CNM · Massachusetts
Supervision Agreement for Certified Nurse-Midwives in Massachusetts
No. Certified Nurse-Midwives practice independently here. Massachusetts does not require one.
CNMs have full practice authority immediately upon licensure — 244 CMR 4.06 requires neither a supervising physician nor written prescriptive guidelines, only an ongoing 'clinical relationship' with an OB-GYN for collaboration/referral, not day-to-day oversight.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
244 CMR 4.06: no supervising physician is required at all; the required 'clinical relationship' with an OB-GYN is a collaboration/referral duty, not a proximity-based supervision standard.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
Schedule II–V under M.G.L. c. 94C §7(g); requires DPH and/or DEA controlled-substance registration — prescribes independently with no physician sign-off.
Written agreement
Not required
Unconditional in the sense that no supervising physician or written guidelines are ever required (244 CMR 4.06) — but a CNM must still maintain an ongoing 'clinical relationship' with an obstetrician-gynecologist for consultation/referral, a collaboration duty distinct from a gating supervisory agreement.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same open item as the general `np` entry — Professional Corporation under M.G.L. c. 156A; nurse-owned PC/PLLC eligibility for CNM-delivered care was not confirmed from primary text this pass.
This ownership question is unaffected by CNM's immediate independent-practice status above — that status governs clinical oversight, not entity ownership.
Legal sources for these rules (2)
- 244 CMR 4.06 — Advanced Practice Registered Nursing, Scope of Practicesecondary
- M.G.L. c. 94C, §7(g) — CNM prescriptive authority
What a supervising physician costs here
Typical monthly cost in Massachusetts
$500 – $600
Estimate for one Certified Nurse-Midwife. Standard-tier state.
About Massachusetts's rules
Full practice authority (Acts 2020, c. 260, §36; 244 CMR 4.00) let NPs, PMHNPs, and CNMs practice independently in MA — CNMs immediately, NPs/PMHNPs after a Board-attested transition (244 CMR 4.07). PAs and CRNAs have no independent-practice pathway. MA's professional-corporation ownership rules (M.G.L. c. 156A) are notably strict; this file could not independently re-verify APRN/PA-specific PLLC eligibility this pass — treat CPOM entries as open items.
Other clinicians in Massachusetts: see the state overview.