Code of Colorado Regulations
700 - Department of Regulatory Agencies
716 - Division of Professions and Occupations - State Board of Nursing
3 CCR 716-1 - NURSING RULES AND REGULATIONS
Section 3 CCR 716-1.29 - RULES AND REGULATIONS FOR PRESCRIPTIVE AUTHORITY FOR CERTIFIED MIDWIVES

Universal Citation: 3 CO Code Regs 716-1 ยง 29

Current through Register Vol. 47, No. 17, September 10, 2024

A. BASIS: The authority for the promulgation of these rules and regulations by the State Board of Nursing ("Board") is set forth in sections 12-20-204(1), 12-255-107(1)(j), and 12-255-112, C.R.S., of the Colorado Revised Statutes (C.R.S.).

B. PURPOSE: Section 12-255-112(4) (a.5), C.R.S. sets forth the legal requirements for a Certified Midwife to obtain prescriptive authority in Colorado. First, the Certified Midwife must obtain Provisional Prescriptive Authority. Generally, those requirements are:

1. Midwife certification in good standing from the American Midwifery Certification Board or its successor entity; and

2. Professional liability insurance coverage of all acts within the scope of practice of a Certified Midwife in the amount of five hundred thousand dollars per claim with an annual aggregate liability for all claims of one million five hundred thousand dollars; and

3. Completion of at least three years of combined clinical work experience as a Certified Midwife.

Upon receiving Provisional Prescriptive Authority, the Certified Midwife is legally authorized to prescribe medications and controlled substances schedules II-V to patients appropriate to the Certified Midwife's Role. Within three years of receiving Provisional Prescriptive Authority the Certified Midwife with Provisional Prescriptive Authority (hereinafter referred to as CMRX-P) must:

4. Complete a 750 hour Mentorship with a Physician or an Advanced Practice Registered Nurse (APRN) with Full Prescriptive Authority or with a Certified Midwife with Full Prescriptive Authority and experience in prescribing medications. The Physician or APRN or Certified Midwife shall have education, training, experience and an active practice that corresponds with the Role of the CMRX-P.

If the CMRX-P does not complete these additional requirements within three years of receiving Provisional Prescriptive Authority such authority will expire for failure to comply with statutory requirements.

C. DEFINITIONS:

1. Advanced Practice Registered Nurse (APRN): A professional nurse who meets the requirements of section 12-255-111, C.R.S., who obtained specialized education or training and is included on the Advanced Practice Registry.

2. Applicant: A Certified Midwife who is licensed seeking Provisional Prescriptive Authority in the Role specified by the American Midwifery Certification Board or its successor entity.

3. Board: The State Board of Nursing.

4. Certified Midwife means an individual who meets the qualifications for practice as a Certified Midwife as specified by the American Midwifery Certification Board or its successor entity and who is currently licensed by the Board.

5. Clinical Work Experience: Any relevant experience accumulated as a Certified Midwife, including paid or unpaid work experience, volunteer work, or student work. The gratuitous care of friends or members of the family is not included in Clinical Work Experience.

6. DEA: Drug Enforcement Administration.

7. Disciplinary Sanction: Any current restriction, limitation, encumbrance or condition on the Physician Mentor's medical license or on the RXN Mentor's nursing license or on the alternative to discipline program authorized by the Mentor's licensing board.

8. Full Prescriptive Authority: The authority granted to the CMRX to prescribe medications upon completion of the requirements set forth in Section (E)(2) of this Rule.

9. Mentor: Physician Mentor: A person who holds a license to practice medicine in Colorado or a physician who is otherwise exempted from licensure pursuant to section 12-240-107(3)(j), C.R.S. The physician's license must be in good standing without Disciplinary Sanction as defined in Section (C)(7) of Rule 1.36. The Physician Mentor must be actively practicing medicine in the State of Colorado and shall have education, training, experience and a practice that corresponds to the Role of the CMRX-P. The Physician Mentor must also have an unrestricted DEA registration.

10. Mentor: RXN Mentor: A professional nurse who has met the qualifications for an APRN, is included on Colorado's advanced practice registry, has Full Prescriptive Authority in Colorado, and has experience prescribing medications with full prescriptive authority preceding the beginning of the Mentorship. The RXN Mentor's nursing license must be without Disciplinary Sanction as defined in Section (C)(7) of Rule 1.36. The RXN Mentor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds to the Role of the CMRX-P. The RXN Mentor must have an unrestricted DEA registration.

