(1) The Alternative Health Care Board adopts and incorporates the organizational rules of the Department of Labor and Industry as listed in chapter 1 of this title.

(1) The Alternative Health Care Board adopts and incorporates the procedural rules of the Department of Labor and Industry as listed in chapter 2 of this title.

(1) The Alternative Health Care Board adopts and incorporates the public participation rules of the Department of Labor and Industry as listed in chapter 2 of this title.

(1) "Continuous care" as defined in 37-27-103, MCA, includes at least five prenatal visits spanning two trimesters, the birth, newborn exam, and two postpartum visits.

(2) "Direct supervision" means the physical presence of the licensed supervisor. Direct supervision is required for level I, II and III-A apprentices.

(3) "Grand multiparity" means a woman who is in her sixth or greater full term pregnancy.

(4) "Home birth" means an anticipated or actual birth whereby the woman in labor is advised, attended, and assisted by a licensed direct-entry midwife or a Level III-B apprentice direct-entry midwife.

(5) "Indirect supervision" means the immediate availability of the licensed supervisor by telephone.

(6) "MEAC" means the Midwifery Education Accreditation Council.

(7) "Morbidity" means a pathological condition of the mother and/or baby that presents with symptoms peculiar to what is within normal limits during the prenatal, intrapartum and postpartum periods which requires transfer of care to a physician, transport to a hospital and/or emergency measures. This, or client refusal to refer to transfer care, shall be reported to the board within 72 hours, on a form prescribed by the board.

(8) "NARM" means the North American Registry of Midwives.

(9) "Personal supervision" means either direct or indirect supervision as required for direct-entry midwife apprenticeships.

(10) "Primary birth attendant" means the person responsible for providing primary care to a woman in labor. 

(1) Fees are payable to the Alternative Health Care Board and are nonrefundable.

(2) Fees for naturopaths are:

(a) license application                                   $300

(b) original license                                           200

(c) license renewal                                          240

(d) specialty certificate                                    100

(e) specialty certificate renewal                        25

(3) Fees for midwives are:

(a) license application                                           300

(b) original license                                                200

(c) license renewal                                               240

(d) apprentice license application                          200

(e) apprentice license renewal                              100

(4) Fees for acupuncturists are:

(a) license application                                            125

(b) license renewal                                                 100

(5) Inactive status fees are as follows:

(a) naturopath                                                                   120

(b) midwife                                                                        120

(c) midwife apprentice                                                         50

(6) Additional standardized fees are specified in ARM 24.101.403.

(1) Each licensee licensed by the board shall store, transport off the premises, treat, and dispose of infectious waste, as defined in 75-10-1003 , MCA, in accordance with the requirements of Title 75, chapter 10, part 10, MCA, and rules adopted by the Department of Environmental Quality pursuant thereto.

(1) The Alternative Health Care Board adopts and incorporates by reference the fee abatement rule of the Department of Labor and Industry found at ARM 24.101.301.

(1) For the purpose of processing nonroutine applications, the board incorporates the definitions of routine and nonroutine at ARM 24.101.402 by reference.

(2) Nonroutine applications must be reviewed and approved by the board before a license may be issued.

(1) The board incorporates ARM 24.101.406 by reference with no modifications.

(1) While on inactive status, a licensee is prohibited from practicing under that license.

(2) To place a license on inactive status, a licensee shall, during the renewal period:

(a) submit a written request to the board;

(b) return the licensee's wall certificate and current license to the board office; and

(c) pay the appropriate inactive status fee.

(3) A licensee on inactive status shall:

(a) renew according to renewal dates specified in ARM 24.101.413;

(b) pay the appropriate inactive status fee; and

(c) meet all other conditions of licensure, except that licensees on inactive status:

(i) are not required to maintain CPR or neonatal resuscitation credentials while on inactive status;

(ii) are exempt from CE requirements; and

(iii) are exempt from reporting requirements pursuant to ARM 24.111.613.

(4) No license may remain on inactive status for more than 26 consecutive months, excluding any time required for board review of a request to return to active status.

(5) Requests to return to active status must include the following:

(a) a completed request on a form prescribed by the department;

(b) verification of the licensee's good standing from every jurisdiction in which the licensee was licensed during the inactive status period;

(c) an official report on the licensee from the National Practitioner Databank;

(d) if the request is not submitted with a renewal application, a license fee equal to the difference between the inactive status fee and the active status fee;

(e) if the request is submitted with a renewal application, the request must also include all requirements and fees required for renewal of an active license; and

(f) any other proof or information as reasonably required by the board.

(6) Department staff may process requests to return to active status without further board review upon proof of the following:

(a) licensee is not subject to legal or disciplinary action in this or any other jurisdiction;

(b) all fees are paid in full;

(c) all CPR and neonatal resuscitation credentials required for licensure are current; and

(d) one year's continuing education requirements are met and verified by certificates.

This rule has been repealed.

(1) Each application for licensure from the board must include: 

(a) a completed application form;

(b) the initial license fee; and

(c) verification of applicable educational requirements.

(2) An applicant licensed in any other jurisdiction at any time shall cause the other jurisdictions to submit a current verification of licensure directly to the board.

(3) An applicant may voluntarily withdraw their application by written request if the application has not appeared on a board agenda.  Application fees are not refundable.

(a) The naturopathic medical college is or was incorporated in the United States under the laws of the state of its residence as a nonprofit, nonproprietary institution exempt from taxation by the IRS, due to its devotion to educational purposes. Foreign country naturopathic medical colleges must possess equivalent qualifications to those required of U.S. naturopathic medical colleges.

(b) The naturopathic medical college has or had formal authority from the appropriate state or provincial governmental agency to grant an N.D. or N.M.D. degree, and has as its major mission the education of naturopathic doctors and their preparation for licensing.

(c) The naturopathic medical college's objective shall be clearly stated and should address the preparation of naturopathic physicians to provide patient care and for licensing by state or provincial authorities. The curriculum shall encompass a minimum of four academic years of a full-time resident program of academic and clinical study of naturopathic medicine.

(d) Educational standards shall include instruction in a core program which requires each student to demonstrate competence in each of the following substantive content areas:

(i) The basic sciences program must include in-depth study and courses on human anatomy, physiology, biochemistry, pathology, pharmacology and pharmacognosy. A basic sciences program may also include, without limitation, courses in public health and naturopathic philosophy. Total hours in basic sciences must be a minimum of 1000 clock hours, with 12 clock hours equal to one quarter credit, or equivalent semester credit.

