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, 5/7/2024]
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, 5/7/2024]
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, 5/7/2024]
16.11.2.4 DURATION: Permanent.
[16.11.2.4 NMAC - Rp, 16.11.2.4 NMAC, 5/7/2024]
16.11.2.5 EFFECTIVE
DATE:
May 7, 2024, unless a later date
is cited at the end of a section.
[16.11.2.5 NMAC - Rp, 16.11.2.5 NMAC, 5/7/2024]
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, 5/7/2024]
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.
(4) “Audit”
means an examination and verification of continuing education and
practice documents.
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) “Client”
means any person domiciled, residing, or receiving care, service
or treatment from a New Mexico licensed CNM. This includes but is not limited
to patients, residents, or consumers.
(4) "CNM
license" means the legal privilege to practice within the scope of
this rule as authorized by the department.
(5) "Contact
hour" means 50-60 minutes of an organized learning experience relevant
to CNM practice.
(6) "Continuance" means the adjournment or postponement of a trial or other
proceeding to a future date.
(7) “Continuing
education” means planned learning experiences occurring after initial
licensure. These experiences are designed to promote the development of
knowledge, skills and attitudes for the enhancement of
midwifery practice, thus improving health care to the
public.
(8) “Continuing
education unit” means 10 contact hours of participation in an organized
continuing education experience.
(9) "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 Section 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 misuse 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,
client 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”: “Substance use
disorder” means a treatable mental disorder that
affects a person's brain and behavior, leading to their inability to control
their use of substances like legal or illegal drugs, alcohol
or medications.
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 client record must be generated by the
encounter.
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, 5/7/2024]
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, 5/7/2024]
16.11.2.9 LICENSURE:
A. Licensure requirements: A CNM practicing in New Mexico shall hold an
active 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 last day of the month
of the CNM’s birth month. A CNM license
shall be valid for a maximum of two years.
(3) If
the licensure process is not completed, the application becomes null and void
one year after the date of application being received, and fees paid are not
refundable.
(4) 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.
(5) 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 last day of the
month of the CNM’s birth month of the second year after it is issued.
(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 substance use disorder
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) A
minimum of two of the contact hours shall be focused on health equity.
Acceptable content includes but is not limited to:
(i) Implicit bias training to identify strategies
to reduce bias during assessment, diagnosis, and care. This may include, but is
not limited to training in bias, racism, and poverty, that manifest as health
inequities.
(ii) Development
of individual and system level interventions and self-reflection to assess how
the CNM’s social position can influence their relationship with clients and
their communities.
(iii) Skills
to enable a health care professional to care effectively for clients from
diverse cultures, groups, and communities and apply health equity concepts
into practices.
(d) 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 C of 16.11.2.10 NMAC,
will count for twice the number of contact hours for which the presentation is
approved with a maximum award of 15 contact hours per
licensure period; 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 for a
semester system and 10 hours of continuing education for a quarter system; and
(iv) acting as preceptor for a midwifery student; each 10 hours of
precepting shall be credited as one continuing education hour, with maximum
award of 10 contact hours; verification shall be provided by an accreditation
commission for midwifery education (ACME) accredited nurse-midwifery education
program or can be verified by a division-approved form. 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 16.11.2.12 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) two hundred dollars ($200.00) 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) fifty
dollars ($50.00) for rejected electronic payment for insufficient funds.
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; failure
to update information within this time frame may result in disciplinary action.
[16.11.2.9 NMAC - Rp, 16.11.2.9 NMAC, 5/7/2024]
16.11.2.10 CONTINUING EDUCATION:
A. Introduction:
(1) The
division prescribes the following regulations establishing requirements for CE
to be met by the licensee to protect the health and well-being of the citizens
of New Mexico and to promote current midwifery knowledge and practice.
(2) Philosophy
of CE: The division believes that CE is one of the most important
responsibilities of the midwife and is a lifelong process. The primary
responsibility for CE rests with the individual midwife. A diversity of midwifery-related learning
activities is recommended to enhance the scope of professional development.
B. Requirements
and rules:
(1) Records:
(a) All
licensees must indicate compliance with the CE required by these rules on the
renewal application. All information must be completed as requested.
(b) Licensees
are responsible for maintaining their own CE records and for keeping the
certificates of verification of attendance of CE activities for at least one
year after the license is renewed.
Copies of certificates must be submitted to the division if audited and
requested.
(2) CE
Audit:
(a) Continuing
education records are subject to audit by the division.
(b) Licensee
may be subject to disciplinary action by the division if non-compliant with a
request for additional information within 60 days of the first notice of CE
non-compliance.
C. Approved
continuing education: To be acceptable
in New Mexico, the CE activity must have been approved by a recognized approval
body and must enhance the licensee’s scope of professional development as
related to CNM scope of practice. The
participant must receive a certificate of attendance which validates the number
of approved CE hours awarded, name of the participant, sponsoring agency,
approval body and date attended.
(1) Recognized
approval bodies for CE for CNMs:
(a) clinician-level continuing education
accrediting agencies approved by the division;
(b) national or state recognized nursing organizations or boards of
nursing;
(c) other state boards of nursing.
(2) Other
CE which may be accepted as approved CE for CNMs:
(a) academic
credit, computation: as set forth in Item (iii) of Subparagraph (d) of
Paragraph (3) of Subsection C of 16.11.2.9 NMAC;
(b) CE
units (CEUs) or contact hours awarded by CE divisions within educational
institutions of higher learning;
(c) educational
offerings approved through other generally recognized health care or
professional organizations as related to CNM’s scope of practice.