11. Mentor: CMRX Mentor. A Certified Midwife who is licensed and has Full Prescriptive Authority in Colorado and has experience prescribing medications with full prescriptive authority preceding the beginning of the Mentorship. The CMRX Mentor's license must be without Disciplinary Sanction as defined in Section (C) (7) of Rule 1.36. The LCMRX Mentor shall have an active practice in Colorado and shall have education, training, experience and a practice that corresponds to the Role of the CMRX-P. The CMRX Mentor must have an unrestricted DEA registration.

12. Mentorship: A formal, Mutually Structured relationship between the CMRX-P as defined in Section (C)(13) of Rule 1.36, and the Physician Mentor or RXN Mentor or CMRX Mentor to further the CMRX-P's knowledge, skill, and experience in prescribing.

13. Mentorship Agreement: A mutually structured agreement documented in writing and signed by the CMRX-P and the Mentor(s), which outlines a process and frequency for ongoing interaction and discussion of prescriptive practice throughout the Mentorship between the Mentor(s) and the CMRX-P to assure safe prescribing practice.

14. Mutually Structured: Developed, implemented, and agree upon by the CMRX-P and the Mentor(s).

15. Provisional Prescriptive Authority: The authority granted to the Applicant to prescribe medications within the Role and, if applicable, Population Focus of the Certified Midwife pursuant to Section (F)(1) and Section (J)(2) of Rule 1.36

16. Role: The advanced practice area for which the Applicant has been prepared including certified midwife (CM), nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and/or clinical nurse specialist (CNS).

17. CMRX: A Certified Midwife who is licensed and has been granted Full Prescriptive

18. CMRX Provisional (CMRX-P): A Certified Midwife who is licensed and who has been granted Provisional Prescriptive Authority by the Board.

19. Synchronous Communication: Real-time communication; existing or happening at the same time; occurring at the same moment of time; simultaneous. Synchronous Communication will be conducted in a secure manner to safeguard protected information. Synchronous Communication may include the use of electronic communication tools such as audio, web or video conferencing. Synchronous Communication does not include email communications.

20. Unencumbered: No current restriction to practice in the state of Colorado.

D. NATIONAL CERTIFICATION REQUIREMENT

1. Pursuant to section 12-255-112(4)(a)(IV), C.R.S., a Certified Midwife applying for prescriptive authority must obtain and maintain national certification from The American Midwifery Certification Board or its successor entity.

E. REQUIREMENTS FOR PRESCRIPTIVE AUTHORITY

1. Requirements for Provisional Prescriptive Authority.
a. Must apply in a manner approved by the Board;

b. Pay application fee;

c. Submit verification of National Certification as described in Section (D) of this Rule;

d. An attestation of having professional liability insurance pursuant to section 12-255-113, C.R.S.

e. An attestation stating the Applicant has completed at least three years of Clinical Work Experience, as defined in Section (C)(5) of this Rule.

f. An attestation stating that the Applicant's Mentor(s) meets requirements in Section (C)(9) or (C)(10) or (C)(11) of this Rule; and

g. Has an active Certified Midwife license that is in good standing and without disciplinary sanctions or significant adverse prescribing as determined by the

2. Requirements for Original Full Prescriptive Authority
a. Submit an application in a manner approved by the Board which includes:
(1) An attestation of successful completion of 750 hours of experience in a Mentorship

b. The application for Full Prescriptive Authority must be submitted within three years of being granted Provisional Prescriptive Authority.
(1) If the CMRX-P cannot meet the requirements in Section (E)(2)(a) of this Rule, the CMRX-P may petition the Board for an exception to demonstrate competence. Exceptions will be reviewed on a case-by- case basis. The decision to grant or deny such exception will be at the sole discretion of the Board.

3. Any application not completed within one year of the date of receipt of the application expires and will be purged.

F. MENTORSHIP REQUIREMENTS

1. To obtain Full Prescriptive Authority, the CMRX-P must complete 750 hours of documented experience in a Mentorship. The Mentorship shall be conducted with a Physician Mentor or RXN Mentor or CMRX Mentor [hereinafter referred to as Mentor(s)] as defined in Sections (C)(9), (C)(10) and (C)(11) of this Rule, respectively. The Mentorship must be completed within three years after Provisional Prescriptive Authority is granted.
a. For the certified midwife (CM), the mentorship hours must cover the range of practice for the specific role.

b. This Section (F) does not apply to the CM with prescriptive authority and at least 750 hours of prescribing experience in another state, US jurisdiction or United States military applying for Full Prescriptive Authority as set forth in Section (H)(2) of this Rule.