(ii) The clinical sciences program must include preparation of the student to diagnose the causes of human ailments and effective treatment of them using naturopathic medications and methods. A clinical sciences program may also include, without limitation, courses in acupuncture and office management. Total hours in clinical sciences must be a minimum of 1200 clock hours with 12 clock hours equal to one quarter credit, or equivalent semester credit. The clinical sciences program must include:

(A) diagnostic courses, which shall include physical, clinical, laboratory and radiological,

(B) therapeutic courses, which shall include materia medica (botanical medicine, homeopathy, emergency drugs), nutrition, physical medicine (including but not limited to naturopathic manipulative therapy and hydrotherapy), and psychological counseling,

(C) specialty courses, which shall include organ systems (cardiology, dermatology, endocrinology, EENT, gastroenterology, orthopedics, neurology), human development (gynecology, natural childbirth, obstetrics, pediatrics, geriatrics), jurisprudence, medical emergencies, and minor surgery.

(iii) The clinical practicum program shall give the student experience in a clinical setting, under licensed supervision, in all aspects of naturopathic practice. The student shall, at a minimum, have primary care responsibility in the institution's teaching clinic and preceptorships in one or more practicing physician's offices. Total hours in clinical practicum must be a minimum of 1000 clock hours, with 12 clock hours equal to one quarter credit, or equivalent semester credit.

(e) The naturopathic medical college must have an identifiable faculty. The faculty must have advanced or professional degrees in either the subject being taught or in related areas. The faculty should be involved in continuing education and provisions should exist in teaching loads to encourage academic excellence through research, publication, attendance at conventions and educational symposia.

(f) The board reserves the right to evaluate individual applications as to their compliance with equivalent naturopathic medical educational standards, on a case-by-case basis, in the sole discretion of the board.

(1) Each application for licensure must include:

(a) a completed application form;

(b) initial application fee;

(c) verification of the applicable education requirements; and

(d) proof of successful passage of the Naturopathic Physician Licensing Examination (NPLEX) as provided in (2).

(2) Except as provided in (3), all applicants for naturopathic physician licensure in Montana must have passed:

(a) Part I – Biomedical Science;

(b) Part II – Core Clinical Science;

(c) Part II – Clinical Elective Pharmacology Examination; and

(d)  Part II – Clinical Minor Surgery Examination.

(3) An applicant seeking licensure under this rule based upon a licensure examination other than the NPLEX examinations listed in (2) may apply to the board for acceptance of a substantially equivalent examination.

(1) A license to practice as a naturopathic physician in the state of Montana may be issued without examination to an applicant who:

(a) has submitted a completed application and correct fee; and

(b) holds a current unencumbered license to practice as a naturopathic physician in another state or jurisdiction whose laws and rules are substantially equivalent to Montana's.  Applicants from another jurisdiction who have not passed the Naturopathic Physician Licensing Examination (NPLEX) Part II – Clinical Elective Pharmacology Examination will be required to do so prior to licensure.

(1) A naturopathic physician licensed in Montana, or an applicant for a Montana naturopathic physician license, who wishes to practice natural childbirth must apply to and receive from the board, a certificate of specialty practice in naturopathic childbirth attendance. To receive and maintain a certificate, the applicant must fulfill the following requirements:

(a) submit an application for the specialty certificate on a form furnished by the board together with the correct fee;

(b) provide an official transcript from an approved naturopathic medical college or hospital or a signed supervisor document showing completion of at least 100 clock hours (where 12 clock hours equal one quarter credit or equivalent semester credit) of academic coursework, internship, or preceptorship in obstetrics at an approved naturopathic medical college or hospital;

(c) provide a signed log of natural childbirths which contains:

(i) each baby's name;

(ii) date of birth;

(iii) county and state of birth;

(iv) name and natural childbirth credentials of supervising physician; and

(v) name of the primary birth attendant showing that the following experience was obtained under the direct supervision of a licensed naturopathic, medical, or osteopathic physician with specialty training in obstetrics and/or natural childbirth:

(A) the applicant has taken part in the care of 50 women in both the prenatal and postnatal periods; and

(B) the applicant has observed and assisted with the intrapartum care and delivery in 50 natural childbirths in a hospital or alternative birth setting, including 25 births that document the applicant as the primary birth attendant. Of the 25 births for which the applicant was the primary birth attendant, three of the births must have occurred within the two years immediately preceding the submission of the application and in at least one of those three births, the applicant must have provided continuous care.

(d) provide proof of having passed a specialty examination in obstetrics approved by the board, or the American College of Naturopathic Obstetrics' (ACNO) obstetrics specialty examination, or the Naturopathic Physician Licensing Examination's (NPLEX) obstetrics specialty examination.

(1) Except as provided in (2), naturopathic physicians may prescribe, administer, and dispense pursuant to 37-2-104, MCA:

(a)  all legend drugs;

(b)  with a DEA registration, all drugs in Schedules II-V as listed at 50-32-224, 50-32-226, 50-32-229, and 50-32-232, MCA, and ARM 24.174.1412;

(c)  all biological substances including extracts and/or their products and residues;

(d)  topical preparations;

(e)  vitamins, minerals, trace minerals, enzymes, and food;

(f)  homeopathic preparations;

(g)  laboratory and diagnostic procedures;

(h)  all amino acids and amino acid combinations;

(i)  barrier contraceptives;

(j)  all botanical extracts and their derivatives;

(k)  electrolytes and fluid replacement;

(l)  expectorants and mucolytics;

(m)  hormones;

(n)  liver preparations; and

(o)  childbirth preparations.

(2) Naturopathic physicians may not prescribe:

(a) general anesthetics;

(b) mifepristone and misoprostol as an abortifacient;

(c) barbiturates, except:

(i)  phenobarbital;

(ii)  butalbital; and

(iii)  primidone;

(d) systemic oncology agents, except antineoplastic agents, in oral and topical form only:

(i)  5fu;

(ii)  anastrozole;

(iii)  letrozole;

(iv)  mechlorethamine;

(v)  megestrol;

(vi)  mercaptopurine;

(vii)  methotrexate;

(viii)  tamoxifen; and

(ix)  tretinoin; and

(e) ketamine.

(3) The licensed pharmacist member of the formulary committee formed pursuant to 37-26-301, MCA, shall serve on the committee for a four-year term unless the pharmacist resigns, or is replaced by vote of the board.

