100.
GENERAL PROVISIONS
101.
PURPOSE AND AUTHORITY
Act 838 of 1983 provided for the lawful practice of Licensed Lay Midwifery in counties having 32.5% or more of their population below the poverty level.Act 481 of 1987 superseded Act 838 of 1983, and expanded the lay midwifery licensure statewide. These Rules govern the practice of Licensed Lay Midwives (LLMs) in Arkansas.
The following Rules are promulgated pursuant to the authority conferred by the Licensed Lay Midwife Act A.C.A. §
17-85-101 et seq. And A.C.A. §
20-7-109.
Specifically, the LLM Act directs the Arkansas State Board of Health to administer the provisions of the Act and authorizes and directs the Board to adopt rules governing the qualifications for licensure of lay midwives and the practice of Licensed Lay Midwifery. The broad authority vested in the Board of Health, pursuant to ACA §
20-7-109, to regulate and to ultimately protect the health of the public is the same authority the Board utilizes in enforcing the Rules, determining sanctions, revoking licenses, etc.
102.
ADMINISTRATION OF PROGRAM
The State Board of Health (BOH) has delegated the authority to the Arkansas Department of Health (ADH).
103.
DEFINITIONS
As used in these Rules, the terms below will be defined as follows, except where the context clearly requires otherwise:
1. ADVERTISEMENT AND ADVERTISING
Any statements, oral or written, disseminated to or before the public, with the intent of selling professional services, or offering to perform professional services. Advertising includes - but is not limited to - promotional literature, websites, and social media sites used for the purpose of selling services.
2. APPRENTICE
A person who is training to become an LLM in Arkansas working under the direct supervision of a preceptor.
3. ARKANSAS DEPARTMENT OF HEALTH CLINICIAN
An ADH physician, Certified Nurse Midwife (CNM) or nurse practitioner providing ADH maternity services at a local health unit.
4. ARKANSAS RULES EXAMINATION
The exam that tests knowledge of the Rules Governing the Practice of Licensed Lay Midwifery in Arkansas.
5. AUTOMATIC LICENSURE
Granting the occupational licensure without an individual having met occupational licensure requirements provided under the Arkansas Code or by other provisions in these Rules.
6. BIRTHING/BIRTH CENTER
Any facility licensed by ADH which is organized to provide family-centered maternity care in which births are planned to occur in a home-like atmosphere away from the mother's usual residence following a low-risk pregnancy.
7. CERTIFIED MIDWIFE (CM)
Individuals who have or receive a background in a health-related field other than nursing, and graduate from a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME). Graduates of an ACME accredited midwifery education program take the same national certification examination as CNMs but receive the professional designation of certified midwife.
8. CERTIFIED NURSE MIDWIFE (CNM)
A person who is certified by the American College of Nurse Midwives and is also currently licensed by the Arkansas State Board of Nursing or the appropriate licensing authority of a bordering state to perform nursing skills relevant to the management of women's health care for compensation, focusing on pregnancy, childbirth, the postpartum period, care of the newborn, family planning, and the gynecological needs of women. The CNM must be currently practicing midwifery unless stated otherwise in these Rules.
9. CERTIFIED PROFESSIONAL MIDWIFE (CPM)
A professional midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM).
10. CLIENT
A pregnant woman, a postpartum woman for a minimum of thirty (30) days, or her healthy newborn for the first fourteen (14) days of life who is the recipient of LLM services.
11. CONSULTATION
The process by which an LLM who maintains primary responsibility for the client's care, seeks the advice of a physician, CNM, or ADH clinician. This may be by phone, in person or by written request. The physician, CNM, or ADH clinician may require the client to come into their office for evaluation.
12. CONTACT HOUR
A unit of measure to describe 50-60 minutes of an approved, organized learning experience that is designed to meet professional educational objectives. It is a measurement for continuing education. One contact hour is equal to 0.1 CEU. Ten contact hours are equal to one (1) CEU.
13. LABOR SUPPORT ATTENDANT
An individual who is present at the request of the client to provide emotional or physical support for the client and her family.
14. LLM ASSISTANT
An individual who is present at the request of the LLM at any point during the course of midwifery care of the client to provide services under LLM supervision.
15. LICENSED LAY MIDWIFE (LLM)
Any person who is licensed by ADH to practice midwifery and who performs for compensation those skills relevant to the management of care of women in the antepartum, intrapartum, and postpartum periods of the maternity cycle.Also manages care of the healthy newborn for the first fourteen (14) days of life.
16. LOCAL HEALTH UNIT
A community-based ADH clinic site that provides medical and environmental services.
17. MIDWIFERY BRIDGE CERTIFICATE
A certification administered by NARM awarded to CPMs following the completion of accredited approved continuing education contact hours based upon identified areas to address emergency skills and the International Confederation of Midwives (ICM) competencies.
18. NORTH AMERICAN REGISTRY OF MIDWIVES (NARM)
The international certification agency that established, and continues to administer, certification for the credential "Certified Professional Midwife" (CPM) and the Midwifery Bridge Certificate (MBC).
19. PHYSICIAN
A person who is currently licensed by the Arkansas State Medical Board - or the appropriate licensing authority of a bordering state - to practice medicine or surgery. For the purposes of any sections of these Rules governing the care of pregnant and postpartum women, "physician" refers to those currently practicing obstetrics. For the purposes of any sections of these Rules governing the care of newborn infants, "physician" refers to those physicians who currently include care of newborns in their practices.
20. PRECEPTOR
A legally practicing obstetric or midwifery practitioner who participates in the teaching and training of apprentice midwifery students and meets NARM preceptor standards including credentials, years of experience, and birth attendance requirements. A preceptor assumes responsibility for supervising the practical (clinical obstetric) experience of an apprentice and for the midwifery services they render during their apprenticeship. In the case of transitional apprentices, the definition of preceptor in Appendix B applies.
21. REFERRAL
The process by which the client is directed to a physician, CNM or ADH clinician for management of a particular problem or aspect of the client's care, after informing the client of the risks to the health of the client or newborn.
22. SUPERVISION
The direct observation and evaluation by the preceptor of the clinical experiences and technical skills of the apprentice while present in the same room.
23. TRANSFER OF CARE
The process by which the LLM relinquishes care of her client for pregnancy, labor, delivery, or postpartum care to a physician, CNM or ADH clinician, after informing the client of the risks to the health or life of the client.
24. UNIFORMED SERVICE MEMBER
An active or reserve component member of the United States Air Force, United States Army, United States Coast Guard, United States Marine Corps, United States Navy, United States Space Force, or National Guard; an active component member of the National Oceanic and Atmospheric Administration Commissioned Officer Corps; or an active or reserve component member of the United States Commissioned Corps of the Public Health Service.
25. UNIFORMED SERVICE VETERAN
A former member of the United States uniformed services discharged under conditions other than dishonorable
104.
