CNM · Missouri
Collaborative Practice Agreement for Certified Nurse-Midwives in Missouri
Yes, a written physician agreement is required. Missouri does not name a specific instrument.
CNM is not a distinct licensure category — Missouri's unified APRN statute (§ 335.016) lists 'Certified Nurse Midwife' as one of four national-certification sub-types under the single APRN license. No CNM-specific supervision statute was found; a CNM practices under the same § 334.104 framework as a general NP.
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Available remotely (no on-site requirement)
Same undefined 'geographic proximity' standard as general NP (§ 334.104).
Supervision ratio
Up to 6 at a time (combined across provider types)
Same 6-FTE combined cap as general NP/PA.
Chart review
10% of charts · As needed (every 14 days)
Same 10%/20% structure as general NP.
Meeting cadence
As needed
Same biweekly-presence standard as general NP.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III-V/hydrocodone framework, 120-hour cap, ≥1,000-hour threshold for the controlled-substance certificate as general NP.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same as the general `np` entry — no CNM-specific ownership rule found.
Legal sources for these rules (2)
What a collaborating physician costs here
Typical monthly cost in Missouri
$500 – $700
Estimate for one Certified Nurse-Midwife. This state's rules add a restrictive-tier premium.
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.