2. The Mentorship Agreement shall contain the following elements:
a. Is documented in writing and signed by the CMRX-P and the Mentor(s).

b. Outlines a process, documentation, and frequency for ongoing Synchronous Communication, interaction and discussion of prescriptive practice throughout the Mentorship between the Mentor(s) and the CMRX-P to provide for safe prescribing practice.

3. The Mentorship Agreement shall be retained for a period of three years by the CMRX and the Mentor(s) following completion of the Mentorship and shall be available to the Board upon request.

4. The CMRX-P and the Mentor(s) shall provide documentation of the successful completion of the Mentorship as requested by the CMRX-P to complete an application to obtain Full Prescriptive Authority. The Mentor(s) shall not, without good cause, withhold his/her signature or otherwise fail to attest to the completion of the Mentorship. Upon submission of the application, the CMRX- P may be granted Full Prescriptive Authority.

5. If a circumstance such as retirement, illness, relocation or other event precludes any Mentor from continuing in the Mentorship, the CMRX-P shall secure a replacement Mentor and enter into a new, Mutually Structured Mentorship. Any hours accrued during the period of time in which the CMRX-P does not have a Mentor will not be credited toward completion of the 750 hour Mentorship.

6. The Mentor(s) shall not require payment or employment as a condition of entering into the mentor relationship. The Mentorship relationship should not be financially burdensome to either party. In recognition of the Mentor(s) time and expertise, reasonable expenses may be paid. Compensation by the CMRX-P to the Mentor(s) should be agreed upon as part of the Mutually Structured Mentorship, shall comply with standards of fair market value, and shall not be onerous or otherwise present a barrier to completion of the Mentorship.

G. OTHER REQUIREMENTS

1. The CMRX-P or CMRX must hold a valid DEA registration to prescribe controlled substances, Schedule II through V, and must adhere to all DEA requirements.

2. Pursuant to section 12-255-112(7)(c)(II), C.R.S., nothing in this Rule shall be construed to require a Certified Midwife to obtain prescriptive authority to deliver anesthesia care.

3. Pursuant to section 12-255-112(9), C.R.S., nothing in this Rule shall be construed to permit dispensing or distribution, as defined in section 12-280-103(14) and (15), C.R.S., by the CMRX, except for receiving and distributing a therapeutic regimen of prepackaged drugs prepared by a licensed pharmacist or drug manufacturer registered with the FDA and appropriately labeled, free samples supplied by a drug manufacturer, and distributing drugs for administration and use by other individuals as authorized by law.

H. REQUIREMENTS FOR A CERTIFIED MIDWIFE WITH PRESCRIPTIVE AUTHORITY IN ANOTHER STATE TO OBTAIN FULL PRESCRIPTIVE AUTHORITY IN COLORADO

1. Applicants must submit an application in a manner approved by the Board.

2. Applicants must be actively licensed as a Certified Midwife in the Role for which the Applicant seeks Prescriptive Authority.

3. Applicants must have Active Prescriptive Authority in another state or U.S. jurisdiction in the Role for which the Applicant seeks Prescriptive Authority.
a. Prescriptive Authority credentials issued by the United States Military are deemed to be substantially equivalent to prescriptive authority in another state or jurisdiction.

4. Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and at least 750 hours of documented experience prescribing medications in another state, U.S. jurisdiction, or U.S. military:
a. Verification of prescriptive authority and 750 hours of documented experience prescribing medications, in another state, jurisdiction, or the U.S. military, in a manner approved by the Board. The acceptance of the documented hours of experience prescribing medications is at the sole discretion of the Board; and

5. Requirements to apply for Full Prescriptive Authority for applicants with prescriptive authority and less than 750 hours of documented experience prescribing medications in another state, jurisdiction, or the U.S. military:
a. Active Provisional Prescriptive Authority granted pursuant to Section (E)(1) of this Rule.

b. Completion of the additional hours, up to at least 750 hours, of experience prescribing medications within a Mentorship as set forth in Section (F) of this Rule.