SCOPE OF PRACTICE
1. The LLM may provide midwifery care according to the protocols in these Rules only to healthy women, determined through a physical assessment and review of the woman's health and obstetric history, who are at low risk for the development of medical or obstetric complications of pregnancy or childbirth and whose expected outcome is the delivery of a healthy newborn and an intact placenta. The LLM shall be responsible for care of the healthy newborn immediately following delivery and for the first fourteen (14) days of life (unless care is transferred to a physician or APRN specializing in the care of infants and children before that). After fourteen (14) days the LLM is no longer responsible and the client should seek further care from a physician or an APRN specializing in the care of infants and children. If any abnormality is suspected, including - but not limited to - a report of an abnormal genetic/metabolic screen or positive antibody screen, the newborn must be sent for medical evaluation as soon as possible but no later than 72 hours. This does not preclude the LLM from continuing to provide counseling regarding routine newborn care and breastfeeding.
2. Although the ADH Licensed Lay Midwifery program is supervised by ADH physicians, each LLM is encouraged to develop a close working relationship with one or more specific physicians in obstetric and pediatric practice, or CNMs in obstetric practice who agree to serve as a referral/consultation source for the LLM. This relationship is optional. The referral physician and LLM relationship, or the CNM and LLM relationship, can be terminated by either party at any time.
3. Apprentice midwives and LLM assistants may only work under the on-site supervision of their preceptor.
4. At various points during the course of midwifery care, the LLM must inform the client of the requirement for tests, procedures, treatments, medications, or referrals specified in Section 300 (Protocols) of these Rules which are for the optimal health and safety of the mother and baby, and refusal is strongly discouraged. However, continuing care of a client who refuses some of these requirements is permitted if the LLM meets certain requirements as outlined in paragraphs 5 through 8.
5. LLMs that have a current Certified Professional Midwife (CPM) credential but do not have a Midwifery Bridge Certificate (MBC) may continue care of clients that:
a. Refuse the following tests listed in Section 302.02 Prenatal Testing:
i. Pap test/HPV test.
ii. Test for Gonorrhea and Chlamydia.
iii. Test for Syphilis.
iv. Hepatitis B test.
v. HIV counseling and test.
b. Refuse recommended Rh immunoglobulin as outlined in 302.05.
c. Refuse a referral or to follow advice against home birth as a result of the identification of these pre-existing conditions listed in 303.02:
i. History of seven (7) or more deliveries.
ii. Maternal age greater than or equal to forty (40) at estimated date of delivery.
iii. Previous infant weighing less than five (5) pounds or more than ten (10) pounds.
iv. Pregnancy termination or loss >= three (3).
d. Refuse the newborn procedures listed in 308.03 and 308.04:
i. Administration of eye medication if indicated.
ii. Administration of Vitamin K.
6. LLMs that have both a current CPM and the MBC, or LLMs that have a CNM or CM, may continue care of clients that refuse any test, procedure, treatment, referral, or medication, except for:
a. The precluded conditions listed in Section 303.01;
b. The requirement of having the Risk Assessments listed in Section 302.01; or
c. Conditions requiring immediate transport as listed in Sections 305.01, 307.01, and 309.01.
7. LLMs that do not have a current CPM credential are not permitted to continue care for clients who refuse any of the required tests, procedures, treatments, medications or referrals specified in these Rules except for recommended Rh immunoglobulin as outlined in 302.05. Should a client refuse Rh Immunoglobulin the LLM must follow 104.#8.b-f.
8. Should a client of the LLM with a CPM, CM, CNM, or CPM/MBC refuse any of the tests or procedures pursuant to paragraphs 5 and 6:
a. The LLM must inform the client that the LLM is only permitted to continue to provide care to the client if the LLM's certification meets the required standard as outlined in 5 and 6.
b. The LLM must inform the client of the potential risks to herself or her baby. It is the responsibility of the LLM to provide current evidence and adequate information, both written and verbal, to the client regarding the risks of declining the test, procedure, treatment, medication or referral, including the risks and benefits of no action at all. This must include the review of any available and relevant ADH-approved sources on each test, procedure, treatment, medication or referral being refused.
c. The LLM must document the client's refusal using the ADH Informed Refusal Form and include:
i. The information shared with the client as outlined in 8.b. and the ADH-approved sources used.
ii. The client's written assertion refusing the test, procedure, treatment, medication or referral.
iii. The client's affirmation of her understanding and acceptance of the risks.
iv. A plan of care for the condition, including a plan for transfer of care if indicated.
d. The ADH Informed Refusal form must be signed and dated by both the LLM and the client, and a copy kept by the LLM in the client's file. Signing the form shows they have discussed the risks and benefits of continuing under the care of the LLM.
e. Each signed refusal form must be documented by completing an Incident Report form and noting the Informed Refusal on the next LLM Caseload and Birth Report Log.
f. Documentation of refusal must be included in the client's record in the event a client changes her mind concerning an informed refusal.
9. It is the responsibility of the LLM to engage in a process of continuous evaluation, beginning with the initial consultation and continuing throughout the provision of care. This includes continuously assessing safety considerations and risks to the client and informing her of the same. The LLM is expected to use their judgment in assessing when the client's condition or health needs exceed the LLM's knowledge, experience or comfort level. The LLM has the right and responsibility to terminate care under these circumstances.
10. If any medications that are provided by ADH or prescribed by a physician or CNM in accordance with these Rules are administered at the home birth site, the LLM shall document this in the client health record and include the following:
a. The name of the medication;
b. The lot number and date of expiration;
c. The strength and amount or dose of the medication;
d. The date and time the medication is administered;
e. The name of the prescriber; and
f. Document:
i. The name and the credentials of the nurse administering the medication, or
ii. That the client, or LLM as agent to the client, administered medication to the newborn.
11. The LLM is required to comply with all provisions of HIPAA (Health Insurance Portability and Accountability Act).
12. The LLM is required to comply with all provisions of CLIA (Clinical Laboratory Improvement Amendments) when tests are performed for the purpose of providing information for the healthcare of midwife clients.
105.
TITLE PROTECTION
1. A person may not practice or offer to act as a lay midwife in Arkansas unless licensed by the State Board of Health. It is unlawful for any person not licensed as a lay midwife by the State Board of Health to receive compensation for attending births as an LLM, or to indicate that they are licensed to practice lay midwifery in Arkansas, excluding licensed CNMs and licensed physicians.
2. Anyone unlawfully practicing lay midwifery without a license shall be deemed guilty of a misdemeanor and upon conviction thereof, shall be punished by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500), or by imprisonment in the county jail for a period of not less than one (1) week nor more than six (6) months, or by fine and imprisonment.
3. The courts of this state having general equity jurisdiction are vested with jurisdiction and power to enjoin the unlawful practice of midwifery in a proceeding by the State Board of Health or any member thereof, or by any citizen of this state in the county in which the alleged unlawful practice occurred or in which the defendant resides, or in Pulaski County.
4. The issuance of an injunction shall not relieve a person from criminal prosecution for violation of the provisions of this chapter, but remedy of the injunction shall be in addition to liability to criminal prosecution.
5. An LLM must use the title "Licensed Lay Midwife" or the initials "LLM" on all materials related to their practice, including all promotional materials.