(a) antepartum care, including:

(i) preconceptional factors likely to influence pregnancy outcome;

(ii) basic genetics, embryology and fetal development;

(iii) anatomy and assessment of the soft and bony structure of the pelvis;

(iv) identification and assessment of the normal changes of pregnancy, fetal growth and position;

(v) nutritional requirements for pregnant women and methods of nutritional assessment and counseling;

(vi) environmental and occupational hazards for pregnant women;

(vii) education and counseling to promote health throughout the childbearing cycle;

(viii) methods of diagnosing pregnancy;

(ix) the etiology, treatment and referral, when indicated, of the common discomforts of pregnancy;

(x) assessment of physical and emotional status, including relevant historical and psychosocial data;

(xi) counseling for individual birth experiences, parenthood and changes in the family;

(xii) indications for, risks and benefits of screening/diagnostic tests used during pregnancy;

(xiii) etiology, assessment of, treatment for and appropriate referral for abnormalities of pregnancy;

(xiv) identification of, implications of and appropriate treatment for various STD/vaginal infections during pregnancy;

(xv) special needs of the Rh negative woman; and

(xvi) identification and care of women who are HIV positive, have hepatitis or other communicable and noncommunicable diseases.

(b) intrapartum care, including:

(i) normal labor and birth processes;

(ii) anatomy of the fetal skull and its critical landmarks;

(iii) parameters and methods for assessing maternal and fetal status, including relevant historical data;

(iv) emotional changes and support during labor and delivery;

(v) comfort and support measures during labor, birth, and immediately postpartum;

(vi) techniques to facilitate the spontaneous vaginal delivery of the baby and placenta;

(vii) etiology, assessment of, appropriate referral or transport of and/or emergency measures (when indicated) for the mother or newborn for abnormalities of the four stages of labor;

(viii) anatomy, physiology, and supporting normal adaptation of the newborn to extrauterine life;

(ix) familiarity with medical interventions and technologies used during labor and birth; and

(x) assessment and care of the perineum and surrounding tissues, including suturing necessary for perineal repair.

(c) postpartum care, including:

(i) anatomy and physiology of the postpartum period;

(ii) anatomy and physiology and support of lactation, and appropriate breast care and assessment;

(iii) parameters and methods for assessing and promoting postpartum recovery;

(iv) etiology and methods for managing the discomforts of the postpartum period;

(v) emotional, psychosocial and sexual changes which may occur postpartum;

(vi) nutritional requirement for women during the postpartum period;

(vii) etiology, assessment of, treatment for and appropriate referral for abnormalities of the postpartum period;

(viii) methods to assess the success of the breastfeeding relationship and identify lactation problems, and mechanisms for making appropriate referrals;

(ix) suturing necessary for episiotomy repair;

(x) dispensing and administering pitocin (intramuscular) postpartum; and

(xi) dispensing and administering xylocaine (subcutaneous).

(d) neonatal care, including:

(i) anatomy and physiology of the newborn's adaptation and stabilization in the first hours and days of life;

(ii) parameters and methods for assessing newborn status, including relevant historical data at gestational age;

(iii) nutritional needs of the newborn;

(iv) ARM and MCA standards for an administration of prophylactic treatments commonly used during the neonatal period;

(v) ARM and MCA standards for indications, risks and benefits of, and method of performing common screening tests for the newborn; and

(vi) etiology, assessment of (including screening and diagnostic tests), emergency measures and appropriate transport/referral or treatments for neonatal abnormalities.

(e) health and social sciences, including:

(i) communication, counseling and teaching techniques, including the areas of client education and interprofessional collaboration;

(ii) human anatomy and physiology relevant to human reproduction;

(iii) ARM and MCA standards of care, including midwifery and medical standards for women during the childbearing cycle;

(iv) interprofessional communication and collaboration with community health and social resources for women and children;

(v) significance of and methods for thorough documentation of client care through the childbearing cycle;

(vi) informed decision making;

(vii) health education, health promotion, and self care;

(viii) the principles of clean and aseptic techniques, and universal precautions;

(ix) psychosocial, emotional and physical components of human sexuality, including indications of common problems and method of counseling;

(x) ethical considerations relevant to reproductive health;

(xi) epidemiologic concepts and terms relevant to perinatal and women's health;

(xii) the principles of how to access and evaluate current research relevant to midwifery practice;

(xiii) family centered care, including maternal, infant and family bonding;

(xiv) identification of an appropriate referral of disease in women and their families; and,

(xv) the importance of accessibility, quality health care for all women that includes continuity of care, and special requirements for home births.

(2) The applicant shall submit certificates of completion or certified transcripts sent directly from the institution, as verification the education is equivalent to or exceeds the minimum direct-entry midwife educational standards required by the board's laws and rules.

(3) The applicant shall submit course and program descriptions, from the time of applicant's graduation or completion, found in pertinent institution catalogs and brochures, to verify the training received fulfills minimum direct-entry midwife educational standards.

(4) The board reserves the right to evaluate individual applications as to their compliance with equivalent direct-entry midwife educational standards, on a case-by-case basis, in the sole discretion of the board.

(1) The terms "direct supervision", "indirect supervision", and "personal supervision" used herein are defined in ARM 24.111.301.

(2) The direct-entry midwife apprenticeship license program shall be that instructional period composed of practical experience time obtained under the personal supervision of a supervisor approved by the board.

(3) Applicants for a direct-entry midwife apprenticeship license shall submit a completed application with the proper fee, a current CPR card indicating certification to perform adult and infant cardiopulmonary resuscitation, a supervision agreement, and a curriculum outline or method of academic learning that meets the board's educational rule requirements for licensure. A supervision agreement shall include:

(a) name of supervisor who shall be a licensed direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of childbirth attendance or a physician licensed under Title 37, chapter 3, MCA;

(b) agreement of parties that supervision shall be provided which is consistent with these rules; and

(c) agreement of supervisor to supervise no more than four direct-entry midwife apprentices at the same time.

(4) A Level I direct-entry midwife apprenticeship is served under the direct supervision of the licensed supervisor, with a focus on prenatal care. To complete Level I, the direct-entry midwife apprentice shall:

(a) observe 40 births;

(b) provide 20 prenatal examinations;

(c) complete Level I skills checklist; and

(d) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level I.

