CNM · North Carolina
Supervision Agreement for Certified Nurse-Midwives in North Carolina
Yes, a written supervising-physician agreement is required. North Carolina does not name a specific instrument.
Independent midwifery practice authority created by S.L. 2023-14 § 4.3 (Care for Women, Children, and Families Act); implementing rules (21 NCAC 33) effective October 1, 2024. Once independently approved, a CNM need only consult/collaborate with and refer to other providers as clinically indicated — no collaborative provider agreement required.
Independent practice requires: ≥24 months of practice as a CNM; ≥4,000 hours of practice as a CNM.
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
below the 24-month/4,000-hour independent-practice threshold: Available remotely (no on-site requirement)
Collaborating provider and CNM must be 'available to each other as needed for consultation' (21 NCAC 33 .0104). Some secondary sources reference in-person contact availability, but no confirmed numeric radius was found — verify exact current rule text before relying on this for compliance decisions.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
on changing collaborating providers: As needed
CNM has 90 days to submit a newly executed Collaborative Provider Agreement to the Midwifery Joint Committee and may continue practicing during that window. No other recurring meeting cadence is codified.
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
CNMs have prescriptive authority for legend drugs and Schedule II–V controlled substances consistent with AMCB certification and 21 NCAC 33 scope rules; requires DEA registration and ≥1 hour/year CE on controlled-substance topics. Chapter 33 was renumbered in the 2023–2024 rule overhaul — confirm exact current subsection before publishing.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) or PLLC — a CNM may co-own a nursing-services entity with any combination of RN/NP/CNS/CRNA, or with a physician (N.C. Gen. Stat. § 55B-14); non-licensees may not hold equity.
This ownership rule is unaffected by whether the CNM has reached independent midwifery practice status — the 24-month/4,000-hour threshold above governs clinical collaboration, not entity ownership.
What a supervising physician costs here
Typical monthly cost in North Carolina
$500 – $600
Estimate for one Certified Nurse-Midwife. Standard-tier state.
About North Carolina's rules
The NP 'SAVE Act' (full practice authority) has failed every session since 2021, most recently as S.B. 966 (2026) — NC NPs have no independent-practice pathway. PA 'team-based practice' (S.L. 2025-37/H.B. 67) is now LIVE: its June 30, 2026 trigger has passed, regardless of whether NCMB's conforming rules were finished by then. Several categories below (CRNA proximity/ratio/chart-review, CNM proximity) have no codified numeric standard — treat as open items to verify with the board, not an absence of one.
Other clinicians in North Carolina: see the state overview.