106.
DELEGATION OF LICENSED LAY MIDWIFERY FUNCTIONS
1. An LLM assistant may be engaged by the LLM to complement their work, but shall not be used as a substitute for the LLM.
a. Tasks that may be delegated to the LLM assistant before an assessment of the client's care needs is completed by the LLM include:
i. Noninvasive and non-sterile tasks if, in the judgment of the LLM, the LLM assistant has the appropriate knowledge and skills to perform the task.
ii. The collecting, reporting, and documentation of temperature, weight, intake, output, and contractions, indicating their frequency and duration.
iii. Reporting changes from baseline data established by the LLM.
iv. Assisting the client with ambulation, positioning or turning.
v. Assisting the client with personal hygiene.
vi. Reinforcing health teaching planned or provided by the LLM.
b. Tasks that must never be delegated to an LLM assistant include, but are not exclusive to, the following:
i. The performance of a physical assessment or evaluation.
ii. Physical examination which includes - but is not limited to - fetal heart rate auscultation, cervical exams, and blood pressure measurements.
iii. The provision of sterile invasive treatments.
iv. The administration of any prescription drugs.
v. The use of any medical devices.
2. The LLM shall monitor and document the care and procedures performed by any LLM assistant or labor support attendant in the client's medical record.
3. An LLM who has agreed to provide care to a client is held accountable to act according to the standards of care set out in these Rules, until such a time as that care is terminated by the client or the LLM in accordance with these Rules.
4. An LLM may request a registered nurse to perform selected acts, tasks or procedures that are outside the scope of the LLM's practice but which do not exceed the scope of practice of the nurse's license. It is the nurse's responsibility to be informed and act in accordance with both the Arkansas Nurse Practice Act and the Arkansas State Board of Nursing Rules.
5. An LLM who also holds an Arkansas nursing license is required to act in accordance with the following: the Rules Governing the Practice of Licensed Lay Midwifery in Arkansas; the Arkansas Nurse Practice Act - as codified in Ark.Code Ann. §
17-87-101 - and the Arkansas State Board of Nursing Rules as promulgated by the Arkansas State Board of Nursing. An LLM practicing under the scope of her nursing license while acting as an LLM may be referred to the Arkansas State Board of Nursing if any improper conduct is suspected.
107.
ADVERTISING
1. ADH permits advertising by LLMs regarding the practice of Licensed Lay Midwifery in accordance with these Rules.
2. No LLM shall disseminate or cause the dissemination of any advertisement or advertising that is in any way false, deceptive, or misleading. Any advertisement or advertising shall be deemed to be false, deceptive or misleading if it:
a. Contains a misrepresentation of facts; or
b. Makes only a partial disclosure of relevant facts; or
c. Contains any representation or claims as to services that the LLM cannot legally perform; or
d. Contains any representation, statement, or claim which misleads or deceives; or
e. Could lead a reasonably prudent person to believe that the LLM is licensed to practice nursing or medicine when not so licensed in the state of Arkansas.
3. Advertising that crosses into other states must clearly state if any of the services offered are legal only in certain states in which the LLM practices.
108.
IMMUNIZATIONS
All LLMs and their apprentices are strongly encouraged to have routine vaccinations to the fullest extent unless contraindicated, and not to rely on the immunization status of others or 'herd immunity' to protect them, their clients, and their families.
109.
MIDWIFERY ADVISORY BOARD
The BOH shall establish and appoint the Midwifery Advisory Board (MAB) to advise ADH and the BOH on matters pertaining to the regulation of midwifery.
1. PURPOSE, DUTIES, AND RESPONSIBILITIES:
a. Reviewing and advising ADH and the BOH regarding the Rules.
b. Reviewing and advising ADH regarding approval of continuing education units (CEUs).
c. Reviewing and advising ADH regarding quality improvement data and information.
d. Serving as community liaisons to educate the public and other providers regarding the practice of midwifery.
e. Promoting the safe practice of midwifery by addressing issues and concerns regarding the practice of midwifery of ADH, BOH, public consumers of midwifery services, and LLMs.
f. Reviewing Reports:
i. Statistical Reports
A. A draft of the annual LLM statistical report will be available to MAB members for comment prior to the presentation to the BOH.
B. Up to two (2) MAB members may consult with ADH program staff in determining the plan for the collection of data.
ii. Disciplinary Case Reports
A. ADH will notify the MAB of all disciplinary hearings taken before the BOH.A copy of the final order will be made available to the MAB.
2. COMPOSITION OF THE MAB
The composition of the MAB will be as follows:
a. Four (4) Arkansas LLMs
b. One (1) CNM, currently licensed as a CNM in Arkansas, preferably practicing.
c. One (1) member at large.
d. Three (3) public consumers who have either had a midwife-attended birth, are the spouse of someone who has had a midwife-attended birth, or are persons who have been involved in promoting midwifery or home birth in the state of Arkansas.
3. NOMINATION OF MEMBERS
Members of the MAB are appointed by the BOH. The BOH requests nominations from the MAB through ADH. The process for applying to serve on the MAB is as follows:
a. Individuals interested in either proposing a nomination or serving on the MAB must obtain an "Application for Midwifery Advisory Board Appointment" from the MAB.
b. The applicant will complete the application form and submit it to the MAB according to the instructions.
4. TERMS OF MIDWIFERY ADVISORY BOARD MEMBERS
a. Midwifery Advisory Board (MAB) members shall serve terms of up to four (4) years.
b. No member may serve more than two (2) consecutive full terms.
c. Members may be eligible for reappointment two (2) years after the date of the expiration of the second full term.
5. ORGANIZATIONAL STRUCTURE OF THE MIDWIFERY ADVISORY BOARD
a. MAB members shall establish and annually review the By-Laws of the Midwifery Advisory Board.
b. Additionally, an organizational chart with delegation of duties of MAB members and officers shall be developed.
c. MAB members shall elect a chair, vice-chair and secretary at its first meeting each year that will serve until their successors are elected.
d. The MAB will schedule and conduct meetings at least two (2) times a year and at other times, as necessary.
110.
CONTINUING EDUCATION ACTIVITIES OF THE MIDWIFERY ADVISORY BOARD
For the purpose of these Rules, the MAB will process the review of continuing education credits by the following criteria:
1. The application for review must be received by the MAB at least sixty (60) days prior to the scheduled course date, and shall be submitted simultaneously to ADH.
2. The MAB will review and evaluate the application for the continuing education course and make a recommendation to ADH.
3. The documentation will be reviewed for appropriate content applicable to the protocols and clinical practice of the Licensed Lay Midwifery program of Arkansas. Each application shall be evaluated on the following criteria:
4. Completeness of application;
5. Agenda;
6. Intended audience;
7. Method of delivery (lecture, video, correspondence, online, other);
8. Course description and objectives; and
9. Biographical data for each speaker including pertinent education and experience.
10. The recommendation of the MAB shall be submitted in writing for ADH approval, no less than thirty (30) days prior to the scheduled course date.ADH will make the final decision for approval of continuing education courses, after consideration of timely received MAB recommendations. All final decisions by ADH denying approval for continuing education courses may be appealed to the Arkansas State BOH within thirty (30) days of receiving the denial.