(5) A Level II direct-entry midwife apprenticeship is served under the direct supervision of the licensed supervisor, with a focus on birth, postpartum, and newborn care. To complete Level II, the direct-entry midwife apprentice shall:

(a) attend ten births as primary birth attendant. Five of the ten births, as primary birth attendant in Level II, must be supervised by a licensed direct-entry midwife. The births must be verified by:

(i) signed birth certificates;

(ii) signed affidavits from the birthing mothers; or

(iii) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records;

(b) provide 40 prenatal examinations;

(c) submit prenatal protocols;

(d) complete Level II skills checklist;

(e) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level II; and

(f) obtain approval from the board to proceed to Level III.

(6) A Level III direct-entry midwife apprenticeship is served as either Level III-A or III-B, as defined below. The focus of Level III shall be continuous prenatal, perinatal, and postnatal care. To complete Level III, the direct-entry midwife apprentice shall:

(a) complete 15 continuous-care births as the primary attendant:

(i) Eight of the 15 continuous-care births in Level III must be supervised by a Montana-licensed direct-entry midwife. The births must be verified by:

(A) signed birth certificates;

(B) signed affidavits from the birthing mothers; or

(C) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records;

(ii) Five of the 15 continuous-care births must include prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam;

(iii) Ten of the 15 continuous-care births must have been performed under the personal supervision of a qualified supervisor;

(iv) At least one of the 15 continuous-care births must include a postpartum exam;

(b) provide 40 prenatal examinations;

(c) submit protocols for birth, postpartum, and newborn care;

(d) complete Level III skills checklist; and

(e) submit a positive evaluation of skills and educational progress form and written verification by supervisor of completion of Level III.

(7) Level III-A and Level III-B direct-entry midwife apprentices are distinguished as follows:

(a) A Level III-A direct-entry midwife apprentice shall require direct supervision by the licensed supervisor;

(b) A Level III-B direct-entry midwife apprentice shall require indirect supervision by the licensed supervisor when, in the professional judgment of the supervisor, with concurrence of the board, the Level III-B apprentice is capable of safely and competently performing midwifery services under indirect supervision after the following requirements have been met:

(i) verification of completion of ten directly supervised continuous-care births which include five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam;

(ii) verification of completion of at least 75 percent of educational/academic requirements for full licensure; and

(iii) a formal outline of the method of indirect supervision communication shall be submitted in writing to the board for approval, which shall include supervisor chart review and telephone contact supervision.

(8) Direct-entry midwife apprenticeship applicants who have at the time of application, through an apprenticeship or other supervisory setting, participated as the primary birth attendant at 25 births, 15 of which included continuous care, may enter directly into direct-entry midwife apprenticeship license Level III-B. To complete Level III-B, at least eight continuous-care births must be supervised by a Montana-licensed direct-entry midwife.

(a) The 25 births and 15 continuous-care births shall be evidenced by:

(i) the signed birth certificate as primary birth attendant;

(ii) an affidavit from the birth mother; or

(iii) documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records.

(b) Documentation of each of the 15 continuous care births as defined in 37-27-103, MCA, must include at least five prenatal exams, one of which must have been performed before the beginning of the 28th week of gestation, as determined by last menstrual period or sonogram, and include one postpartum exam. Ten of the 15 continuous care births must have been performed under the direct supervision of a qualified supervisor.

(9) To be approved by the board as a supervisor of a direct-entry midwife apprentice, each supervisor applicant must submit an application on a form provided by the department and shall:

(a) hold a current, unencumbered Montana license as a direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of naturopathic childbirth attendance, or a physician as defined in 37-3-102, MCA:

(i) A licensed direct-entry midwife who has not completed 20 postlicensure continuous care births may only supervise Level I apprentices;

(ii) A licensed direct-entry midwife who has completed 20 postlicensure continuous-care births as primary attendant may apply to supervise Level II and III apprentices;

(b) review and sign all documents required by the board under the direct-entry midwife apprenticeship program;

(c) supervise no more than four direct-entry midwife apprentices at the same time;

(d) notify the board in writing of any change in the supervisory relationship, including advancement from direct to indirect supervision, termination of the supervisory relationship, or any other relevant changes, and submit supervision change notification to the board so that it is received on or before the day that supervised tasks are performed in order for them to count toward licensure requirements; and

(e) be directly responsible for all activities undertaken by the apprentice(s) under their supervision agreement.

(10) Violation of the board statutes or rules may result in license discipline action against the direct-entry midwife apprentice, or supervisor, or both.

(1) The antepartum protocol standards include, but are not limited to, the following:

(a) abruptio placenta (suspected);

(b) anemia;

(c) bleeding, first, second and third trimesters;

(d) breech presentation;

(e) candidiasis;

(f) care schedule;

(g) date/size discrepancy;

(h) ectopic pregnancy;

(i) fetal demise first, second, third trimester;

(j) genetic counsel;

(k) glycosuria/glucose screen;

(l) group beta strep;

(m) Hepatitis B;

(n) HIV;

(o) human papilloma virus (HPV);

(p) hyperemesis gravidarum;

(q) internal pelvic examination;

(r) intrauterine growth retardation;

(s) minor pregnancy discomfort (heartburn, constipation, insomnia, etc.);

(t) placenta previa (suspected);

(u) polyhydramnios;

(v) post dates pregnancy;

(w) pregnancy induced hypertension (mild, severe);

(x) proteinuria;

(y) Rh negative;

(z) sexually transmitted diseases (chlamydia, herpes, bacterial vaginosis, gonorrhea, trichomosis, etc.);

(aa) transfer of care/termination of midwife-parent relationship;

(ab) twins (diagnosis of);

(ac) ultrasound (indications for);

(ad) urinary tract infection;

(ae) vaginal birth after cesarean.

(2) The intrapartum protocol standards include, but are not limited to, the following:

(a) amnionitis/chorioamnionitis;

(b) bleeding in labor;

(c) care schedule;

(d) edematous cervical lip;

(e) emergency breech delivery;

(f) emergency twin delivery;

(g) face presentation;

(h) fetal distress;

(i) fetal heart rate evaluation;

(j) indications for transfer of care;

(k) meconium staining;

(l) nuchal cord;

(m) oxygen in labor;

(n) perineal support;

(o) placenta abruptio;

(p) posterior fetal presentation;

(q) premature labor;

(r) prolonged rupture of membranes;

(s) prolapsed cord;

(t) shoulder dystocia;

(u) stillbirth;

(v) vaginal birth after cesarean.

