills;
(vi) appearing
overly sedated or intoxicated upon presentation; or
(vii) an unfamiliar patient requesting
a controlled substance by specific name, street name, color, or identifying
marks.
(k) comply with
the opioid antagonist prescribing practices as set forth in the Pain Relief Act
Section 24-2D-1, et.al NMSA1978.
D. Prescription
Monitoring Program (PMP) Requirements:
The department requires participation in the PMP to assist practitioners
in balancing the safe use of controlled substances with the need to impede
harmful and illegal activities involving these pharmaceuticals. Any practitioner who holds a federal drug
enforcement administration registration and a New Mexico controlled substance
registration shall register with the board of pharmacy to become a regular
participant in PMP inquiry and reporting.
A practitioner may authorize delegate(s) to access the prescription
monitoring report consistent with board of pharmacy regulation 16.19.29 NMAC. While a practitioner’s delegate may obtain a
report from the state’s prescription monitoring program, the practitioner is
solely responsible for reviewing the prescription monitoring report and
documenting the receipt and review of a report in the patient’s medical record.
Before a practitioner prescribes or
dispenses for the first time, a controlled substance in Schedule II, III, IV or
V to a patient for a period greater than four days, or if there is a gap in
prescribing the controlled substance for 30 days or more, the practitioner
shall review a prescription monitoring report for the patient for the preceding
12 months. When available, the
practitioner shall review similar reports from adjacent states. The practitioner shall document the receipt
and review of such reports in the patient’s medical record. A prescription monitoring report shall be
reviewed a minimum of once every three months during the continuous use of a
controlled substance in Schedule II, III, IV or V for each patient. The practitioner shall document the review of
these reports in the patient’s medical record.
Nothing in this section shall be construed as preventing a practitioner
from reviewing prescription monitoring reports with greater frequency than that
required by this section.
(1) A practitioner does not have to
obtain and review a prescription monitoring report before prescribing,
ordering, or dispensing a controlled substance in Schedule II, III, IV or V:
(a) for a period
of four days or less; or
(b) to a patient
in a nursing facility; or
(c) to a patient
in hospice care.
(d) or when
prescribing, dispensing, or administering of: testosterone, pregabalin,
lacosamide, ezogabine or
stimulant therapy for pediatric clients/patients less than age 14.
(2) Upon review of a prescription
monitoring report for a patient, the practitioner shall identify, be aware, and
document if a patient is currently:
(a) receiving
opioids from multiple prescribers;
(b) receiving
opioids and benzodiazepines concurrently;
(c) receiving
opioids for more than 12 consecutive weeks;
(d) receiving
more than one controlled substance analgesic;
(e) receiving
opioids totaling more than 90 morphine milligram equivalents per day;
(f) exhibiting
potential for abuse or misuse of opioids and other controlled substances, such
as any of the following indicators:
(g) over-utilization;
(h) requests to
fill early;
(i) requests for a controlled substance or specific opioid by
specific name, street name; color, or identifying marks;
(j) requests to
pay cash when insurance is available;
(k) receiving
opioids from multiple pharmacies; or
(l) appearing
overly sedated or intoxicated upon presentation.
(m) receiving a
new prescription for any long-acting controlled substance analgesic
formulation, including oral or transdermal dosage forms or methadone.
(3) Upon recognizing any of the above
conditions described in Subparagraph (j) of Paragraph (2) of Subsection C of 16.11.2.10
NMAC, the practitioner, using professional judgement based on prevailing
standards of practice, shall take action as appropriate to prevent, mitigate,
or resolve any potential problems or risks that may result in opioid misuse,
abuse, or overdose. These steps may
involve counseling the patient on known risks and realistic benefits of opioid
therapy, prescription and training for naloxone, consultation with or referral
to a pain management specialist, or offering or arranging treatment for opioid
or substance use disorder. The
practitioner shall document actions taken to prevent, mitigate, or resolve the
potential problems or risks.
(4) Practitioners licensed to practice in
an opioid treatment program, as defined in 7.32.8 NMAC, shall review a
prescription monitoring report upon a patient’s initial enrollment into the
Opioid Treatment Program and every three months thereafter while prescribing,
ordering, administering, or dispensing opioid treatment medications in Schedule
II-V for the purpose of treating opioid use disorder. The practitioner shall document the receipt
and review of a report in the patient’s medical record.
E. Immediate reporting: A CNM must report within 48 hours to the
division any neonatal or maternal mortality in clients/patients for whom the
provider has cared in the perinatal period in a setting other than a licensed
health facility; this includes stillbirths. These will be reviewed by the
division on a case by case basis for compliance with these CNM regulations.