200.
LICENSING
1. An LLM license, valid for up to three (3) years, is issued upon application and favorable review.Application materials and instructions are available from the ADH website or by contacting the ADH Women's Health Section for assistance.
2. Unless otherwise specified by these Rules, individuals who wish to become licensed as an LLM in Arkansas are required to have either current NARM CPM certification, current certification by the American Midwifery Certification Board as a CNM or CM, or current certification deemed equivalent and approved by ADH.
3. LLMs seeking renewal of their license must have current CPM, CNM or CM certification unless they were licensed continuously prior to these Rules and have never been certified as a CPM. Those LLMs may renew their license by showing documentation of CEUs as required in Section 202 #2d and completing the renewal application process.
4. It is the responsibility of the LLM to ensure their credentials and certifications are current at all times. These include - but are not limited to - CPM, CPR, and neonatal resuscitation. The licensee must provide documentation upon request.
5. LLMs who receive a CPM or MBC must provide verification with initial application and for license renewal, or within thirty (30) days of initial certification.A notarized copy of the certificate or a verification letter sent directly from NARM must be submitted to ADH.
6. In the event of a lapse or revocation of any licensure or certification held the LLM must notify ADH within thirty (30) days of revocation.
7. If the name used on the application is not the same as that on any of the supporting documentation, the applicant must submit proof of name change with application.
8. Apprentices who hold a valid permit prior to the effective date of these Rules will follow the requirements for licensure found in Appendix B: Transitional Provisions and Forms.
9. If an application for licensure or renewal is denied, the applicant may appeal that denial to the Arkansas State BOH with thirty (30) days of receipt of the denial.
201.
ELIGIBILITY REQUIREMENTS FOR INITIAL LICENSURE
Applicants for initial licensure must meet the following requirements, except for those noted in Section 200. #3:
1. An applicant for an initial license to practice midwifery shall submit:
a. A completed application, provided by ADH.
b. A passport style and size photo of the applicant, head and shoulders, taken within sixty (60) days prior to the submission date of the application and attached to the application.
c. A copy of one of the following documents that demonstrates the applicant is twenty-one (21) years of age or older:
i. The applicant's birth certificate.
ii. The applicant's U.S. passport, U.S. Driver's License, or other state-issued identification document.
iii. Any document issued by federal, state or provincial registrar of vital statistics showing age.
d. Documentation of a high school diploma or its equivalent, and documentation of the highest degree attained after high school. This documentation should include the name of the issuing school or institution and the date issued.
e. Documentation that applicant is certified by NARM as a CPM or by the American Midwifery Certification Board (AMCB) as a CNM or a CM, or holds a certification deemed equivalent and approved by ADH. Documentation may be received in the form of a verification letter directly from the credentialing body or a notarized copy of the applicant's credential.ADH may request additional documentation to support applicants' qualifications or certifications. It is the responsibility of the licensee to ensure relevant credentials are current at all times and documentation must be provided upon request.
f. If applicable, documentation that applicant holds an MBC issued by NARM. Documentation may be received in the form of a verification letter directly from the certifying body or a notarized copy of the applicant's certificate.
g. A list on the application form of all current professional health-related licensure including those from other jurisdictions.ADH may request verification.
2. Upon satisfactory review of the application by ADH, the applicant:
a. Shall take the Arkansas Rules Examination, which will be administered at ADH, three (3) times each year on dates chosen and publicized by ADH.
b. Shall provide proof of identity upon request in the form of a government-issued photographic identification card at the time of testing.
c. Shall receive a written notice of examination results. If the applicant scores 80% or higher on the Arkansas Rules Examination, a license will be issued.
d. Shall be permitted to re-test if their score is below 80%.
3. All final decisions by ADH denying issuance of license may be appealed to the Arkansas State BOH pursuant to the Arkansas Administrative Procedures Act.
4. Prohibiting Criminal Offenses
a. An individual is not eligible to receive or hold a license issued by the ADH if that individual has pleaded guilty or nolo contendere to or been found guilty of any of the offenses detailed in Ark.Code Ann. §
17-3-102 et. seq. By any court in the State of Arkansas or of any similar offense by a court in another state or of any similar offense by a federal court, unless the conviction was lawfully sealed under the Comprehensive Criminal Record Sealing Act of 2013 §
16-90-1401 et. seq. or otherwise sealed pardoned or expunged under prior law.
b. ADH may grant a waiver as authorized by Ark.Code Ann. §
17-3-102 in certain circumstances.
c. For the purpose of issuing a lay midwife license, ADH is not authorized to conduct criminal background checks, but may inquire about criminal convictions upon application or renewal of a license. Any applicant or licensee which provides false information to ADH regarding a criminal conviction may be subject to suspension, revocation or denial of a license.
5. Pre-Licensure Prohibiting Offense Determination
a. Pursuant to Act 990 of 2019, an individual may petition for a pre-licensure determination of whether the individual's criminal record will disqualify the individual from licensure and whether a waiver may be obtained.
b. The individual must obtain the pre-licensure criminal background check petition form from Appendix A of these Rules.
c. ADH will respond with a decision in writing to a completed petition within a reasonable time.
d. ADH response will state the reason(s) for the decision.
e. All decisions of ADH in response to the petition will be determined by the information provided by the individual.
f. Any decision made by ADH in response to a pre-licensure criminal background check petition is not subject to appeal.
g. ADH will retain a copy of the petition and response and it will be reviewed during the formal application process.
202.
RENEWAL
1. Licenses expire on August 31 of the renewal year, and applications and documentation must be submitted by July 2 of the renewal year to be timely. Renewal will only occur upon receipt of application and favorable review of required activity reports by ADH. This review will ensure that the LLM has acted in accordance with these Rules.
2. Applications for renewal for LLMs who have been continuously licensed in the State of Arkansas prior to the effective date of these Rules, and who have never received certification as a CPM, must include:
a. A completed application for renewal provided by ADH.
b. A copy of both sides of current certification in adult and infant cardiopulmonary resuscitation (CPR).Approved CPR courses include the American Heart Association and the American Red Cross. Note: Only certification from courses which include a hands-on skills component are accepted. Online-only courses are not accepted. It is the responsibility of the licensee to ensure this certification is current at all times and documentation must be provided upon request
c. A copy of both sides of current certification in neonatal resuscitation through a course approved by NARM. Note: Only certification from courses which include a hands-on skills component are accepted. Online-only courses are not accepted. It is the responsibility of the licensee to ensure this certification is current at all times and documentation must be provided upon request
d. Documentation of thirty (30) hours of continuing clinical education within the past three (3) years. Continuing Education Units (CEUs) and contact hours will be approved according to the following guidelines:
i. A maximum of five (5) hours may be granted for documented peer review.
ii. CPR or neonatal resuscitation courses may not be used as part of your CEU totals.
