Licensure for CNM and CM

On March 20, 2021 Governor Northam signed HB1953/SB1320 into law making Virginia the 8th state in the nation and the first in the south to license Certified Midwives. Then, on March 23, 2021 the Governor signed HB1817 into law granting full-practice authority for CNMs with >1,000 practice hours and allowing CNMs with more than 2 years of experience to serve as consultants for newly licensed midwives.  

A template consultation agreement for CMs can be found here. [coming soon]

A template consultation agreement for CNMs can be found here

A template attestation agreement for CNMs with more than 1,000 practice hours can be found here

Sample language for hospital by-laws can be found here. [coming soon]

Guidance documents for high-risk pregnancy conditions required for midwives serving clients at home or in birth centers can be found here

Meetings of the Joint Boards of Nursing and Medicine are open, at least in part, to members of the public. Click here to view the calendar. 

June 16, 2021
October 13, 2021
December 8, 2021


UPDATE June, 23, 2021: 

Virginia Department of Health Professions

Virginia Board of Nursing

 

Subject:          IMPORTANT MESSAGE from Jay Douglas, Executive Director of the Virginia Board of Nursing, on behalf of the Joint Boards of Nursing and Medicine, Virginia Department of Health Professions

 HB1817         Amended Statutes for Certified Nurse Midwife (CNM) Practice and Licensure      

 On March 25, 2021, Governor Northam signed into law HB1817 which amends §§ 54.1-2957, 54.1-2957.01, and 54.1-2957.03 of the Virginia Code affecting the practice of CNMs.  Modifications to CNM practice requirements effective July 1, 2021 are as follows:

  1. Prescriptive Authority - § 54.1-2957.01(G)
    1.  All CNMs with prescriptive authority may prescribe Schedule II through VI controlled substances.
  2.  Practice Agreement Requirements - § 54.1-2957(H)
    1. CNMs with fewer than 1,000 practice hours must enter into a practice agreement with EITHER a licensed physician or a CNM with more than 2 years of clinical practice experience
      1. The practice agreement needs to
        1. address the availability of the consulting CNM or physician for routine and urgent consultation on patient care, and
        2. include prescribing of Schedule II through VI controlled substances
      2. The practice agreement must be maintained by the CNM and provided to the Boards only upon request
  3. Practicing without a Practice Agreement - § 54.1-2957(H)
    1. Upon completion of 1,000 hours of practice, the CNM may practice without a practice agreement upon receipt by the CNM of an attestation from the consulting CNM or physician stating:
      1. that such certified nurse midwife or licensed physician has provided consultation to the certified nurse midwife pursuant to a practice agreement meeting the requirements of this section and
      2. the period of time for which such certified nurse midwife or licensed physician practiced in collaboration and consultation with the certified nurse midwife pursuant to the practice agreement.
      3. Statute does not require submission of this attestation to the Joint Boards.
    2. Enactment Clause (end of HB1817) That any certified nurse midwife who has practiced as a certified nurse midwife in the Commonwealth for at least 1,000 hours, as determined by the Boards of Medicine and Nursing, prior to the effective date of this act shall be deemed to have met the requirements of subsection H of § 54.1-2957 of the Code of Virginia, as amended by this act, related to requirements for practice as a certified nurse midwife without a practice agreement and shall be eligible to practice as a certified nurse midwife in the Commonwealth without a practice agreement.
      1. CNMs who have practiced for at least 1,000 hours as of July 1, 2021 will be deemed to have met the requirements as determined by the Boards and may practice without a practice agreement
      2. The Joint Boards will rely on documentation submitted by the CNM in order to deem that the CNM has met the practice requirements prior to July 1, 2021, as outlined in the enactment clause.  Examples of such documentation includes, but is not limited to, the following:
        1. Written statement from consulting physician
        2. Written statement from the Human Resources department or employer
        3. Official records from employment, military service, Medicaid/Medicare reimbursement
        4. Practice Agreement(s)
      3. The Joint Boards is currently accepting documentation using the following procedure:
        1. CNM submits scanned pdf documentation in an email to [email protected]  
          IMPORTANT:   Subject Line for email:  “CNM – Documentation Submission
        2. Joint Boards documentation review conducted
        3. If CNM is deemed to have met the requirements of the enactment clause, a notification will be emailed or mailed to the CNM at the address of record 



FAQ

What do these laws do? HB1953/SB1320 were identical bills introduced and passed in each chamber of the General Assembly. These bills amended and re-enacted sections in the Code of Virginia including: § 54.1-2900. to define "licensed certified midwife" and the "practice of certified midwifery", and adds § 54.1-2957.04 which defines licensure, practice, use of title, and required disclosures to clients if a midwife serves people at home or in birth centers.  This section also directs the Joint Boards of Nursing and Medicine to adopt regulations for practice consistent with the ACNM Standards for the Practice of Midwifery. CMs will be licensed to practice in accordance with a practice agreement with a physician that specifies the availability of the physician for routine or urgent consultation based on the needs of the patient. CMs will be able to prescribe schedule II through VI medications. 