(3) The postpartum protocol standards include, but are not limited to, the following:

(a) assessment of placenta;

(b) breast care;

(c) care schedule;

(d) delivery of placenta;

(e) depression;

(f) hematoma;

(g) hemorrhage;

(h) hemorrhoids;

(i) perineal second degree laceration or episiotomy repair (suture);

(j) preparation of mother for transport;

(k) retained placenta (manual removal);

(l) Rh negative mom;

(m) shock;

(n) subinvolution;

(o) uterine infection;

(p) uterine inversion.

(4) The newborn protocol standards include, but are not limited to, the following:

(a) care schedule (postpartum visits);

(b) eye prophylaxis;

(c) hypoglycemia (suspected);

(d) hypothermia;

(e) infection (suspected sepsis);

(f) evaluation of jaundice;

(g) neonatal resuscitation;

(h) newborn examination to include gestational age determination and assessment of minor anomalies;

(i) newborn metabolic screening;

(j) newborn critical congenital heart disease screening using pulse oximetry;

(k) normal newborn transition to include maintenance of body temperature, cardiopulmonary function;

(l) normal infant feeding patterns;

(m) polycythemia (suspected);

(n) preparation of infant for transport;

(o) problems of large- and small-for-gestational-age infants;

(p) respiratory distress;

(q) umbilical cord care;

(r) vitamin K administration.

(1) Applicants for direct-entry midwifery licensure by examination shall submit a completed application with the proper fees and supporting documents to the board office. Applications for licensure by examination shall expire one year from the date of receipt of the application. An applicant who, for any reason, fails or neglects to take the examination within the year shall be required to file another application and submit another application fee. Supporting documents shall include:

(a) written documentation of good moral character consisting of three letters of reference, at least one of which must be from a licensed direct-entry midwife; and

(b) any other documents, affidavits, and certificates required by 37-27-201 or 37-27-203, MCA, whichever is applicable, and board rules.

(2) All applicants shall take the North American Registry of Midwives (NARM) examination as endorsed by the board, or any other examination to be prescribed or endorsed by the board, and have their scores reported to the board office by the proper NARM interstate reporting service, or its equivalent. All applicants for NARM examination shall:

(a) sit for the NARM examination only when administered by the board, at its designated Montana site, or when administered by proper NARM officials in conjunction with the annual Midwives Alliance of North America (MANA) national meeting;

(b) achieve a scaled score of 75.

(3) Applicants who fail the licensing examination twice shall in addition to being retested, file in advance with the board a plan regarding arrangements for securing further professional training and experience.

(1) A license to practice as a direct-entry midwife in the state of Montana may be issued at the discretion of the board provided the applicant completes and files with the board an application for licensure and the required application fee. The candidate must meet the following requirements:

(a) The candidate holds a current, valid, and unrestricted license to practice as a direct-entry midwife in another state or jurisdiction that has current standards substantially equivalent to or greater than current standards in this state as established in 37-27-201 or 37-27-203, MCA, and the administrative rules.

(i) Official written verification of such licensure status must be received by the board directly from the other state(s) or jurisdiction(s).

(ii) The candidate must supply a copy of the current laws and rules from the state of licensure. 

(1) An applicant must be a NARM Certified Professional Midwife, demonstrated by:

(a) graduation from a MEAC-accredited program; or

(b) completing the Portfolio Evaluation Process through NARM; and

(c) passing the NARM examination with a scaled score of 75.

(i) Applicants must have the examination score reported to the board from NARM.

(ii) Applicants who have failed the examination twice must file a remedial plan with the board, which includes arrangements for securing further professional training and experience prior to each examination attempt.

(2) In addition to NARM certification, applicants must show:

(a) observation of ten births; and

(b) participation as the primary birth attendant at five continuous care births, shown by the signed birth certificate as primary birth attendant, an affidavit from the birth mother; or documented records from the person who supervised the births to include prenatal records, birth records, and postpartum records.

(1) Applicants who are acquiring practical experience shall apply for an apprentice license.

(2) Applicants must provide proof of enrollment in a MEAC-accredited program or enrollment in NARM's Portfolio Evaluation Process at the time of application.

(3) Midwife apprentices must work under the supervision of a currently licensed direct-entry midwife, a certified nurse midwife, a licensed naturopathic physician who is certified for the specialty practice of naturopathic childbirth attendance, or a physician.

(a) Apprenticeship supervisors must be registered with NARM as preceptors.

(a) a recommendation that mothers:

(i) be screened prenatally for Hepatitis C;

(ii) be screened prenatally for group "B" Beta Strep; and

(iii) obtain a prenatal Pap smear; and

(b) a recommendation that infants:

(i) be screened for bilirubin within 72 hours after birth;

(ii) have expanded newborn metabolic tests within 72 hours after birth; and

(iii) have a newborn hearing screening within one month after birth.

(2) When the above recommendations are required to be made to clients of Level I, II, or III-A apprentices or to clients of Level III-B apprentices who are not approved by the board for indirect supervision, such recommendations shall be made by the apprentice's supervisor. If the supervisor is a physician or nurse-midwife who is not subject to the board's jurisdiction, the recommendation shall be made by the apprentice.

(3) Level III-B apprentices approved by the board for indirect supervision shall always make the recommendations required by this rule to clients of the Level III-B apprentice.

(4) Documentation of compliance with this rule shall be maintained in the client record.

(1) If the following conditions are present, the licensed direct-entry midwife shall not accept the woman as a client:

(a) chronic medical problems:

(i) cardiac disease (Class II or greater);

(ii) diabetes mellitus requiring medication;

(iii) essential hypertension (greater than 140/90 Hg, not controlled by medication);

(iv) hemoglobinopathies:

(v) renal disease (chronic, diagnosed, not urinary tract infection);

(vi) thrombophlebitis or pulmonary embolism;

(vii) epilepsy currently on medication;

(viii) current severe psychiatric condition requiring medication within a six-month period prior to pregnancy;

(ix) active: tuberculosis, syphilis, gonorrhea, hepatitis, AIDS, genital herpes at onset of labor;

(x) current drug or alcohol abuse/dependency;

(xi) current malignant disease;

(xii) chronic obstructive pulmonary disease, except for controlled asthma.

(b) current pregnancy related conditions:

(i) pregnancy induced hypertension (preeclamptic or eclamptic symptoms);

(ii) premature labor (before 36 1/2 weeks gestation verified estimated date of delivery by dates and physical exam);

(iii) placental abruption;

(iv) placenta previa at onset of labor;

(v) has a fetus in any presentation other than vertex at onset of labor;

(vi) multiple gestation;

(vii) contracts primary genital herpes in the first trimester;

(viii) Rh sensitization.