iii. Workshops or conferences relevant to the clinical practice of midwifery in Arkansas that are sponsored by the following organizations are pre-approved by the Licensed Lay Midwifery Advisory Board for CEUs:
A. American College of Nurse Midwives
B. American College of Obstetrics and Gynecology
C. Arkansas Department of Health
D. International Childbirth Education Association
E. La Leche League International
F. University of Arkansas for Medical Sciences
G. Midwifery Education Accreditation Council (MEAC)
H. Any state Nurses Association
I. Arkansas Osteopathic Medical Schools
3. Applications for renewal for the LLM licensed by ADH and certified as a CPM, CNM or CM or having a certification previously approved by ADH (Section 201.#1.e.) must include:
a. A completed application for renewal in a format provided by ADH.
b. Proof that the relevant credential is current. Documentation may be received in the form of:
i. Verification letter sent directly from the certifying agency, or
ii. Notarized copy of the certificate.
c. A list of all professional health-related licensure in other jurisdictions on the renewal application. ADH may request verification.
d. ADH may request additional documentation to support applicants' qualifications or certifications. It is the responsibility of the licensee to ensure relevant credentials are current at all times and documentation must be provided upon request.
4. The state Arkansas Rules Examination must be taken for each licensing period within one hundred and eighty (180) days prior to the expiration of the midwifery license. A score of eighty percent (80%) or higher must be achieved. The test for renewal of licenses will be available on the ADH website or by contacting the ADH Women's Health section for information. The applicant must submit a copy of the certificate of completion with the application for license renewal.
5. All final decisions by ADH denying renewal of license may be appealed to the Arkansas State BOH pursuant to the Arkansas Administrative Procedures Act.
203.
GROUNDS FOR DENIAL OF APPLICATION, DISCIPLINE, SUSPENSION, OR REVOCATION OF LICENSE
ADH may refuse to issue, suspend or revoke a license for violation of the Licensed Lay Midwife Act or any provision of these Rules, including - but not limited to - any of the following reasons:
1. Securing a license or permit through deceit, fraud, or intentional misrepresentation.
2. Submitting false or misleading information to ADH, the BOH, or the MAB.
3. Practicing midwifery on expired credentials.
4. Knowingly making or filing a false report or record, intentionally or negligently failing to file a report or record required by these Rules, or willfully impeding or obstructing such filing.
5. Failure to submit requested midwifery records in connection with an investigation.
6. Engaging in unprofessional conduct or dereliction of any duty imposed by law, which includes - but is not limited to - any departure from, or failure to conform to, the standards of the practice of midwifery as established by these Rules.
7. Revocation of CPM certification by NARM.
8. Permitting another person to use the licensee's license or permit.
9. Knowingly or negligently employing, supervising, or permitting (directly or indirectly) any person to perform any work not allowed by these Rules.
10. Obtaining any fee by fraud or misrepresentation.
11. Knowingly or negligently allowing an LLM apprentice to practice midwifery without a supervising preceptor present, except in an emergency.
12. Using, causing, or promoting the use of any advertising material, promotional literature, or any other representation - however disseminated or published -which is misleading or untruthful.
13. Representing that the service or device of a person licensed to practice medicine will be used or made available when that is not true, or using the words "doctor", "registered nurse", "Certified Nurse Midwife" or similar words, abbreviations, acronyms or symbols including MD (Medical Doctor), DO (Doctor of Osteopathic Medicine), RN (Registered Nurse), CNM, CM, APRN (Advanced Practice Registered Nurse), RNP (Registered Nurse Practitioner), EMT (Emergency Medical Technician) or paramedic, falsely implying involvement by such a medical professional.
14. Use of the designation "birth center" or "birthing center" in reference to the LLM's home or office, or charging facility fees for delivery in a "birth center" or "birthing center", unless that center is licensed as such in compliance with the requirements set forth by the Rules for Free-Standing Birthing Centers.
15. Violation of the Arkansas Legend Drugs and Controlled Substances Law, A.C.A. §§
20-64-501 et seq., or the Federal Food, Drug and Cosmetic Act, 21 U.S.C. §§
301 et seq.
16. Displaying the inability to practice midwifery with reasonable skill and safety because of illness, disability, or psychological impairment.
17. Practicing while knowingly suffering from a contagious or infectious disease that may be transmitted through the practice of midwifery.
18. Practicing midwifery while under the influence of any intoxicant or illegal drug.
19. Judgment by a court of competent jurisdiction that the individual is mentally impaired.
20. Disciplinary action taken by another jurisdiction affecting the applicant's legal authority to practice midwifery in that jurisdiction.
21. Disciplinary action taken by another licensing or credentialing body due to negligence, willful disregard for patient safety, or other inability to provide safe patient care.
22. Gross Negligence.
23. Conviction of a felony.
24. Failure to comply with an order issued by the Arkansas State BOH or a court of competent jurisdiction.
25. Practicing outside the scope of practice and protocols as outlined in these Rules.
204.
DISCIPLINARY ACTIONS
Suspected cases involving violation of the Licensed Lay Midwifery Act or these Rules may be referred by ADH to the BOH for a hearing, according to the Arkansas Administrative Procedures Act. If the BOH finds that a person holding a license or permit has violated the Licensed Lay Midwifery Act or these Rules' sanctions, which include -but are not limited to - the following, may be imposed:
1. Revocation of license or permit.
2. Suspension of a license or permit for a determinate period of time.
3. Written or verbal reprimand of a licensee or permit holder.
4. Probation of license or permit.
5. Limitations or conditions on the practice of a person holding a license or permit.
6. Continuing education requirements to address known deficiencies.
7. Fines as imposed by the BOH under their general authority to regulate.
ADH will notify licensee of any actions to be imposed. Decisions may be appealed to the Circuit Court pursuant to the Arkansas Administrative Procedures Act.
Any applicable certification or licensing agencies will be notified of final actions on licenses including - but not limited to - NARM and any states where the midwife holds a license.
205.
INACTIVE STATUS
Inactive status is automatic on the day after the license expires. LLMs who do not maintain a current license will be considered inactive. Inactive status may be maintained for up to three (3) years. An LLM with inactive status may not practice midwifery until the license is reactivated. To reactivate a license with inactive status, the applicant must:
1. Submit a copy of their current CPM, CNM, or CM credential or, if the applicant was licensed prior to the effective date of these Rules, document additional continuing education credits totaling ten (10) hours for each year of inactive status,
2. Submit current CPR certification,
3. Submit current NARM-approved neonatal resuscitation certification, and
4. Take the Arkansas Rules Examination and achieve a score of eighty percent (80%) or higher.
206.
REACTIVATION OF EXPIRED LICENSE
After three (3) years, a license in inactive status automatically expires. To become relicensed the applicant must successfully fulfill all of the requirements for initial licensure as outlined in Section 201.
207.
APPRENTICESHIPS
Apprentices who hold a valid permit prior to the effective date of these Rules will follow the requirements found in Appendix B; Transitional Provisions and Forms.