[16.11.2.10 NMAC - N, 5/7/2024]
16.11.2.11 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 clients from
adolescence to beyond menopause. These
services include primary care; sexual and reproductive health care; gynecologic
health; family planning services; pre-conception care; care during pregnancy,
childbirth, and the postpartum period; and care of the normal newborn up to six
weeks of age. CNMs provide care for all individuals who seek midwifery care,
inclusive of all gender identities and sexual orientations. CNMs 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 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 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 client if, at the time of the
prescription, the CNM has a valid CNM-client relationship. The relationship includes:
(i) 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;
(ii) the CNM has sufficient information to
ensure that a dangerous drug or controlled substance is not contraindicated for
the individual;
(iii) the CNM provides a client with
appropriate information on the proper dosage, route, frequency, and duration of
a drug treatment;
(iv) the CNM informs the client of possible
untoward effects and side effects of a proposed treatment;
(v) the CNM provides care for a client in
the event of an untoward effect or a side effect that requires care;
(vi) the CNM provides for client education
regarding a condition and the condition’s treatment to enhance client
compliance with plan of care;
(vii) the CNM provides for appropriate
follow-up care, including further testing, treatment
and education, as appropriate; and
(viii) the CNM documents, at minimum, the
indication, drug, and dosage of any prescribed drugs in a health record for the
individual.
(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
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 misuse and overdose. Effective dosages should be prescribed, with
both under- and over-prescribing to be avoided, using client protection as a
guiding principle. The CNM should
provide control of the client’s pain for its duration, while effectively
addressing other aspects of the client’s functioning, including physical,
psychological, social, and work-related factors. A CNM may treat clients with substance use
disorder, physical dependence, or tolerance who have pain,
however such clients require very close monitoring and precise documentation.
(1) If, in a CNM’s professional opinion,
a client is seeking pain medication for reasons that are not medically
justified, the CNM is not required to prescribe controlled substances for the
client.
(2) When prescribing, dispensing, or
administering controlled substances for management of chronic pain, a CNM
shall:
(a) obtain a PMP report for the client
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 client’s psychological and pain
status, any previous history of significant pain, past
history of alternate treatments for pain, potential for substance
misuse, 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 client or legal guardian and document this
discussion in the medical record;
(f) make a written agreement with the
client or legal guardian outlining client responsibilities, including a
provision stating that the chronic pain client 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 client’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 a client with addiction, substance use disorder or physical
dependence, use drug screening prior to and during the course
of treatment to identify the drugs the client is consuming and compare
the screening results with clients’ self-reports (this should be included in
the written agreement, see Subparagraph (f) above);
(j) note possible indications of drug
misuse by a client and take appropriate steps to further investigate and to
avoid contributing to drug misuse; 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 misuse
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 client 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 client’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 client 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 client 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 client’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 client in a nursing facility; or
(c) to a client in hospice care.
(d) or when prescribing, dispensing, or
administering of: testosterone, pregabalin, lacosamide, ezogabine or stimulant
therapy for pediatric clients less than age 14.
(2) Upon review of a prescription
monitoring report for a client, 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 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 16.11.2.11
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 or overdose.
These steps may involve counseling the client 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 client’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 client’s medical record.
E. Immediate reporting: A CNM must report within 48 hours to the
division any neonatal or maternal mortality in clients 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.
[16.11.2.11 NMAC - Rp, 16.11.2.10 NMAC, 5/7/2024]
16.11.2.12 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 V 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 of a felony pursuant to
Paragraph (1) of Subsection A of Section 28-2-4 NMSA.
(6) Conviction
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) Failure
to report to the department a change in contact information within 30 days of
the change as set forth in Subsection G of 16.11.2.9 NMAC.
(11) Non-compliance
for requirements of CEs as determined by audit as set
forth in Paragraph (2) of Subsection B of 16.11.2.10
NMAC.
(12) 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 16.11.2.12 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 (ULA). Disciplinary
proceedings related to a CNM’s treatment of a client, 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.
[16.11.2.12 NMAC - Rp, 16.11.2.11 NMAC, 5/7/2024]
16.11.2.13 ADVISORY
BOARD:
The department shall appoint a CNM advisory board to make
recommendations to the department regarding the regulation of CNMs:
A. The board may be comprised of:
(1) up to four New Mexico licensed CNMs,
at least two of whom are 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 New Mexico licensed
board-certified obstetrician-gynecologist physician;
(5) one
student nurse-midwife, who may continue to serve out their term following
graduation; and
(6) 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; a student nurse-midwife who has completed their education is
not eligible for a second term as the student member. 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.
[16.11.2.13 NMAC - Rp, 16.11.2.12 NMAC, 5/7/2024]
16.11.2.14 SEVERABILITY: If any part or
application of these rules is determined to be illegal, the remainder of these
rules shall not be affected.
[16.11.2.14 NMAC - Rp, 16.11.2.13 NMAC, 5/7/2024]
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.
16.11.2 NMAC, Certified Nurse Midwives (filed 11/13/2020)
repealed 5/7/2024.
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.
16.11.2 NMAC, Certified Nurse Midwives (filed 11/13/2020)
replaced by 16.11.2 NMAC, Certified Nurse Midwives effective 5/7/2024.