F. Other rules: a CNM shall fulfill the requirements of all
relevant department rules including:
(1) "bureau
of vital records and health statistics," 7.2.2 NMAC;
(2) "control
of disease and conditions of public health significance," 7.4.3 NMAC;
(3) "newborn
genetic screening," 7.30.6 NMAC;
(4) "prevention
of infant blindness," 7.30.7 NMAC;
(5) “requirement
for freestanding birth centers,” 7.10.2 NMAC; and
(6) “birthing
workforce retention fund,” 7.30.9 NMAC.
[16.11.2.10 NMAC - Rp, 16.11.2.10 NMAC, 11/24/2020]
16.11.2.11 LICENSE DENIAL, SUSPENSION, OR REVOCATION; DISCIPLINARY
ACTION:
The department may deny, revoke, or suspend any license held or applied
for or reprimand or place a license on probation on the grounds of
incompetence, unprofessional conduct, or other grounds listed in this section,
pursuant to Subsection R of Section 24-1-3, NMSA 1978.
A. Grounds for action.
(1) Incompetence. A CNM who fails to possess and apply the
knowledge, skill, or care that is ordinarily possessed and exercised by CNMs or
as defined by the ACNM "core competencies for basic midwifery
practice" is considered incompetent.
Charges of incompetence may be based upon a single act of incompetence
or upon a course of conduct or series of acts or omissions which extend over a
period of time and which, taken as a whole, demonstrate incompetence. Conduct of such a character that could result
in harm to the client or to the public from the act or omission or series of
acts or omissions constitutes incompetence, whether or not actual harm
resulted.
(2) Unprofessional conduct. For purposes of this rule
"unprofessional conduct" includes, but is not limited to, the
following:
(a) verbally or
physically abusing a client;
(b) engaging in
sexual contact with or toward a client;
(c) abandonment
of a client;
(d) engaging in
the practice of midwifery when judgment or physical ability is impaired by
alcohol or drugs or controlled substances;
(e) practice
that is beyond the scope of CNM licensure;
(f) dissemination
of a client's health information or treatment plan to individuals not entitled
to such information and where such information is protected by law from
disclosure;
(g) falsifying
or altering client records or personnel records for the purpose of reflecting
incorrect or incomplete information;
(h) obtaining or
attempting to obtain any fee for client services for one's self or for another
through fraud, misrepresentation, or deceit;
(i) aiding, abetting, assisting, or hiring an individual to
violate any rule of the department;
(j) failure to
follow established procedure regarding controlled substances;
(k) failure to
make or to keep accurate, intelligible entries in records as required by the
ACNM “standards for the practice of midwifery”;
(l) obtaining
or attempting to obtain a license to practice certified nurse-midwifery for
one's self or for another through fraud, deceit, misrepresentation, or any
other act of dishonesty in any phase of the licensure or relicense process;
(m) practicing
midwifery in New Mexico without a valid New Mexico license or permit or aiding,
abetting or assisting another to practice midwifery without a valid New Mexico
license;
(n) delegation
of midwifery assessment, evaluation, judgment, or medication administration to
a non-licensed person; or
(o) failure to
provide information requested by the department pursuant to this rule within 20
business days of receiving the request.
(3) Failure to comply with the New Mexico
Parental Responsibility Act, Section 40-5A-1 through 40-5A-13, NMSA 1978.
(4) Dereliction of any duty imposed by
law.
(5) Conviction or having been found
guilty, or entered into an agreed disposition, of a felony offense under
applicable state or federal criminal law.
(6) Conviction
or having been found guilty, or entered into an agreed disposition, of a
misdemeanor offense related to the practice of midwifery as determined on a
case-by-case basis.
(7) Failure to report in writing to the
division any complaint or claim made against the CNM’s practice as a
registered, certified, or licensed health care provider in any jurisdiction,
including as a registered nurse. Such
notification shall include the credentialing jurisdiction and the location,
time, and content of the complaint or claim.
It shall be made within 20 business days of the CNM becoming aware of
the complaint or claim.
(8) Conduct resulting in the suspension
or revocation of a registration, license, or certification to perform as a
health care provider.
(9) Failure to report a CNM who appears
to have violated the rule for the practice of certified nurse-midwifery. Anyone reporting an alleged violation of this
rule shall be immune from liability under this rule unless the person acted in
bad faith or with malicious purpose.
(10) Violation of any of the provisions of
this rule.
B. Non-disciplinary proceedings: For non-disciplinary actions involving denial
of renewal of a license the applicant will be provided a notice of contemplated
action and the right to the hearing procedures set forth in Paragraphs (4) and
(5) of Subsection (C) of 16.11.2.11 NMAC.
