55 N.J.R. 1983(a)

VOLUME 55, ISSUE 18, SEPTEMBER 18, 2023
RULE PROPOSALS

Reporter
55 N.J.R. 1983(a)
NJ - New Jersey Register  >  2023  >  SEPTEMBER  >  SEPTEMBER 18, 2023  >  RULE PROPOSALS  >  LAW AND PUBLIC SAFETY -- DIVISION OF CONSUMER AFFAIRS

Interested Persons Statement 

INTERESTED PERSONS 
Interested persons may submit comments, information or arguments concerning any of the rule proposals in this issue until the date indicated in the proposal. Submissions and any inquiries about submissions should be addressed to the agency officer specified for a particular proposal. 
The required minimum period for comment concerning a proposal is 30 days. A proposing agency may extend the 30-day comment period to accommodate public hearings or to elicit greater public response to a proposed new rule or amendment. Most notices of proposal include a 60-day comment period, in order to qualify the notice for an exception to the rulemaking calendar requirements of  N.J.S.A. 52:14B-3. An extended comment deadline will be noted in the heading of a proposal or appear in a subsequent notice in the Register. 
At the close of the period for comments, the proposing agency may thereafter adopt a proposal, without change, or with changes not in violation of the rulemaking procedures at      N.J.A.C. 1:30-6.3. The adoption becomes effective upon publication in the Register of a notice of adoption, unless otherwise indicated in the adoption notice. Promulgation in the New Jersey Register establishes a new or amended rule as an official part of the New Jersey Administrative Code. 
Agency