An LLM will be responsible for notifying ADH of any apprentices accepted under their supervision within thirty (30) days of signing, but prior to the apprentice providing any services. The ADH Preceptor-Apprentice Agreement form (found in Appendix A or available on the ADH website) shall be used for this notification. Preceptors must meet all NARM preceptor requirements. Any changes in the apprentice's contact information must be provided to ADH by the LLM within thirty (30) days of the status change. If the apprentice is still under the LLM's supervision after three (3) years, the LLM must complete a new form indicating this status.
Should the Preceptor-Apprentice Agreement be terminated by either party, it is the responsibility of both parties to notify ADH immediately. An apprentice must not continue to perform under any preceptor(s) unless a new signed Preceptor-Apprentice Agreement is on file with ADH.A signed Preceptor-Apprentice Agreement for every preceptor under whom an apprentice trains must be signed and sent to ADH.
Apprentices shall follow all applicable Arkansas laws and these Rules.
Apprentices are required to comply with all provisions of HIPAA (Health Insurance Portability and Accountability Act).
208.
LICENSURE OF UNIFORMED SERVICE MEMBERS, UNIFORMED SERVICE VETERANS, AND THEIR SPOUSES
1. Applicability
This Rule applies to a:
a. Uniformed service member stationed in the State of Arkansas;
b. Uniformed service veteran who resides in or establishes residency in the State of Arkansas;
c. The spouse of (a) or (b) including a:
i. Uniformed service member who is assigned a tour of duty that excludes the spouse from accompanying the uniformed service member and the spouse relocates to Arkansas; or,
ii. Uniformed service member who is killed or succumbed to his or her injuries or illness in the line of duty if the spouse establishes residency in Arkansas.
2. Automatic Licensure
Automatic Licensure shall be granted to persons listed in section 1 (a) if:
The person is a holder in good standing of occupational licensure with similar scope of practice issued by another state, territory, or district of the United States
3. Credit Toward Initial Licensure
Relevant and applicable uniformed service education, training, or service-issued credential shall be accepted toward initial licensure for a uniformed service member or a uniformed service veteran who makes an application within one (1) year of his or her discharge from uniformed service.
4. Expiration Dates and Continuing Education
(a) A license expiration date shall be extended for a deployed uniformed service member or spouse for one hundred eighty (180) days following the date of the uniformed service member's return from deployment.
(b) A uniformed service member or spouse shall be exempt from continuing education requirements in Rule 202.02d for one hundred eighty (180) days following the date of the uniformed service member's return from deployment.
(c) Any uniformed service member or spouse exercising the exemption shall provide evidence of completion of continuing education before renewal or grant of a subsequent license.
5. ADH shall grant such automatic licensure upon receipt of all of the below:
a. Evidence that the individual holds a substantially equivalent license in another state; and
b. Evidence that the applicant is a qualified applicant under Section 208.1 a., b., or c.; and
c. The applicant shall hold his or her occupational licensure in good standing;
2. The applicant shall not have had a license revoked for:
a. An act of bad faith; or
b. A violation of law, rule, or ethics;
3. The applicant shall not hold a suspended or probationary license in a United States jurisdiction.
b. A completed application, provided by ADH.
c. A passport style and size photo of the applicant, head and shoulders, taken within sixty (60) prior to the submission date of the application and attached to the application.
d. If applicable, documentation that applicant holds an MBC issued by NARM. Documentation may be received in the form of a verification letter directly from the certifying body or a notarized copy of the applicant's certificate.
e. A list on the application form of all current professional health-related licensure, including those from other jurisdictions. ADH may request verification.
6. All applicants who are licensed pursuant to Section 208 must adhere to all LLM protocols as outlined in these Rules.
209.
RECIPROCAL LICENSURE
Pursuant to Act 1011 of 2019, reciprocal licensure will be granted based on substantially equivalent licensure in another U.S. jurisdiction. Refer to Section 201.1.e of these Rules for all certifications deemed substantially equivalent.
1.
Reciprocity
a. Required Qualifications. An applicant applying for reciprocal licensure shall meet the following requirements:
i. The applicant shall hold a substantially similar license in another United States jurisdiction.
1. Refer to Section 201.1.e of these Rules for all certifications deemed substantially equivalent.
2. The applicant shall hold his or her occupational licensure in good standing;
3. The applicant shall not have had a license revoked for:
a. An act of bad faith; or
b. A violation of law, rule, or ethics;
4. The applicant shall not hold a suspended or probationary license in a United States jurisdiction;
ii. The applicant shall be sufficiently competent in the lay midwifery; and
iii. The applicant will provide documentation to ADH verifying current certification is held as required by Section 201.1.e.
b. Required documentation. An applicant shall submit the documentation described below:
i. A completed application, provided by ADH.
ii. A passport style and size photo of the applicant, head and shoulders, taken within sixty (60) prior to the submission date of the application and attached to the application.
iii. A list on the application form of all current professional health-related licensure, including those from other jurisdictions. ADH may request verification.
iv. As evidence that the applicant's license from another jurisdiction is substantially similar to Arkansas', the applicant shall submit the following information:
1. Evidence of current and active licensure in that state.ADH may verify this information online if the jurisdiction at issue provides primary source verification on its website or by telephone to the other's state's licensing board; and
2. Evidence that the other state's licensure requirements match those listed in Section 201.1.e.ADH may verify this information online or by telephone to the other's state's licensing board.
v. To demonstrate that the applicant meets the requirements in Section 209.2.a.i.2-4, the applicant shall provide ADH with:
1. The names of all states in which the applicant is currently licensed or has been previously licensed;
2. Letters of good standing or other information from each state in which the applicant is currently or has ever been licensed showing that the applicant has not had his license revoked for the reasons listed in Section 209.2.a.i.3 and does not hold a license on suspended or probationary status as described in Section 209.2.a.i.4.ADH may verify this information online if the jurisdiction at issue provides primary source verification on its website or by telephone to the other's state's licensing board.
vi. As evidence that the applicant is sufficiently competent in the field of lay midwifery, an applicant shall:
1. Provide documentation to ADH verifying current certification is held as required by Section 201.1.e.
2. If applicable, documentation that applicant holds an MBC issued by NARM. Documentation may be received in the form of a verification letter directly from the certifying body or a notarized copy of the applicant's certificate.
2.
Temporary License
a. ADH shall issue a temporary license immediately upon receipt and satisfactory review of the application and the documentation required under Section 209.1.b.
b. The temporary license shall be effective for ninety (90) days or until ADH makes a decision on the application, unless ADH determines that the applicant does not meet the requirements in Section 209.2.a-b, in which case the temporary license shall be immediately revoked.
c. An applicant may provide the rest of the documentation required in Section 201 in order to receive a license, or the applicant may only provide the information necessary for the issuance of a temporary license.
d. Upon issuance of a temporary license, the applicant will have up to ninety (90) days to successfully complete the Arkansas Rules Examination as specified in Section 201.2.
e. Upon successful completion of the Arkansas Rules Examination, the applicant will be issued a standard Arkansas Lay Midwife License valid for up to three (3) years.
f. All standard license holders will follow the renewal process outlined in Section 202 of these Rules.
g. If the applicant does not successfully complete the Arkansas Rules Examination within ninety (90) days of issuance of a temporary and provisional license, the temporary license will be considered invalid.
h. If the applicant scores less than 80% on the Arkansas Rules Examination, the temporary license will be considered invalid.
i. A temporary license cannot be reissued or extended.
j. The applicant must successfully complete the Arkansas Rules Examination as specified in Section 201.2 in order to obtain a standard Arkansas Lay Midwife License.