HB1817 was introduced in the House and amends § 54.1-2957 subsection H to specify that CNMs who have practiced fewer than 1,000 hours, need a practice agreement with a physician or a CNM with at least 2 years of practice experience that specifies the availability of the midwife or physician for urgent or routine consultation. For midwives with >1,000 hours with a practice agreement, the CNM can obtain an attestation from their consultant and will then be able to practice autonomously, including the authorization to prescribe schedule II-VI. The law specifies that a CNM practicing without a practice agreement shall continue to consult, collaborate, and refer with appropriate healthcare providers based on the needs of the patient.

In addition, HB1953/SB1320 directed the Department of Health Professions to convene a work group to study licensure and regulation of CNMs, CMs, and CPMs to determine the appropriate licensing entity for all midwives. The findings of the workgroup are required to be reported to the Governor and the General Assembly by November 1, 2021.

When will these laws go into effect? As of July 1, 2021, CNMs will be able to practice according to education, national certification, and the ACNM Standards of Practice without a practice agreement after completing 1,000 hours in consultation with a physician or CNM. For midwives with <1,000 hours, a CNM who has practiced for at least 2 years will be able to serve as a consultant and provide consultation and collaboration services for another midwife. A CNM may still establish consultation agreements with physicians as required. As a new licensure category, CMs will not be able to apply for license to practice until the process is approved by the Boards of Nursing and Medicine. We are hopeful that this process will be complete by the end of the year. 

Does this mean midwives will no longer consult or collaborate? No. CNMs and CMs practice in accordance with the Midwifery Model of Care, ACNM Standards for the Practice of Midwifery, and the ACNM Code of Ethics. Consultation, collaboration, and referral based on the needs of the client is a fundamental to midwifery care. 

When will CMs be able to apply for license? Though the law will be effective July 1, 2021, it is not clear exactly when CMs will be able to apply for license. We continue to work with the Department of Health Professions, our lobbyist, and our representative to the Joint Boards of Nursing and Medicine. 

Can CMs practice without a practice agreement? No. At this time, a CM can only be licensed to practice on the bases of a practice agreement with a physician which specifies that the physician will be available for routine or urgent consultation based on the needs of the patient. In order for CMs to be able to practice without a consultation agreement with a physician we will need to introduce and pass new law. 

As a CNM with >1,000 practice hours, will I have to apply for a new license? No. There is no new license for CNMs practicing without a practice agreement. You must have a signed attestation from the physician or CNM with whom you had the practice agreement that the agreement was in effect for at least 1,000 practice hours. CNMs in VA are encouraged to use the attestation form above. 

If I have autonomous practice, will I be able to get hospital privileges? Hospital privileges are specific to each institution. CNMs will need to advocate for inclusion of CNMs who are licensed to practice without a practice agreement as members of the medical staff in the hospital's by-laws. They should be granted privileges in accordance with state law and consistent with the ACNM Standards for the Practice of Midwifery, including the ability to admit and discharge patients without additional authorization or co-signature by a physician. 

I am new to practice in Virginia, what kind of practice agreement is needed? Under the new law as of July 1, 2021, the first 1,000 hours of practice for a CNM in Virginia must be under a consultation agreement with a physician or a CNM with at least 2 years of clinical experience. 

I provide care for labor and birth at home and in birth centers. What information is required to be disclosed to clients? Midwives practicing at home or birth center are required to disclose to patients the "risks associated with birth outside of a hospital, including but not limited to: vaginal birth after prior cesarean section, breech birth, high-risk pregnancy, and multiple gestation". Specific disclosures were initially developed by the Board of Medicine in conjunction with the Advisory Board of Midwifery which regulates CPMs. These guidance documents are found here. 

What do these laws change for the licensure or practice of Certified Professional MidwivesThese laws do not change licensure or practice for CPMs who are practice midwifery as Licensed Midwives under a different section of the Code of Virginia. They are regulated under the Board of Medicine through an Advisory Board of Midwifery. 

Who will be part of the work group to determine the appropriate licensing entity for CNMs, CMs, and CPMs? The work group will include midwives of each credential and other key stakeholders from the Department of Health Professions. As of June 1, 2021 the members of this group have not been announced. The goal, as stated in the law, will be focused on determining the best regulatory entity for midwives and does not address scope of practice. All midwives are cautious about any proposal to change laws specific to licensure or regulation. VA ACNM specifically advocates for license, regulation, and practice of CNMs and CMs and works to collaborate with VMA to advocate for access to full-scope midwifery practice of CPMs so that all midwives are able to practice to the full extent of education and national certification.