A physician may enter into a
collaborative agreement with certified nurse midwives not exceeding a
cumulative three hundred and sixty (360) hours (nine FTEs) per week. The
physician shall not collaborate with or supervise any combination of certified
registered nurse practitioners, certified nurse midwives and/or assistants to
physicians exceeding three hundred and sixty (360) hours per week (nine
full-time equivalent positions). "One full- time equivalent" (FTE) is herein
described as a person/persons collectively working forty hours a week,
excluding time on call.
(a) A physician
collaborating with more than four FTEs per week shall engage in documented
quality assurance review with each CNM every month for six (6) months following
the commencement of a collaborative practice with a new CNM.
(b) A physician shall disclose to the Board
of Medical Examiners the existence of all collaborative and supervisory
agreements to which the physician is a party, including collaborative and
supervisory agreements in other states, and shall not be eligible to
collaborate with or supervise any combination of certified registered nurse
practitioners, certified nurse midwives and/or assistants to physicians
exceeding three hundred and sixty (360) hours per week (nine full-time
equivalent positions), inclusive of collaborative and supervisory agreements
existing in other states. Agreements with an individual certified registered
nurse practitioner, certified nurse midwife, and/or assistant to physician in
multiple states shall only be counted once for purposes of calculating the
total number of full-time equivalent positions.
(2) Employees of the Alabama Department of
Public Health and county board of health are specifically exempt from the
requirements of paragraph (1) of this rule.
A physician in collaborative practice may
request approval for additional full-time certified nurse midwife positions by
the Joint Committee, with consideration given to the following factors to
ensure that an acceptable standard of care is rendered:
(a) Availability of the physician
(b) Practice settings and staffing needs for
extended hours of service
preparation, specialty and experience of the parties in the collaborative
(e) Complexity and risk of
procedures to be performed
(4) A physician in collaboration with CRNP,
CNM or supervising Physician Assistant personnel totaling 360 hours per week
(nine (9) FTEs) may request a transitional allowance increasing the total
weekly hours for the purpose of orientation of the incoming CNM. The
transitional allowance shall not exceed 45 days. The physician shall request
the transitional allowance in writing and specify the starting date for this
Ala. Admin. Code r.
New Rule: Filed June 20,
1996; effective July 26, 1996. Amended: Filed August 25, 2003; effective
September 29, 2003.
Administrative Monthly Volume XXXIII, Issue No. 10, July 31,
2015, eff. 8/6/2015.
Administrative Monthly Volume XXXIX, Issue No. 07, April 30,
2021, eff. 6/14/2021.
Was previously Rule
renumbered as per certification filed August 25, 2003; effective September 29,
2003. Was previously Rule
renumbered as per certification filed April 23, 2004; effective May 28,
Author: Alabama Board of Medical
Statutory Authority: Code of Ala.