c. Submission of an application for Full Prescriptive Authority within three years of obtaining Provisional Prescriptive Authority, providing evidence of the following:
(1) Verification of prescriptive authority and hours of documented experience prescribing medications, in another state, in a manner approved by the Board. The acceptance of the documented hours of experience prescribing medication is at the sole discretion of the Board; and

(2) Additional mentored prescribing hours, up to at least 750 hours, completed within a Mentorship in Colorado.

d. Upon petition by the applicant, and with due consideration of the need to protect the public, the Board may accept a substantially equivalent method of establishing the requirements set forth in this Section (H)(5) of this Rule. It is anticipated that such alternative will rarely be used. The decision to accept such substantially equivalent method of establishing the requirements is at the sole discretion of the Board.

I. REINSTATEMENT OF PRESCRIPTIVE AUTHORITY

1. To apply for reinstatement of prescriptive authority the Applicant must possess an active, Colorado Certified Midwife license that is in good standing and without Disciplinary Sanction as defined in Section (C)(7) of this Rule.

2. A Certified Midwife applying to reinstate Full Prescriptive Authority must complete the reinstatement application for Full Prescriptive Authority and meet the requirements as set forth in Sections (D), (E), (F) and (G) of this Rule.
a. If a Certified Midwife fails to meet the requirements as set forth in section 12-255-112, C.R.S., and the Provisional Prescriptive Authority expires by operation of law, the Certified Midwife must complete a new application for Provisional Prescriptive Authority and meet the current requirements as set forth in Sections (D), (E), and (F) of this Rule.

3. A Certified Midwife whose Provisional or Full Prescriptive Authority is withdrawn as the result of a disciplinary action under section 12-255-119, C.R.S., as set forth in Section (K)(2)(a) of this Rule, shall not be eligible to apply for Prescriptive Authority for two years after the date of the withdrawal of such Prescriptive Authority. After the end of the two year waiting period a Certified Midwife must complete a new application and meet all requirements as set forth in this Rule.

4. Every Certified Midwife with prescriptive authority applying for reinstatement, except those who qualify for an exemption, must fulfill the substance use prevention training requirements set forth in Section (C) of Rule 1.25.

J. RENEWAL OF PRESCRIPTIVE AUTHORITY

1. Renewal of Provisional or Full Prescriptive Authority is required at the time of the CMRX's Certified Midwife license renewal in Colorado. Certified Midwives granted Provisional or Full Prescriptive Authority by the Board shall be required to renew the Provisional or Full Prescriptive Authority every two years and shall be issued a specific expiration date for the Prescriptive Authority.

2. Every Certified Midwife with prescriptive authority applying for renewal, except those who qualify for an exemption, must fulfill the substance use prevention training requirements set forth in Section (C) of Rule 1.25.

K. WITHDRAWAL OF PROVISIONAL OR FULL PRESCRIPTIVE AUTHORITY

1. The CMRX may request that the Provisional or Full Prescriptive Authority be voluntarily withdrawn.

2. The Board may withdraw Provisional or Full Prescriptive Authority if the Certified Midwife no longer meets the requirements for Provisional or Full Prescriptive Authority or the Certified Midwife is subject to discipline under section 12-255-120, C.R.S., in accordance with the procedures set forth in section 12-255-119, C.R.S.
a. The Certified Midwife whose Provisional or Full Prescriptive Authority has been withdrawn as a result of disciplinary action under section 12-255-119, C.R.S., shall not be eligible to apply for Prescriptive Authority for two years after the date of the Board's withdrawal of such Prescriptive Authority. For the purpose of this Section (K)(2)(a), withdrawal of Provisional or Full Prescriptive Authority shall include surrender or revocation of same.

3. If Provisional or Full Prescriptive Authority has been withdrawn, and the Certified Midwife wishes to apply for Provisional or Full Prescriptive Authority, the Certified Midwife must file a new application and meet all requirements as set forth in this Rule at the time of application.

L. DISCIPLINE OF CERTIFIED MIDWIVES WITH PRESCRIPTIVE AUTHORITY

1. CMRX and CMRX-P disciplinary proceedings shall be the same as set forth in section 12- 255-119, C.R.S., and the grounds for discipline are as set forth in section 12-255-120, C.R.S.

Adopted: January 24, 2024

Effective: March 16, 2024

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