3.
License for person from a state that doesn't license profession.
Applicants from another U.S. jurisdiction where substantially equivalent licensure is not available, refer to Section 201 for licensure requirements.
4. All applicants who are licensed pursuant to Section 209 must adhere to all LLM protocols as outlined in these Rules.
500.
RECORD KEEPING AND REPORTING REQUIREMENTS
501.
MONTHLY REPORTS
1. A monthly reporting log, referred to as the Caseload and Birth Log (found in Appendix A or available on the ADH website), will be maintained and sent to ADH postmarked no later than the 10th of each month regardless of any changes or additions to the Log.
2. Each woman receiving care for two (2) or more visits shall be listed on the Caseload and Birth Log in the following month of care, regardless of whether or not the LLM attended the birth.
502.
INCIDENT REPORTS
1. When any complication occurs (whether or not the LLM remained in attendance) the care must be documented in greater detail using ADH forms (found in Appendix A or available on the ADH website). The LLM shall send these forms to ADH by the 10th of the month following the event.
2. When an LLM's client delivers outside the hospital without attendance by an LLM, the LLM must submit an incident report (form found in Appendix A or available on the ADH website) describing the circumstances and outcome of the unattended birth. The LLM shall send these reports to ADH by the 10th of the month following the event.
503.
RECORD AUDITS
ADH will audit selected records from each LLM's practice each year. The purpose of the audit will be to confirm compliance with these Rules. The LLM will be required to submit the records for each client selected by ADH for auditing.
504.
DOCUMENTATION BY LLM APPRENTICES
1. LLMs supervising an apprentice midwife should record the name of the apprentice on the Birth Log when the apprentice provided care during the intrapartum and immediate postpartum period. Because the LLM is responsible for the clinical work of their apprentices, all reports will be filed by the attending LLM.
2. Clinical services provided by apprentice midwives shall be documented by the apprentice in the client record and co-signed by the LLM. Initials may be used providing the initials clearly identify the person providing care.
505.
REPORTING MATERNAL, FETAL, OR NEWBORN EVENTS
The LLM is required to track maternal and newborn events for thirty (30) days unless care is terminated by the client. Maternal events, pregnancy loss at any gestational age, or newborn events must be reported according to the following schedule. In each of these instances, LLMs will complete the required incident report (found in Appendix A or available on the ADH website) and submit it, with a complete copy of the client record, to ADH.
1. Complications resulting in intrauterine fetal death, or death of a mother or newborn within 48 hours of delivery must be reported to ADH within two (2) business days;
2. Maternal or newborn deaths that occur between two (2) through thirty (30) days of birth must be reported to ADH within five (5) business days;
3. Maternal or newborn hospitalizations that occur within thirty (30) days of delivery must be reported to ADH within five (5) business days.
506.
CLIENT HEALTH RECORD
The LLM is responsible for ensuring that all required services are documented on client records maintained by the LLM. Each page of the client record must contain the client ID number. The records will remain confidential. They are subject to periodic review by ADH staff. All client records must be maintained for at least 25 years.
507.
VITAL RECORDS
The LLM shall follow all applicable laws pertaining to vital records.
900.
CERTIFICATION
This will certify that the Rules Governing the Practice of Licensed Lay Midwifery in Arkansas were prepared pursuant to A.C.A. 20-7-109 and A.C.A. 17-85-101 et seq.
This will also certify that the foregoing Rules Governing the Practice of Licensed Lay Midwifery in Arkansas were adopted by the Arkansas Board of Health at a regular session of same held in Little Rock, Arkansas on the 28th day of October, 2021
APPENDIX A: FORMS
ARKANSAS DEPARTMENT OF HEALTH LLM DISCLOSURE FORM
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ARKANSAS DEPARTMENT OF HEALTH LLM INFORMED REFUSAL FORM
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ARKANSAS DEPARTMENT OF HEALTH
LLM INITIAL LICENSE AND REACTIVATION OF LICENSE APPLICATION
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ARKANSAS DEPARTMENT OF HEALTH LLM LICENSE RENEWAL APPLICATION
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ARKANSAS DEPARTMENT OF HEALTH
INSTRUCTIONS FOR COMPLETING LLM REQUIRED REPORTS
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ARKANSAS DEPARTMENT OF HEALTH
PRECEPTOR-APPRENTICE AGREEMENT FOR NARM PEP APPRENTICES
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ARKANSAS DEPARTMENT OF HEALTH
LLM PRE-LICENSURE CRIMINAL BACKGROUND CHECK PETITION
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ARKANSAS DEPARTMENT OF HEALTH
HOSPITAL REPORTING FORM - LAY MIDWIFE PATIENT TRANSFER
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APPENDIX B: TRANSITIONAL PROVISIONS AND FORMS
TRANSITIONAL APPRENTICES
Apprentices with active permits issued prior to the effective date of these Rules, henceforth referred to as "Transitional Apprentices", will have three (3) years from the date these Rules take effect to successfully complete their apprenticeship and submit an application for lay midwifery licensure to ADH, and request approval to sit for the NARM written examination under the requirements listed in this Appendix. If they have not done so by that date, it will be necessary for the applicant to fulfill the requirements listed in Section 201 (Initial Licensure).
1. The apprentice must submit a signed Preceptor-Apprentice Agreement to ADH within thirty (30) days of signing for each preceptor under which the apprentice trains during the course of their apprenticeship. The ADH Preceptor-Apprentice Agreement form (found in this Appendix) or available on the ADH website) shall be used for this notification.
2. Should the Preceptor-Apprentice Agreement be terminated by either party, it is the responsibility of both parties to notify ADH immediately. An apprentice must not continue to perform under any preceptor(s) unless a new signed Preceptor-Apprentice Agreement is on file with ADH.
3. Preceptors must be an Arkansas-licensed midwife or certified nurse-midwife, or if outside of Arkansas, preceptors must be licensed by the state of residency as a direct-entry midwife or certified nurse midwife, or have a Certified Professional Midwife credential from the North American Registry of Midwives.
4. Any changes in the apprentice's contact information must be provided to ADH by the apprentice within thirty (30) days of the status change.
5. Apprentices shall follow all applicable Arkansas laws and these Rules.
6. Apprentices are required to comply with all provisions of HIPAA (Health Insurance Portability and Accountability Act).
7. Permit Renewal
For those apprentices holding valid Apprentice Permits, on or before the effective date of these Rules, the permit must be renewed by the permit's expiration date if necessary. Renewal will only occur upon application and favorable review by ADH. This review will assure that the lay midwife apprentice is acting under the supervision of the preceptor and in accordance with these Rules. The permit will be valid until three (3) years from the effective date of these Rules. If an apprentice has not obtained Arkansas licensure by that date, the applicant will no longer be considered a transitional apprentice and must follow the guidelines for licensure found in Section 201 (Initial Licensure).
