(This appeared as an article in the January/February 1999 issue of Quickening. Information in the comparison chart was updated in February 2006.)
With the decision by the American Midwifery Certification Board (AMCB) (formerly the ACNM Certification Council) regarding requirements for the Certification Maintenance Program (CMP), questions may arise about who the CMP impacts, how the CMP relates to the American College of Nurse-Midwives' (ACNM) Continuing Competency Assessment (CCA) Program, and where to turn to for more information. To provide a better understanding of some of the recent changes in national certification, this article will give an overview of the administration of certification to date, highlight the important distinction of the CMP and CCA programs, and provide a summary table comparing the differences and similarities between the two programs.
An Overview of National Certification
A national certification examination to confer the credential Certified Nurse-Midwife (CNM) was first instituted in 1971 by ACNM. In 1991, AMCB was incorporated as an independent certification organization, separate from ACNM. In 1992, AMCB assumed responsibility for the provision the National Certification Examination (NCE) and issuance of certificates for nurse-midwives. In 1997, AMCB first issued the credential Certified Midwife (CM). Today, AMCB is the only organization that officially (1) confers the credential CNM or CM; (2) verifies certification for purposes such as employment or state licensure, and (3) issues replacements for lost certificates for any CNM or CM, regardless of whether the initial certificate was issued by ACNM or AMCB. AMCB is responsible for creating and administering the NCE, and developing and implementing the CMP.
Distinctions between CMP and CCA
AMCB began issuing time limited certificates to anyone who passed the NCE after January 1, 1996. The certificates expire approximately 8 years from when the individual passed the exam. This time limited certificate has been issued to all CMs and approximately 1,500 CNMs to date. For individuals with a time limited certificate, choosing between the CMP and CCA is not an either/or option.They must meet the CMP requirements in order to receive a new certificate. However, they also may participate in the CCA Program if they choose or if their state or employer requires CCA participation in addition to CMP. For CNMs who do not have a time limited certificate, the CMP is a voluntary process, although states and employers may require participation.
In 1986, ACNM established the CCA Program. When originally established, the CCA Program was mandatory for all CNMs in active clinical practice or teaching in a education program. In 1995, the ACNM Board of Directors changed the position on CCA to make it a voluntary program for any CNM or CM. The CCA Program does not have any impact on national certification, but it may have impact on the ability of some CNMs to receive state licensure. In addition, some employers may require participation in CCA as a condition for employment.
CMP and CCA Requirements
The CMP and CCA program requirements are similar in some areas and different in other areas. The summary table that follows was designed to give a brief overview of the two programs. For more detailed information or clarification for each program, please contact the appropriate organization designated at the bottom of each column.
Certification Maintenance Program (CMP)
Continuing Competency Assessment (CCA) Program
Program Sponsor
American Midwifery Certification Board
(AMCB)
American College of Nurse-Midwives (ACNM)
Program Became Effective
January 1, 1996
Began in 1987 as mandatory for all CNMs in active clinical practice or teaching. Changed to a voluntary program in 1995
Participation Requirements
Mandatory for all CNMs and CMs certified after January 1, 1996
Voluntary for CNMs certified prior to December 31, 1995, but may be mandated by states (such as OK)
Voluntary for all CNMs and CMs
May be mandated by states (such as AL, GA, MD, ME, MO, NM) or employer
Completion Options
Accrual of 20 contact hours or 2 continuing education units (CEUs) approved by either ACNM or ACCME for Category I activities during 8-year certification period
-AND EITHER-
Option 1: Completing and successfully passing open book post-tests for 3 certification maintenance modules (CMM) within the 8-year certification period
-OR-
Option 2: Passing the NCE between beginning of the 7th yearand end of the 8-year certification period.