C. Disciplinary proceedings: Disciplinary proceedings shall be conducted
in accordance with Sections 61-1-1 through 61-1-31 NMSA 1978 of the Uniform
Licensing Act (UCLA). Disciplinary
proceedings related to a CNM’s treatment of a patient, for chronic pain
or other conditions, with a controlled substance shall be conducted in
accordance with Sections 24-2D-1 through 24-2D-6 NMSA 1978 of the Pain Relief
Act, in addition to this rule.
(1) Filing of a complaint:
(a) A written complaint must be filed
with the division before a disciplinary proceeding may be initiated.
(i) A complaint is an allegation of a
wrongful act(s) or omission(s).
(ii) An allegation of a wrongful act may
include knowledge of a judgment or settlement against a licensee.
(b) A written complaint may be filed by
any person, including a member of the board.
(2) Investigation of a complaint.
(a) All complaints alleging a violation
of the rules adopted by the department shall be investigated to determine
whether a violation of applicable law or rule has occurred.
(b) The investigation may result in a
notice of contemplated action (NCA), as defined in the ULA, being issued by the
department if a violation occurred or it may result in a dismissal of the
complaint if no actionable violation can be substantiated. Once dismissal of a complaint is made
following an investigation, the licensee will be notified of the dismissal.
(3) Notice of contemplated action.
(a) The NCA shall be drafted by the
department.
(b) The director of the division, or her/his designee shall sign all NCAs.
(c) The NCAs shall contain written
information in accordance with the requirements of the ULA and shall be served
on the licensee in accordance with the ULA.
(4) Request for a hearing, notice of
hearing and request for continuance.
(a) Every licensee shall be afforded notice
and an opportunity to be heard.
(b) Within 20 days of receiving the NCA,
a licensee may request a hearing in writing by certified mail. The department shall notify the licensee of
the time and place of hearing within 20 days of receipt of the request. The hearing shall be held no more than 60 nor less than 15 days from the date of service of the notice
of hearing. However, if the ULA
designates time requirements different from the above stated time requirements,
the ULA time requirements shall prevail.
The department shall notify the licensee of these prevailing time
requirements when it sends the NCA.
(c) The licensee may request to explore a
settlement by negotiating a stipulation and agreement with the administrative
attorney of the department at any time prior to the hearing;
if a settlement is negotiated, the proposed stipulation and
agreement shall be presented to the department for final approval; the proposed
stipulation and agreement does not divest the department of its authority to require
a formal hearing or final approval, amendment, or rejection; if a settlement is
not reached, a hearing shall be held.
(d) Once a hearing has been scheduled, if
a request for a continuance is made it shall be presented to the department’s
hearing officer, in writing, at least 10 days prior to the scheduled hearing. The hearing officer may approve or deny the
request.
(e) If a person fails to appear after
requesting a hearing, the department may proceed to consider the matter and
make a decision.
(f) If no request for a hearing is made
within the time and manner stated in the NCA, the department may take the
action contemplated in the NCA. Such
action shall be final and reportable to NPDB.
(g) The department shall keep a record of
the number of complaints received and the disposition of said complaints as
either substantiated or unsubstantiated.
(5) Administrative hearing.
(a) All hearings shall be conducted by a
hearing officer designated by the secretary or authorized representative of the
department. The hearing officer shall have authority to rule on all
non-dispositive motions.
(b) All hearings before the department
shall be conducted in the same manner as a hearing in a court of law with the
exception that the rules of evidence may be relaxed in the hearing pursuant to
the ULA.
(i) Hearsay evidence is admissible if it
is of a kind commonly relied upon by reasonable prudent people in the conduct
of serious affairs.
(ii) Disciplinary action against a CNM
license must not be based solely on hearsay evidence.
(c) The hearing officer may take
testimony, examine witnesses and direct a continuance of any case.
(d) The hearing officer shall have the
power to issue subpoenas to compel the attendance of witnesses or the production
of books, documents or records pertinent to the matter of a case before the
department.
(e) The hearing officer shall issue a
report and recommended finding to the department secretary.
(f) Decision of the department: the secretary of the department shall render
a final administrative determination after reviewing the report and recommended
findings issued by the hearing officer. Copies
of the written decision shall be mailed via certified mail to the licensee in
accordance with the ULA and placed in the CNM’s licensure file. The department shall mail a copy of the
written decision to the authority(ies)
that license(s) the CNM as a registered nurse and shall report the decision to
the NPDB if the decision is to uphold the disciplinary action.
D. Reinstatement of a suspended or
revoked license.
(1) Individuals who request reinstatement
of their license or who request that their probation be lifted or altered shall
provide the department with substantial evidence to support their request. This evidence must be in the form of notarized
written reports or sworn written testimony from individuals who have personal
knowledge of the individual’s activities and progress during the period of
probation, suspension, or revocation.
