1. (1) In order to participate in the program a nurse midwife must submit a completed application form along with a copy of current registered nurseand nurse midwife licensure, plus copy of the written signed agreement between the nurse midwife and the physician consultant. If the application isapproved, Medicaid will offer the applicant a one year renewable contract.
2. (2) Only in-state and border line out-of-state (within a 30-mile radius of Alabama's state line) providers who meet enrollment requirements areeligible to participate in the Alabama Medicaid Program.

3. (3) Nurse Midwives who want to participate in the Medicaid program should contact the Medicaid Agency for an enrollment application. Send therequest to:

   1. P. O. Box 5624

      Montgomery, Alabama 36103-5624

   Administrator of Nurse Midwife Program

   Alabama Medicaid Agency

   501 Dexter Avenue

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§401, et seq., 440.165, 441.21; Code of Ala. 1975, §§34-19-2, etseq.

History: Rule effective October 1, 1982. Effective date of this emergency amendment June 14, 1993. Effective date of this amendment August12, 1993. Amended Filed: July 6, 1995; effective August 12, 1995.