Option 1: Passing the NCE once during 5 year CCA cycle (initial certification does not count)
-OR-
Option 2: Completing 50 contact hours or 5 CEUs of ACNM approved and/or ACCME Category I continuing education activities and/or any of the four alternatives in lieu of CEUs
Dates Effective
Initial certification becomes effective the day a graduate takes and passes the NCE and expires eight full years later on December 31
Subsequent certifications become effective January 1 and expire eight years later on December 31
A CCA cycle always begins on September 1 and expires five years later on August 31. The year it begins depends of when an enrollment application is submitted, regardless of graduation or certification date
Subsequent CCA cycles begin when a new enrollment application is submitted for each cycle
Self Reporting Forms (SRFs) are always due by October 1 following the cycle's expiration date
Upon Successful Completion of Program Requirements
For CNMs and CMs with a time limited certificate, a new 8-year time limited certificate is issued
For CNMs without a time limited certificate, a certificate of completion is issued
Certificate of Satisfactory Completion is issued once random audit of cycle is completed
Failure to Meet Program Requirements
For CNMs/CMs with time limited certificate:
For certificants who choose Option 1 and fail a CMM post-test, another post-test may be resubmitted. If they fail the second post-test, they may submit the post-test for the updated module in the content area once, if available within 8-year certification period. If the post-test is failed a third time, the certificant must pass the NCE. If the certificant's certificate expires before passing the NCE, the certificant may apply to the Credentials Administration and Reporting (CAR) committee chair for a limited extension of the certificate. The certificant must take the examination at the first available opportunity.
Certificants who select Option 2 will be allowed to take the NCE as many times as possible within the last two years (potential is up to 9 times in a two year period).
Policies for re-entry into practice after failure or lapse of CMP requirements are currently under development.
If a CNM without a time limited certificate does not meet the CMP requirements, no certificate of completion is issued, but original certification is still valid
No Certificate of Satisfactory Completion issued
Participant is invited to enroll in next CCA cycle
Enrollment
CNMs and CMs with time limited certificates are automatically enrolled in the CMP and are required to keep the AMCB informed of any changes to name, address or status of licensure
Participant must submit a completed CCA Enrollment Form at the beginning of the CCA cycle
Documentation and Verification of Meeting Program Requirements
Certificants are required to maintain individual records of accumulated CEUs. A 10% audit of all certificants whose certificate expire that year will be conducted in the eighth year of certification.
Participant must submit a completed SRF listing activities completed in the 5 year period that meet the CCA Program requirements. The SRF must be postmarked by October 1 of the year the cycle ends. No documentation is due with the SRF. An audit is conducted of 10% of the cycle participants selected at random plus any SRFs that did not demonstrate meeting the minimum requirements. Audit participants are asked to submit copies of documentation of reported CEU or alternative activities
Mechanism for Verification of Participation
Certificate with valid dates or letter of verification issued by AMCB.
CCA Enrollment card with valid dates for participation in current cycle
Certificate of Satisfactory Completion for previous cycles
Ability to Change Options
Certificants who originally elect to complete the CMMs may choose to change to passing the NCE at any time
Certificants who originally elect to pass the NCE between years 7 and 8 may not choose to change to completing CMMs
If participant cannot complete 5 CEUs within 5 year CCA cycle, must pass exam before end of CCA cycle
If participant does not pass exam, must submit a Self Reporting Form (SRF) documenting completion of 5 CEUs no later than the CCA reporting deadline
Fees
Annual administrative fee
A certificant must pay an annual administrative fee for each year of the
8 year cycle or the cost of the exam if they choose to retake it at the
end of their 8 year cycle but not both. There is no cost to retake the
post tests but there may be a fee for additional post test booklets.
Late fees are assessed as appropriate.
One time fee per cycle of $100 for ACNM members/$200 for non-ACNM members, due with application to enroll in cycle
For More Information Contact
American Midwifery Certification Board
849 International Dr., Suite 205
Linthicum, MD 21090
ph: (410) 694-9424
American College of Nurse-Midwives
8403 Colesville Road
Suite 1550
Silver Spring, MD 20910
240/485-1846
fax: 240/485-1818
e-mail: educ@acnm.org
web site: www.midwife.org