(2) For reinstatement of licenses for
reasons other than noncompliance with Section 40-5A-1 to -13 NMSA 1978,
Parental Responsibility Act, requests for reinstatement of a revoked license
shall not be considered by the department prior to the expiration of one year
from the date of the order of revocation.
The date of the order of revocation is the controlling date, unless
otherwise specified in the order. Reinstatement
of a revoked license requires proof of meeting the renewal requirements set
forth in this rule and payment of the reinstatement of revoked license fee of
Paragraph (4) of Subsection F of 16.11.2.9 NMAC.
(3) Requests for reinstatement of a
suspended license shall be considered at such time as provided by the
department in the order of suspension. Reinstatement
of a suspended license requires proof of meeting the renewal requirements as
set forth in this rule, any remedial education, supervised practice or other
condition specified in the order for suspension required by the department and
payment of the reinstatement of current or suspended
license fee of Paragraph (4) of Subsection F of 16.11.2.9 NMAC.
(4) When a license is revoked solely
because the licensee is not in compliance with the Parental Responsibility Act,
Section 40-5A-1 to 13 NMSA 1978, the license shall be reinstated upon
presentation of a subsequent statement of compliance.
[16.11.2.11 NMAC - Rp, 16.11.2.11 NMAC, 11/24/2020]
16.11.2.12 ADVISORY BOARD: The department shall appoint a CNM advisory
board to make recommendations to the department regarding the regulation of
CNMs.
A. The board shall be comprised of:
(1) three New
Mexico licensed CNMs, at least one of whom is actively practicing midwifery;
(2) one New
Mexico licensed midwife (LM) who is actively practicing midwifery;
(3) two members
of the general public, who shall not have any significant financial interest,
direct or indirect, in the profession regulated;
(4) one actively
practicing board-certified obstetrician-gynecologist physician; and
(5) one employee
of the division.
B. Board members other than the
department representative shall be appointed for staggered terms up to three
years in length. Board members shall
serve on a voluntary basis without compensation. They shall not serve for more than two consecutive
terms. The department representative
shall not be subject to term limits.
C. The board shall meet a minimum of
two times a year when a meeting of the board is called by the director of the
division.
D. Board members may submit requests
for reimbursement of in-state travel and per diem for attending board meetings
in accordance with the Per Diem and Mileage Act, Section 10-8-1 to -8 NMSA 1978
and the department of finance administration rules, Section 2.42.2 NMAC.
E. Any member failing to attend two
consecutive board meetings without good cause and an absence excused prior to
the meetings shall be deemed to have resigned from the board.
[16.11.2.12 NMAC - Rp, 16.11.2.12 NMAC,11/24/2020]
16.11.2.13 SEVERABILITY: If any part or application of these rules is
determined to be illegal, the remainder of these rules shall not be affected.
[16.11.2.13 NMAC - Rp, 16.11.2.13 NMAC, 11/24/2020]
HISTORY OF 16.11.2 NMAC:
Pre-NMAC History: The material in this part was derived from
that previously filed with the commission of public records-state records
center and archives.
DPHW 67-24, Nurse Midwife
Regulations For New Mexico, filed 12/12/1967.
HSSD 76-2, Nurse Midwife Regulations
For New Mexico, filed 1/20/1976.
HED-80-6 (HSD), Regulations
Governing the Practice of Certified Nurse Midwives, filed 10/17/1980.
DOH 91-06 (PHD), Regulations
Governing the Practice of Certified Nurse Midwives, filed 11/04/1991.
History of Repealed Material:
16 NMAC 11.2, Certified Nurse
Midwives (filed 10/18/1996) repealed 10/15/2009.
16.11.2 NMAC, Certified Nurse
Midwives (filed 9/28/2009) repealed 8/30/2013.
16.11.2 NMAC, Certified Nurse
Midwives (filed 6/6/2019) repealed 11/24/2020.
Other History:
DOH 91-06 (PHD), Regulations
Governing the Practice of Certified Nurse Midwives (filed 11/04/1991) was
renumbered into first version of the New Mexico Administrative Code as 16 NMAC
11.2, Certified Nurse Midwives, effective 10/31/1996.
16 NMAC 11.2, Certified Nurse
Midwives (filed 10/18/1996) was replaced by 16.11.2 NMAC Certified Nurse
Midwives, effective 10/15/2009.
16.11.2 NMAC, Certified Nurse
Midwives (filed 9/28/2009) was replaced by16.11.2 NMAC, Certified Nurse
Midwives, effective 8/30/2013.
16.11.2 NMAC, Certified Nurse
Midwives (filed 8/15/2013) was replaced by16.11.2 NMAC, Certified Nurse
Midwives, effective 6/25/2019.
16.11.2 NMAC, Certified Nurse
Midwives (filed 6/6/2019) replaced by 16.11.2 NMAC, Certified Nurse Midwives
effective 11/24/2020.