LAW AND PUBLIC SAFETY > DIVISION OF CONSUMER AFFAIRS > STATE BOARD OF MEDICAL EXAMINERS

Administrative Code Citation


Proposed New Rule: N.J.A.C. 13:35-2A.17A      

Text

 Midwifery Early Aspiration Abortion
Authorized By: Board of Medical Examiners, Antonia Winstead, Executive Director.
Authority: N.J.S.A. 45:9-2.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2023-091.
Submit comments by November 17, 2023, to:
Antonia Winstead, Executive Director
Board of Medical Examiners
140 East Front Street, 2nd Floor
PO Box 183
Trenton, NJ 08625
or electronically at: http://www.njconsumeraffairs.gov/Proposals/Pages/default.aspx
The proposal of the agency follows:
Summary
On December 6, 2021, the Board of Medical Examiners (Board) repealed N.J.A.C. 13:35-4.2, which provided that only a physician licensed to practice medicine and surgery in New Jersey could perform a termination of pregnancy procedure. At the same time, the Board adopted new N.J.A.C. 13:35-4A.19, which recognizes that a physician licensed to practice medicine and surgery in New Jersey may authorize an "advanced practice clinician" to perform "minor procedures" consistent with their respective scopes of practice and as addressed within their individual collaborating agreements. Pursuant to N.J.A.C. 13:35-4A.3, "advanced practice clinicians" includes physician assistants, advanced practice nurses, certified nurse midwives (CNMs), and certified midwives (CMs). The definition of "minor procedures" includes, among other things, early aspiration abortions. The Board now proposes new N.J.A.C. 13:35-2A.17A to establish the requirements for CNMs and CMs to perform early aspiration abortions.
Proposed new N.J.A.C. 13:35-2A.17A defines the term "authorized practitioner" to include a physician, a CNM, or CM who has met the requirements of the proposed new rule, or an advanced practice nurse, or physician assistant whose scope of practice includes the performance of early aspiration abortions, as determined by the Board of Medical Examiners, Midwife Liaison Committee, Physician Assistant Advisory Committee, or the Board of Nursing. The rule also defines "early aspiration abortion" as "a procedure that terminates a pregnancy in the first trimester of pregnancy (defined as up to 14 completed weeks as calculated by an estimate of gestational age that utilizes the last menstrual period, ultrasound, and/or physical examination, as appropriate to the standard of care) utilizing manual or electric suction to empty the uterus."
A CNM or CM could perform an early aspiration abortion once the CNM or CM has met the coursework and clinical education requirements of the proposed new rule. The course the CNM or CM will be required to complete would have to be offered by an accredited college or university or by an organization recognized by the American College of Obstetrics and Gynecology, the American College of Nurse Midwives, or the National Association of Nurse Practitioners in Women's Health. This course must cover the Early Abortion Training Curriculum, the Training in Early Abortion for Comprehensive Healthcare (TEACH), published by the Bixby Center for Global Reproductive Health, which is an interactive curriculum with tools to train new reproductive health providers, or a curriculum of comparable scope and rigor. Under the supervision of an authorized practitioner, a CNM or CM will also have to complete the Core Competencies for Early Abortion Care included in the TEACH or a program of comparable scope and rigor. A CNM or CM who has completed coursework and clinical experience in another state that is substantially similar to that required by the proposed new rule will be authorized to perform early aspiration abortions in New Jersey.
The proposed new rule sets forth the documentation that a CNM or CM will need to retain regarding the coursework and clinical education that are required to perform early aspiration abortions. The proposed new rule also requires CNMs and CMs who have met the requirements of the proposed new rule to amend their clinical guidelines to indicate that early aspiration abortions are within their scope of practice.
The Board has provided a 60-day comment period for this notice of proposal. Therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.
Social Impact
The proposed new rule will benefit CNMs and CMs who seek to perform early aspiration abortions by providing clear guidance as to the coursework and clinical education they must complete to perform early aspiration abortions safely and effectively. The proposed new rule will also have a positive impact on individuals seeking early aspiration abortions by expanding access to early aspiration abortions in a manner that complies with safety and health standards. By enlarging the pool of practitioners who are authorized to perform early aspiration abortions, the proposed rule will make it less likely that individuals seeking early aspiration abortions will have to travel long distances to access abortion care, thus reducing delays in care and the higher costs and increased risks associated with such delays.
Economic Impact
The proposed new rule will impose costs on CNMs and CMs who seek to provide early aspiration abortions. Such CNMs and CMs will likely pay a fee for the required coursework and clinical education required by the rule. By enlarging the pool of practitioners who are authorized to perform early aspiration abortions, the proposed rule will make it less likely that individuals seeking early aspiration abortions will have to travel long distances to access abortion care, thus reducing the higher costs associated [page=1984] with such delays. The Board does not anticipate that the proposed new rule will have any other economic impact.
Federal Standards Statement
A Federal standards analysis is not required because there are no Federal laws or standards applicable to the proposed new rule.
Jobs Impact
The Board does not believe that the proposed new rule will result in the creation or loss of jobs in the State.
Agriculture Industry Impact
The proposed new rule will have no impact on the agriculture industry in the State.
Regulatory Flexibility Analysis
Any CNM or CM licensed by the Board who is a "business which is resident in this State, independently owned and operated and not dominant in its field, and which employs fewer than 100 full-time employees" constitutes a "small business" within the meaning of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq. (RFA). To the extent a CNM or CM qualifies as a "small business" pursuant to the RFA, the following analysis applies pursuant to N.J.S.A. 52:14B-19.
The costs imposed on small businesses are the same as those imposed on all CNMs and CMs, as discussed in the Summary and Economic Impact above. The Board does not believe that CNMs and CMs will need to employ any additional professional services to comply with the requirements of the proposed new rule. The proposed new rule imposes no reporting requirements; however, it does impose compliance and recordkeeping requirements as detailed in the Summary above.
As the compliance and recordkeeping requirements in the proposed new rule help to ensure that CNMs and CMs are adequately prepared to provide early aspiration abortions in a safe and effective manner, the Board believes that the rules must be uniformly applied to all CNMs and CMs who perform, or intend to perform, this procedure and no exemptions are provided based on the size of a CNM's or CM's business.
Housing Affordability Impact Analysis
The proposed new rule will have an insignificant impact on the affordability of housing in New Jersey and there is an extreme unlikelihood that the proposed new rule would evoke a change in the average costs associated with housing because the proposed new rule concerns CNMs and CMs who seek to provide early aspiration abortions.
Smart Growth Development Impact Analysis
The proposed new rule will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rule would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers under the State Development and Redevelopment Plan in New Jersey because the proposed new rule concerns CNMs and CMs who seek to provide early aspiration abortions.
Racial and Ethnic Community Criminal and Public Safety Impact
The Board has evaluated this rulemaking and determined that it will not have an impact on pretrial detention, sentencing, probation, or parole policies concerning adults and juveniles in the State. Accordingly, no further analysis is required.
Full text of the proposed new rule follows:
SUBCHAPTER 2A. LIMITED LICENSES: MIDWIFERY
13:35-2A.17A Early aspiration abortion
(a) The following words and terms, when used in this section, shall have the following meanings:
"Authorized practitioner" means:
1. A physician;
2. A CNM or CM who has met the requirements of this section; or
3. An advanced practice nurse or physician assistant whose scope of practice includes the provision of early aspiration abortions.
"Early aspiration abortion" means a procedure that terminates a pregnancy in the first trimester of pregnancy (defined as up to 14 completed weeks as calculated by an estimate of gestational age that utilizes the last menstrual period, ultrasound, and/or physical examination, as appropriate to the standard of care) utilizing manual or electric suction to empty the uterus.
(b) A CNM or CM who has successfully completed a course as required pursuant to (c) below and clinical experience as required pursuant to (d) below, or who has met the requirements at (f) below, may perform an early aspiration abortion.
(c) A CNM or CM who intends to perform an early aspiration abortion shall complete a course, given by a college or university accredited by an accrediting association recognized by the U.S. Department of Education or given by an organization recognized by either the American College of Obstetrics and Gynecology, the American College of Nurse Midwives, or the National Association of Nurse Practitioners in Women's Health, that covers the topics included in the Training in Early Abortion for Comprehensive Healthcare (TEACH), Abortion Training Curriculum, 7th Edition, 2022, incorporated herein by reference, as amended and supplemented, published by the Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA 94110, or a curriculum of comparable scope and rigor.
(d) A CNM or CM who intends to perform an early aspiration abortion independently shall complete, under the supervision of an authorized practitioner, the Core Competencies for Early Abortion Care included in the Training in Early Abortion for Comprehensive Healthcare (TEACH), Abortion Training Curriculum, 7th Edition, 2022, incorporated herein by reference, as amended and supplemented, published by the Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA 94110, or a program of comparable scope and rigor.
(e) A CNM or CM who intends to perform an early aspiration abortion shall retain:
1. A certificate from the sponsor of the early aspiration abortion course indicating that the CNM or CM has completed the course required at (c) above; and
2. A certificate or a letter indicating that the CNM or CM has completed the clinical experience required at (d) above from either:
i. An authorized practitioner who has observed the CNM or CM perform an early aspiration abortion under their supervision; or
ii. An organization, site of care, or facility at which the CNM or CM performed an early aspiration abortion.
(f) A CNM or CM who has completed the education and clinical experience in another state that are substantially similar to those required at (c) and (d) above shall be authorized to perform early aspiration abortions, provided the CNM or CM satisfies the other requirements of this section.
(g) A CNM or CM who intends to perform early aspiration abortions pursuant to (f) above shall retain documentation of the education and clinical experience the CNM or CM completed in another state which is substantially similar to the requirements at (c) and (d) above.
(h) A CNM or CM who intends to perform early aspiration abortions shall amend the clinical guidelines to indicate that early aspiration abortions are within the CNM's or CM's scope of practice.