CNM · Texas
Collaborative Practice Agreement for Certified Nurse-Midwives in Texas
Yes, a written physician agreement is required. Texas does not name a specific instrument.
CNMs' nursing-scope clinical judgment is autonomous under BON licensure, but prescribing/ordering drugs requires the same Prescriptive Authority Agreement (Tex. Occ. Code §§ 157.0511–.0512) as any other APRN — no CNM-specific carve-out or independence pathway exists, unlike some states' hours-based CNM tracks. Freestanding-birth-center rules (Health & Safety Code Ch. 244) may add facility-level requirements — unconfirmed, flag for follow-up.
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
No proximity requirement
Same as `np` — no codified mileage/radius or continuous-availability standard.
Supervision ratio
Up to 7 at a time (combined across provider types)
Same combined APRN+PA cap as `np` (§ 157.0512(c)).
Chart review
Not codified — left to the agreement
Meeting cadence
Monthly, in person or via telehealth
Same cadence and no-fixed-percentage chart-review rule as `np` (§ 157.0512(e)(9)).
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
CNMs are presumed to have met the graduate pharmacotherapeutics/pathophysiology/health-assessment coursework prerequisite for prescriptive authority on the basis of their advanced-practice nursing program (22 Tex. Admin. Code § 222.2) — unlike CNS (see that entry), no additional dedicated coursework is required.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same as the general `np` entry — CNMs are an APRN category not listed in § 301.012, so no statutory ownership pathway into a medical PA/PLLC exists. A CNM may own a nursing/midwifery-scope-only entity under § 301.003's same-profession rule.
This ownership limitation is unaffected by practice setting — it applies the same whether the CNM practices in an office or a freestanding birth center.
Legal sources for these rules (4)
- Tex. Occ. Code §§ 157.0511, 157.0512
- 22 Tex. Admin. Code § 222.2 — Prescriptive Authority coursework prerequisites
- 22 Tex. Admin. Code §§ 221.12–221.13 — BON, APRN core practice standards
- Tex. Health & Safety Code Ch. 244 — Birthing Centers (facility-level rules, not independently verified against implementing TAC chapter in this pass)
What a collaborating physician costs here
Typical monthly cost in Texas
$500 – $650
Estimate for one Certified Nurse-Midwife. This state's rules add a restrictive-tier premium.
About Texas's rules
Texas has no independent-practice pathway for any APRN type (NP/PMHNP/CRNA/CNM/CNS) at any experience level — a 2025 rural 10-year/20,000-hour bill (S.B. 3055) died in committee, as did 2023's full-practice-authority S.B. 1700. No chart-review percentage is codified (the physician and provider set the number themselves) — the commonly-cited 10%/20% figures reflect a pre-2013 rule since repealed. PA is the only non-physician profession with a statutory joint-ownership pathway into a medical entity.
Other clinicians in Texas: see the state overview.