(c) previous obstetrical history:

(i) previous Rh sensitization;

(ii) history of inverted uterus.

(1) If the following conditions are present in a client, the direct-entry midwife shall attempt to consult a physician and/or transfer care to a physician. A certified nurse midwife or licensed direct-entry midwife shall also be consulted if appropriate attempts to consult a physician have been unsuccessful. Documentation of the condition, recommendation (including continuation of care by the licensed direct-entry midwife, if appropriate) and treatment must be maintained in the client records. Conditions include, but are not limited to the following:

(a) prenatal factors:

(i) severe hyperemesis;

(ii) rubella contracted in the first or second trimester;

(iii) maternal anemia (hemoglobin less than ten, hematocrit less than 30) unresponsive within one month of treatment;

(iv) oligohydramnios (suspected);

(v) polyhydramnios (suspected);

(vi) premature rupture of membranes at less than 36 1/2 weeks;

(vii) post term at 42 weeks by dates and physical exam;

(viii) large for gestational age (LGA) or small for gestational age (SGA) (suspected);

(ix) Rh sensitization in present pregnancy (not resulting from recent Rhogam);

(x) history of severe postpartum hemorrhage requiring transfusion;

(xi) known serious maternal viral/bacterial infection at term;

(xii) blood pressure greater than 140/90 or increase of 30 mm Hg systolic or 15 mm Hg diastolic over baseline, that is unresolved within seven days;

(xiii) develops signs and symptoms of preeclampsia;

(xiv) develops signs and symptoms of gestational diabetes;

(xv) has unresolved vaginitis that requires antibiotic treatment;

(xvi) has unresolved urinary tract infection;

(xvii) continued vaginal bleeding before onset of labor;

(xviii) signs of fetal distress including prolonged fetal tachycardia (more than 170) or prolonged fetal bradycardia (less than 100), or fetal demise;

(xix) persistent fever;

(xx) history of preterm delivery (less than 36 1/2 weeks);

(xxi) positive maternal diagnosis of HIV;

(xxii) abnormal Pap smear (showing atypia or CIN);

(xxiii) all condylomas;

(xxiv) grand multiparity;

(xxv) maternal age less than 16 or greater than 40;

(xxvi) history of previous stillbirth;

(xxvii) history of incompetent cervix;

(xxviii) history of previous birth with Erb's Palsy or fractured clavicle or humerus;

(xxix) history of neonatal anomaly; or

(xxx) history of previous cesarean birth.

(b) labor, birth risks, and postpartum factors:

(i) significant fetal distress including prolonged fetal tachycardia (more than 170) or prolonged fetal bradycardia (less than 100);

(ii) unengaged vertex above -3 station in primipara in active labor;

(iii) fever of 102 degrees Fahrenheit or greater;

(iv) prolonged rupture of membranes (greater than 24 hours with no progress of labor);

(v) meconium stained fluid with delivery not imminent;

(vi) severe bleeding prior to or during delivery;

(vii) maternal respiratory distress;

(viii) mother desires consult or transfer;

(ix) uncontrolled maternal hemorrhage;

(x) third or fourth degree perineal laceration;

(xi) signs of infection;

(xii) evidence of thrombophlebitis.

(c) newborn risk factors:

(i) less than three vessels in umbilical cord;

(ii) Apgar score less than seven at five minutes;

(iii) fails to urinate or move bowels within 24 hours;

(iv) obvious anomaly;

(v) respiratory distress;

(vi) cardiac irregularities;

(vii) pale cyanotic or gray color;

(viii) abnormal cry;

(ix) jaundice within 24 hours of birth;

(x) signs of prematurity, dysmaturity, or postmaturity;

(xi) lethargic;

(xii) has edema;

(xiii) signs of hypoglycemia;

(xiv) abnormal facial expression;

(xv) abnormal body temperature (outside the 97-100 degrees Fahrenheit range, not resolved within one hour);

(xvi) abnormal neurological signs, including jitteriness, decreased tones, seizures or poor sucking reflex; or

(xvii) inability to nurse after 12 hours.

(1) A licensed direct-entry midwife shall not assume primary responsibility for prenatal care and/or birth attendance for women who have had a previous cesarean section, unless all of the following conditions are met:

(a) An informed consent statement, on a form furnished by the board, shall be signed by all prospective VBAC parents and the licensee, and retained in the licensee's records. The form shall include:

(i) VBAC educational information, including history of VBAC and client's own personal information;

(ii) associated risks and benefits of VBAC at home;

(iii) a workable hospital transport plan;

(iv) alternatives to VBAC at home;

(v) other information as required by the board.

(b) A workable hospital transport plan must be established for home VBAC. The plan shall include:

(i) provision for physician/hospital backup, e.g., through the physician/hospital policy on backup;

(ii) place of birth within 30 minutes of transport to the nearest hospital able to perform an emergency cesarean;

(iii) readily available phone numbers for physician backup and nearest hospital, in writing, in client's records;

(iv) phone contact with nearest hospital at onset of labor and prior to any transport to notify that transport is in progress; and at conclusion of home birth if no transport is necessary.

(c) Licensee shall obtain prior doctor/hospital cesarean records, in writing, prior to acceptance of the woman as a client, and shall analyze the indication for the previous cesarean, and retain the records and a written assessment of the physical and emotional considerations in licensee's files. Records which show a previous classical uterine/vertical incision, any other uterine scars into the endometrium, or less than 18 months between last surgery to the next delivery are contraindications to VBAC at home, and shall require immediate transfer of care of the client. If a licensee is unable to obtain written records, the licensee shall not retain the woman as a client.

(d) VBAC deliveries shall be performed by a fully licensed midwife (not an apprentice licensee), skilled with VBAC support, able to assess true complications and emergencies, to be present from the onset of active labor, throughout the immediate postpartum period.

(2) The board shall conduct a "sunset" review, including the necessity for and safety of the VBAC rule, on or about May, 2001, or five years from the effective date of this rule.

(a) If a licensed direct-entry midwife does not have any clients during a reporting period, the licensee shall notify the board in writing by the reporting date.

(2) A licensed direct-entry midwife who is supervising a licensed midwife apprentice shall be responsible for filing the statutorily required 72-hour mortality/morbidity report and the semiannual summary report on clients seen by a Level I, II or III apprentice who is not approved for indirect supervision.

(a) A Level III-B apprentice direct-entry midwife, approved by the board for indirect supervision, shall be responsible for filing the statutorily required 72-hour mortality/morbidity report and the semiannual summary report.