To renew the permit, the Apprentice shall submit the following evidence at least sixty (60) days before the expiration date of the permit:
a. A completed application (Appendix A).
b. A copy of both sides of current certification in adult and infant cardiopulmonary resuscitation (CPR). Approved CPR courses include courses that are approved by NARM. Note: Only certification from courses which include a hands-on skills component are accepted. Online-only courses are not accepted. It is the responsibility of the apprentice to ensure this certification is current at all times and documentation must be provided upon request.
c. A copy of both sides of current certification in neonatal resuscitation through a course approved by NARM. Note: Only certification from courses which include a hands-on skills component are accepted Online-only courses are not accepted. It is the responsibility of the apprentice to ensure this certification is current at all times and documentation must be provided upon request.
d. Documentation of clinical experience for the time period covered for the current permit period. This includes progress made toward licensure for those years, i.e. number of antepartum (AP) visits conducted, labor managements and deliveries, newborn evaluations and postpartum examinations conducted under supervision.
e. Verification of all current Preceptor-Apprentice relationships documented by a Preceptor Apprentice Agreement form for each preceptor signed within 90 days of application submission.
8. Initial Licensure
Transitional apprentices who are approved by ADH to sit for, and who pass, the NARM written examination will be issued a license upon completion of all other requirements.
A transitional apprentice who receives licensure must go through NARM and become certified as a CPM in order to be eligible to renew their license at the end of their initial licensure period. License renewal will follow the procedures outlined in Section 202.
Once the CPM certification is received, a notarized copy of the certificate or a verification letter sent directly from NARM must be submitted to ADH within thirty (30) days of certification.
Eligibility requirements for approval for transitional apprentices to sit for the NARM written examination:
a. A completed application.
b. Additional documentation as follows:
i. A passport style and size photo of the applicant, head and shoulders, taken within sixty (60) days of the submission date of the application and attached to the application.
ii. A copy of one of the following documents that demonstrates the applicant is 21 years of age or older:
A. The applicant's birth certificate.
B. The applicant's U.S. passport, U.S. Driver's License or other state-issued identification document.
C. Any document issued by federal, state or provincial registrar of vital statistics showing age.
c. A copy of both sides of current certification in adult and infant cardiopulmonary resuscitation (CPR). Approved CPR courses include courses that are approved by NARM. Note: Only certification from courses which include a hands-on skills component are accepted. Online-only courses are not accepted. It is the responsibility of the licensee to ensure this certification is current at all times and documentation must be provided upon request.
d. A copy of both sides of current certification in neonatal resuscitation through a course approved by NARM. Note: Only certification from courses which include a hands-on skills component are accepted. Online-only courses are not accepted. It is the responsibility of the licensee to ensure this certification is current at all times and documentation must be provided upon request.
e. Documentation of a high school diploma, or its equivalent, and documentation of the highest degree attained after high school. This documentation should include the name of the issuing school or institution and the date issued. Applicant's name must be the same as on the copy of the diploma or degree. If applicant's name is not the same, applicant must submit proof of name change with application.
f. Verification of professional health-related licensure in other jurisdictions may be requested by ADH.
9. Documentation of Practical Experience
Applicants for licensure must demonstrate competency in performing clinical skills during the antepartum, intrapartum, postpartum, and the immediate newborn periods. Each applicant must successfully complete an evaluation of clinical skills. The applicant must submit a statement that the following minimal practical experience requirements have been performed under the supervision of a physician, CNM, or LLM.
These forms should be submitted only after the applicant has a "pass" on each item, except for certain emergencies that may not occur during a preceptorship. The following required forms must be submitted:
a. Clinical Experience Documentation for Births as a Primary Midwife form
b. Preceptor Verification Form for LLM Application
c. Documentation of Acquisition of Clinical Knowledge and Skills (completed by each Preceptor Midwife)
i. The applicant must attend a minimum of 20 births as an active participant.
ii. Functioning in the role of primary LLM under direct on-site supervision, the applicant must attend a minimum of an additional 20 births, of these:
A. A minimum of 10 must occur in an out-of-hospital setting and
B. A minimum of 3 must include at least 4 prenatal exams, birth attendance, the newborn exam, and 1 postpartum exam, each conducted personally by the applicant with direct supervision.
C. 75 prenatal exams, including 20 initial exams
D. 20 newborn exams
E. 40 postpartum exams
10. Licensing Examination
a. After the provisions listed above are satisfactorily completed, the applicant is eligible to take the NARM licensing exam.
b. Upon receipt of documentation that the applicant has passed the NARM examination the applicant is eligible to take the Arkansas Rules Examination, administered at ADH at least three (3) times each year.
c. The applicant shall provide proof of identity by a government-issued photographic identification card upon the request of the individual administering the test.
d. If an applicant scores eighty percent (80%) or higher correct answers on the Arkansas Rules Examination, ADH shall provide to an applicant a written notice of examination results and a license will be issued.
ARKANSAS DEPARTMENT OF HEALTH
PRECEPTOR-APPRENTICE AGREEMENT FOR TRANSITIONAL APPRENTICES
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ARKANSAS DEPARTMENT OF HEALTH
APPRENTICE PERMIT RENEWAL
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DOCUMENTATION OF ACQUISITION OF CLINICAL KNOWLEDGE AND SKILLS FOR TRANSITIONAL APPRENTICES ONLY:
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APPENDIX C: CEU CALCULATIONS
CALCULATIONS FOR NUMBER OF CEUS REQUIRED FOR LLM RENEWAL OF LICENSE BASED ON ALL BEING RENEWED IN AUGUST EVERY 3 YEARS.
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Months since license was issued
|
Number of CEUs required
|
|
36
|
30 hours
|
|
35
|
29 hours
|
|
34
|
28 hours
|
|
33
|
27 hours
|
|
32
|
27 hours
|
|
31
|
26 hours
|
|
30
|
25 hours
|
|
29
|
24 hours
|
|
28
|
23 hours
|
|
27
|
23 hours
|
|
26
|
22 hours
|
|
25
|
21 hours
|
|
24
|
20 hours
|
|
23
|
19 hours
|
|
22
|
18 hours
|
|
21
|
17 hours
|
|
20
|
17 hours
|
|
19
|
16 hours
|
|
18
|
15 hours
|
|
17
|
14 hours
|
|
16
|
13 hours
|
|
15
|
12 hours
|
|
14
|
11 hours
|
|
13
|
10 hours
|
|
12
|
10 hours
|
|
11
|
9 hours
|
|
10
|
8 hours
|
|
9
|
7 hours
|
|
8
|
6 hours
|
|
7
|
5 hours
|
|
6
|
4 hours
|
|
5
|
3 hours
|
|
4
|
3 hours
|
|
3
|
2 hours
|
|
2
|
1 hours
|
|
1
|
0 hours
|
