Title of Regulation: 18VAC85-130. Regulations Governing the Practice of Licensed Midwives (amending 18VAC85-130-45).

Statutory Authority: §§ 54.1-2400 and 54.1-2957.9 of the Code of Virginia.

Public Hearing Information:

September 7, 2018 - 8:30 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233

Public Comment Deadline: September 5, 2018.

Effective Date: September 20, 2018.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4558, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Medicine the authority to promulgate regulations to administer the regulatory system, and § 54.1-2957.9 of the Code of Virginia, which provides that the board shall adopt regulations governing the practice of midwifery.

Purpose: The purpose of the amended regulation is to provide a sufficient timeframe for completion of a midwifery portfolio for evaluation by the North American Registry of Midwives (NARM) to qualify a person to sit for the certification examination and thus qualify for licensure. Since persons engaged in gaining practical experience are directly and immediately supervised by a licensed physician or midwife, the public continues to be protected. The goal is to ensure that supervised practice continues for the time period that may be necessary for someone to complete a portfolio.

Rationale for Using Fast-Track Rulemaking Process: The amended regulation was requested by the Advisory Board on Midwifery and unanimously approved by the Board of Medicine. It is less burdensome and noncontroversial.

Substance: The amendment will change the timeframe from three years to 10 years in which a person who is enrolled in a midwifery education program or completing a midwifery portfolio is allowed to perform tasks related to the practice of midwifery under direct and immediate supervision.

Issues: The primary advantage to the public may be the ability for some persons to complete a NARM portfolio within a more reasonable timeframe and thereby become licensed to provide midwifery services. There are no disadvantages to the public since such persons must provide services under direct and immediate supervision. There are no advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Medicine (Board) proposes to amend its Regulations Governing the Practice of Licensed Midwives to change the time during which a person who is enrolled in a midwifery education program, or completing her portfolio,¹ is allowed to perform tasks related to the practice of midwifery under direct and immediate supervision.²

Result of Analysis. Benefits likely outweigh costs for all proposed changes.

Estimated Economic Impact. Current regulation allows individuals enrolled in an accredited midwifery education program, or who are completing their portfolio, to perform midwifery tasks under direct and immediate supervision without being licensed until those individuals have either taken and received the results for the examination required for the Certified Professional Midwife (CPM) or for a period of three years, whichever occurs sooner. Current regulation also allows individuals who are practicing under supervision to request, "for good cause shown," an extension not to exceed one year in length to the three-year limit on supervised practice. The Board now proposes to extend the time limitation on supervised practice to 10 years and to eliminate the extension allowance. Under the proposed regulation, individuals working toward midwife licensure will be able to work under supervision for a maximum of 10 years, rather than the maximum four years that is currently allowed.

As all practice under this provision will still have to be directly and immediately supervised, the new time limits does not raise safety concerns. Accordingly, no affected entities are likely to incur any additional costs on account of the proposed regulatory change. This proposed change will benefit those who are working to obtain midwife licensure because it allows them greater flexibility to get "on-the-job experience" as they complete their educational requirements.

Businesses and Entities Affected. This regulatory action will affect all individuals who may wish to pursue midwife licensure in the future. Board staff does not know how many individuals are currently enrolled in midwifery education programs or completing a North American Registry of Midwives (NARM) portfolio but does report that there were seven individuals licensed as midwives in 2016-2017.

Localities Particularly Affected. No locality will be particularly affected by this regulatory action.

Projected Impact on Employment. These proposed regulatory changes are unlikely to affect employment in the Commonwealth.

Effects on the Use and Value of Private Property. These proposed regulatory changes are unlikely to affect the use or value of private property in the Commonwealth.

Real Estate Development Costs. These proposed regulatory changes are unlikely to affect real estate development costs in the Commonwealth.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. No small businesses are likely to incur any additional costs on account of these proposed regulatory changes.

Alternative Method that Minimizes Adverse Impact. No small businesses are likely to incur any additional costs on account of these proposed regulatory changes.

Adverse Impacts:

Businesses. No businesses are likely to incur any additional costs on account of these proposed regulatory changes.

Localities. Localities in the Commonwealth are unlikely to see any adverse impacts on account of these proposed regulatory changes.

Other Entities. No other entities are likely to be adversely affected by these proposed changes.

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¹The North American Registry of Midwives (NARM) Portfolio Evaluation Process allows candidates who have been educated outside of established pathways to have their qualifications evaluated for credentialing. In order to be licensed in Virginia, midwives must have NARM's Certified Professional Midwife credential.

²Licensed doctors of medicine or osteopathic medicine, certified nurse midwives and licensed midwives may provide supervision.

Agency's Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The amendment changes the timeframe from three years to 10 years during which a person enrolled in a midwifery education program or completing a midwifery portfolio is allowed to perform tasks related to the practice of midwifery under direct and immediate supervision.

18VAC85-130-45. Practice while enrolled in an accredited midwifery education program Practical experience under supervision.

A person may perform tasks related to the practice of midwifery under the direct and immediate supervision of a licensed doctor of medicine or osteopathic medicine, a certified nurse midwife, or a licensed midwife while enrolled in an accredited midwifery education program or during completion of the North American Registry of Midwives' Portfolio Evaluation Process Program without obtaining a license issued by the board until such person has taken and received the results of any examination required for CPM certification or for a period of three 10 years, whichever occurs sooner. For good cause shown, a person may request that the board grant any extension of time beyond the three years, for a period not to exceed one additional year.