(b) If a Level III-B direct-entry midwife apprentice does not have any clients during a reporting period, the apprentice shall notify the board in writing by the reporting date.

(c) Certified nurse midwife, physician or naturopathic supervisors of an apprentice direct-entry midwife shall be responsible to ensure the Level I, II or III (not approved for indirect supervision) apprentice files the statutorily required 72-hour mortality/morbidity report and the semiannual summary reports.

(1)  Midwives may become endorsed to obtain and administer prescription drugs per 37-27-302, MCA, by submitting an application that demonstrates the applicant either: 

(a) holds the certified professional midwife (CPM) credential through MEAC accreditation (obtained after January 1, 2021); or 

(b) completed both:

(i) an MEAC approved, pharmacology specific to midwives training course covering all drugs listed in the formulary of 37-27-302(2), MCA; and

(ii) an IV therapy course having a practical component that is:

(A) provided by the Montana Health Network;

(B) provided by MEAC; or

(C) another eight-hour course having a practical component.

(1)  Endorsed midwives may obtain formulary drugs as allowed by law, including from: 

(a) a person or entity licensed as a wholesale distributor by the Montana Board of Pharmacy; and 

(b) a retail pharmacy, in minimal quantities for office use.

(2)  Endorsed midwives must:

(a)  store all formulary drugs in secure areas suitable for preventing unauthorized access and for ensuring a proper environment for the preservation of the drugs; and

(b)  dispose of drugs using means that are reasonably calculated to guard against unauthorized access by persons and harmful excretion of the drugs into the environment.  The means that may be used include, without limitation:

(i) transferring the drugs to a reverse distributor who is registered to destroy drugs with the U.S. Drug Enforcement Agency;

(ii) removing the drugs from their original containers, mixing them with an undesirable substance such as coffee grounds or kitty litter, putting them in impermeable, non-descript containers such as empty cans or sealable bags, and throwing the containers in the trash; or

(iii) flushing the drugs down the toilet if the accompanying patient information instructs that it is safe to do so.

(3)  Endorsed midwives may carry drugs to the home setting while providing care within the course and scope of the practice of midwifery.

(1) Endorsed midwives may use the drugs in 37-27-302(2), MCA, according to the following protocol describing the indication for use, dosage, route of administration, and duration of treatment: 

(1)  A low risk of adverse birth outcomes indicates a clinical scenario for which there is not clear demonstratable benefit for a medical intervention or transfer to a physician's care under ARM 24.111.610 or 24.111.611. 

(2)  Consultation with a physician as required by ARM 24.111.611(1)(a) does not preclude a low risk of adverse birth outcomes.

(3)  Preexisting arrangements for emergency transportation to a nearby hospital if needed do not preclude a low risk of adverse birth outcomes.

(1) Applicants for licensure must pass the Foundations of Oriental Medicine, Acupuncture with Point Location, and Biomedicine examinations required for certification in acupuncture by the National Commission for the Certification of Acupuncture and Oriental Medicine, or its successor.

(2) Applicants for licensure must pass the examination in clean needle technique administered by the Council of Colleges for Acupuncture and Herbal Medicine, or its successor.

(1)  Point injection is the subcutaneous, intramuscular, and intradermal injection of substances consistent with the practice of acupuncture to stimulate acupuncture points, ashi points, trigger points, motor points, and pathways.  Point injection includes trigger points as a subset of acupuncture points and ashi points as recognized in the current practice of acupuncture and Eastern medicine. 

(a)  Substances for point injection include, but are not limited to, saline, sterile water, and herbs, vitamins in liquid, and homeopathic and nutritional substances which are specifically manufactured for injection by means of hypodermic needles.  

(b)  Point injection also includes injection of local anesthetics, such as lidocaine and procaine, for reduction of pain during point injection, consistent with the practice of acupuncture and Eastern medicine and training requirements as defined in rule.

(2)  To perform point injection, an acupuncturist must be trained in point injection.  Only acupuncturists who have NCCAOM Oriental Medicine Certification, which includes specific herbal training requirements and testing, may perform point injection with herbs.

(3) Point injection training requires:

(a) twenty-four contact hours of training including at least eight hours of in person, hands-on experience;

(b) indications, contraindications, and universal precautions;

(c) compounding and administration of the substances authorized for point injection, including aseptic technique, recordkeeping, and storage;

(d) emergency procedures, such as administration of oxygen and responding to adverse reactions and including the use of intramuscular epinephrine.  Up to two hours of training in the use of intramuscular epinephrine may be counted toward point injection training.  An acupuncturist who holds an additional active license with a scope of practice that includes the authority to prescribe, dispense, or administer epinephrine does not need to meet the requirements of this subsection;

(e) an instructor with the following credentials:

(i) a health care license in good standing with a scope of practice that includes point injection; and

(ii)  at least five years of experience in a health care practice that includes point injection; and

(f) providing a successful candidate with:

(i) a certificate of successful completion of the training; and

(ii) a course syllabus which outlines the schedule and curriculum of the training.

(4) Acupuncturists shall order and use traditional oriental and modern medical diagnostic techniques to assist in acupuncture diagnosis, corroboration, monitoring of an acupuncture treatment plan, or referral of a patient to other health care providers.

(1) Each acupuncture licensee shall earn 30 clock hours of accredited continuing acupuncture education during each two-year licensing period. Clock hours or contact hours shall be the actual number of hours during which instruction was given.

(2) A maximum of eight clock hours may be given for the first-time preparation of a new course, in-service training workshop, or seminar which is related to the enhancement of acupuncture practice, values, skills, and knowledge; or a maximum of eight clock hours credit may be given for the preparation by the author or authors of a professional acupuncture paper published for the first time in a recognized professional journal; or given for the first time at a statewide or national professional meeting.

(3) If a licensee completes more than 30 hours of continuing education in a two-year licensing period, excess hours in an amount not to exceed 15 hours may be carried forward to the next two-year licensing period.

(4) Any licensee may apply for a hardship exemption from the continuing acupuncture education requirements of these rules by filing a statement with the board setting forth good faith reasons why he or she is unable to comply with these rules and an exemption may be granted by the board.

(5) Continuing education is not required for licensees renewing their license for the first time.

(1) Continuing education programs must:

(a) have significant intellectual or practical content, and the primary objective shall be to increase the participant's professional competence as an acupuncturist; and

(b) constitute an organized program of learning dealing with matters directly related to the practice of acupuncture, professional responsibility, or ethical obligations of acupuncturists.

(2) Approved continuing education includes:

(a) courses accredited by the National Commission for the Certification of Acupuncture and Oriental Medicine;

(b) courses sponsored by a state acupuncture association or an acupuncture school; and

(c) teaching acupuncture in an accredited academic or continuing education program.

(3) Licensees may claim five hours of self-study toward meeting the requirements of ARM 24.111.815.

(1) The department is authorized to audit CE requirements and shall determine the percentage to audit based on a statistically relevant sampling of the total number of licensees and the compliance rate of past audits.

(2) All CE must be documented to show proof of completion. The licensee is responsible for maintaining CE records for one year following the renewal cycle reporting period and for making the records available upon request. Documentation must include the following information:

(a) licensee name;

(b) course title and description of content;

(c) presenter or sponsor;

(d) course date(s); and

(e) number of CE hours earned.

This rule has been repealed.

(1) Naturopaths must obtain 15 continuing education credits each renewal period, except as provided in (8). At least five of the credits must be in naturopathic pharmacy. If the naturopath holds a naturopathic childbirth specialty certification as provided in ARM 24.111.510, an additional five credits per renewal period must be obtained in obstetrics. One hour of education (excluding breaks) equals one continuing education credit.

(2) No more than three continuing education credits per renewal period will be approved for preparation of and for a single presentation of a program meeting the requirements of this rule.

(3) Continuing education programs will not be preapproved by the board or staff.

(4) In order to be approved, a continuing education program must:

(a) have significant intellectual or practical content;

(b) relate to substantive naturopathic medicine topics within the scope of practice for naturopaths in Montana, except as otherwise provided herein;

(c) be presented by person(s) qualified by practical experience and academic credentials; and

(d) issue certificates of completion (except nonlive programs) and program agendas/syllabi containing the following information:

(i) title and date(s) of program;

(ii) name(s) and qualification of presenter(s);

(iii) outline of program content;

(iv) credit hours of instruction;

(v) description of presentation delivery (i.e., live or nonlive); and

(vi) identification of sponsoring organization.

(5) Continuing education programs from other professions or academic disciplines are eligible for approval if substantially related to the role of naturopaths.

(6) In accordance with 37-1-131, MCA, compliance with this rule shall be attested to by the naturopath on the renewal application. The board will conduct random audits after each renewal period closes of 20 percent of all naturopaths with renewed licenses, for documentary verification of compliance. Documentary evidence of program completion must be maintained by the naturopath for a period of two years for audit purposes. Documentary evidence of completion of nonlive programs (e.g., internet, videotape, audiotape, DVD) may be in the form of proof that the naturopath passed an exam on the program content, a certificate of completion, or the naturopath's notes summarizing the program content.

(7) No continuing education credits are required for a naturopath renewing the naturopath's Montana license for the first time.

(8) Continuing education credit will not be approved for programs:

(a) relating to general business or economic issues other than workers' compensation; or

(b) primarily intended to educate the general public such as CPR and first aid other than programs relating to public health issues.

(1) Midwives must obtain 14 continuing education credits each renewal period except as provided in (7). One hour of education (excluding breaks) equals one continuing education credit.

(2) No more than three continuing education credits per renewal period will be approved for preparation of and for a single presentation of a program meeting the requirements of this rule.

(3) Continuing education programs will not be preapproved by the board or staff.

(4) In order to be approved, a continuing education program must:

(a) have significant intellectual or practical content;

(b) relate to substantive midwifery topics within the scope of practice for direct-entry midwives in Montana, except as otherwise provided herein;

(c) be presented by person(s) qualified by practical experience and academic credentials; and

(d) issue certificates of completion (except nonlive programs) and program agendas/syllabi containing the following information:

(i) title and date(s) of program;

(ii) name(s) and qualification of presenter(s);

(iii) outline of program content;

(iv) credit hours of instruction;

(v) description of presentation delivery (i.e., live or nonlive); and

(vi) identification of sponsoring organization.

(5) Continuing education programs from other professions or academic disciplines are eligible for approval if substantially related to the role of midwives.

(6) Documentary evidence of completion of nonlive programs (e.g., internet, videotape, audiotape, DVD) may be in the form of proof that the midwife passed an exam on the program content, a certificate of completion, or the midwife's notes summarizing the program content. Documentary evidence of program completion must be maintained by the midwife for a period of two years for audit purposes.

(7) No continuing education credits are required for a midwife renewing his/her Montana license for the first time.

(8) Continuing education credit will not be approved for programs:

(a) relating to general business or economic issues other than workers' compensation; or

(b) primarily intended to educate the general public such as CPR and first aid other than programs relating to public health issues.

This rule has been repealed.

(1) It is unprofessional conduct for a licensee or applicant to violate any statute, rule, or standard of care governing their scope of practice. In addition, the following is unprofessional conduct:

(a) failing to cooperate with an investigation of the board by failing to respond in full or in part;

(b) failing to adequately supervise auxiliary staff to the extent that the patient's physical health or safety is at risk;

(c) practicing while the license is suspended, revoked, or expired;

(d) offering, undertaking or agreeing to cure or treat disease or affliction by a secret method, procedure, treatment, or the treating, operating, or prescribing for any health condition by a method, means, or procedure which the licensee refuses to divulge upon demand from the board;

(e) abandoning, neglecting, or otherwise physically or emotionally abusing a client or patient requiring care;

(f) intentionally or negligently causing physical or emotional injury or abuse to a client or patient in a clinical setting, or sexual abuse, sexual misconduct, or sexual exploitation by the licensee, whether or no related to the licensee's practice;

(g) operating under unsanitary conditions after a warning from the board or consistently maintaining an unsanitary office;

(h) failure by a midwife to maintain current and valid certifications in adult and infant cardiopulmonary resuscitation and neonatal resuscitation as provided by 37-27-201 , MCA;

(i) prescribing a scheduled drug without a current DEA registration.

(1) The board authorizes the department to: 

(a) administratively suspend licenses for deficiencies set forth in 37-1-321(1)(a) though (e), MCA; or 

(b) file a complaint pertaining to the deficiencies in (1) that are based on repeated or egregious conduct, or that have co-occurring misconduct allegations that directly implicate public safety and may warrant formal disciplinary action.

(2) An administrative suspension is not a negative, adverse, or disciplinary action under Title 37, MCA, and is not reportable under federal law and regulations implementing the Healthcare Practitioner Databank or the department's licensee lookup and license verification databank.

This rule has been repealed.

This rule has been repealed.