Alabama Administrative Code Chapter 610-X-14 — Medication Assistant, Certified (MAC)

610 Alabama Board of Nursing

Ala. Admin. Code r. 610-X-14-.01 Definitions

(1) Approved Program: A medication assistant, certified (MAC) education program that meets all of the standards as specified in these rules.

(2) Clinical and Theoretical Competence: The possession of knowledge, skills, and abilities necessary to meet current standards of MAC practice and education as specified in 610-X-14-.02 Qualifications of Applicants for Permit.

(3) Clinical Learning Experience: Organized plan of learning experiences, under the oversight of an experienced clinical supervisor, that provides student opportunities to integrate knowledge and skills related to the administration of medications appropriate to the scope of practice for the MAC program.

(4) Clinical Supervisor: A licensed registered nurse or practical nurse, acting in a supervisory capacity of clinical learning experiences, who is accessible to assign or prescribe a course of action, provide guidance, and evaluation for MAC students.

(5) Curriculum: An organized plan of study that includes both theoretical and clinical learning experiences essential for preparing students to be eligible upon course or program completion to apply for a MAC permit.

(6) Student Learning Outcomes: A common set of competencies within an organized plan of study expected of completers which are clear, measurable demonstrations of student learning.

(7) Program Outcomes: A common set of outcomes within an organized plan of study expected of completers which include program completion, job placement, and certification pass rates.

(8) Deficiency(ies): Failure of a medication assistant, certified program to meet one or more of the standards as stated in Chapter 610-X-14.

(9) MAC Instructor: Registered nurse, with at least an associate degree in nursing, who is employed full-time or part-time by the governing institution and has completed a board-approved MAC train-the-trainer course. Instructors are responsible for teaching and evaluating - student performances in MAC courses.

(10) MAC Program Coordinator: Individual who is employed full-time by the governing institution, has completed the board-approved MAC coordinator training, and has primary accountability and responsibility for administration of the MAC program.

(11) Off-campus instructional site: A geographical location apart from an institution’s main campus where instruction is delivered, either entirely or partially, utilizing its own or sharing instructors with the main campus.

(12) Healthcare facilities: A facility described in Code of Ala. 1975, Section 22-21-20(1), other than a healthcare maintenance organization, which has an organized medical staff, or which employs the services of a medical director who is a physician licensed to practice medicine in Alabama. The term healthcare facility shall not include the private offices of physicians or dentists, whether in individual, group, registered corporation, or registered association practice.

(13) Survey: A comprehensive, Board-authorized on-site evaluation or review of a written report, and/or documents, for a proposed or existing program that serves to assess the program’s compliance with the Board’s education standards.

(14) Governing Institution Administrator: Person with overall administrative authority for the campus/instructional sites where the MAC program is located.

(15) Certification Pass Rate: The percentage of completers of a MAC program taking the certification examination during a calendar year who achieve a passing score on the certification examination during the calendar year.

(16) Notice of Deficiency: An official notice by the Board which identifies areas of deficiency and provides the expected date of correction. The notice may require follow-up site visits and submission of additional documents, evaluations, and reports.

(17) Notice of Correction: An official notice by the Board notifying a MAC program of the correction of previous areas of deficiency and current approval status of the MAC program.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Amended: Published January 31, 2022; effective March 17, 2022. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.02 Qualifications Of Applicants For Permit

(1) The applicant for a MAC permit shall:

(a) Be a high school graduate or the equivalent, as determined by the Board.

(b) Be of good character. A criminal background check may be conducted by the Board at its discretion.

(c) Have successfully completed one of the following:

1. A Board-approved medication assistant education program in Alabama, or a medication assistant, certified program located in another jurisdiction or territory that substantially meets the same educational criteria as Alabama programs, as determined by the Board.

2. NUR 113: Nursing Concepts 1 (Alabama Community College System Curriculum) or a substantially equivalent course, as determined by the Board.

3. US Armed Forces training equivalent to educational preparation for US Army Healthcare Specialist, US Navy Corpsman, and USAF Medical Technician, as determined by the Board according to the applicant's academic transcript validating education preparation.

(d) Complete a certification exam recognized by the board with a passing score.

(2) An applicant shall provide a valid social security number prior to the Board issuing a permit.

(3) Be a citizen or legal resident of the United States. Individuals who are not legally present in the United States are not eligible for permit.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Amended: Published January 31, 2022; effective March 17, 2022. Amended: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.03 Permit By Examination

(1) The Board shall determine the official examination for medication assistant, certified permits.

(2) Each individual seeking entry into practice as a medication assistant, certified in Alabama shall give official evidence of having met a passing standard on the Board-designated official examination.

(3) Examination performance for each applicant shall be measured as provided by the Board-approved testing service. In the event that examination data are lost or destroyed through circumstances beyond the control of the Board, the applicant shall be required to retake the examination in order to meet requirements for permit.

(4) A Pass-Fail designation shall be recorded as the official result. An applicant who fails the certification examination shall not be approved or receive a permit and is not authorized to practice as a medication assistant, certified in Alabama.

(5) Official results shall be released by the Board to the applicant and the program from which the applicant graduated. Results may be released electronically or by mail at the Board's discretion. The Board shall not otherwise release individual examination results without written authorization from the applicant or licensee.

(6) An applicant who fails the certification examination in another jurisdiction or territory shall not be eligible for licensure by examination in Alabama until eligibility has been established by the original jurisdiction or territory.

(7) Any MAC practicing under the nursing delegation program described in §610-X-7-.11 prior to January 1, 2022 shall be issued a permit to practice as a MAC in the state of Alabama. Such permits shall be valid through December 31, 2023, at which time the permit may be renewed during the renewal period for MACs.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.04 Application Process For Permit By Examination

(1) The applicant shall submit to the Board a complete electronic application and the required fee(s).

(2) A primary source official school transcript shall be submitted to the Board and shall indicate the date of completion of the program and/or date degree/certificate was conferred:

(3) The Board shall determine the applicant's eligibility to take the certification examination.

(4) If the applicant for permit by examination is issued a permit during the renewal period, the permit shall expire at the end of the next permit period.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.05 Applicant Request For Special Accommodation(s)

(1) An applicant for permit by examination who is otherwise qualified shall not be deprived of the opportunity to take the examination solely by reason of disability.

(2) Written requests for modification of the procedures for administering the examination shall be submitted to the Board at the time of application for certification. The written request shall include:

(a) An evaluation of the disability by the applicant's licensed physician or licensed psychologist, including the DSM IV diagnosis if appropriate.

(b) A statement from the director of the nursing education program addressing any accommodations made during the nursing education program.

(c) The specific accommodation being requested.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.06 Permit By Endorsement

(1) The applicant for permit by endorsement shall:

(a) Have been duly approved and as a medication assistant, certified (MAC) under the laws of another state or territory and shall meet the requirements for the certification examination.

1. The Board may deny consideration of an applicant who has a revoked certification, approval or permit in another jurisdiction.

2. The Board may deny consideration of an applicant who has a suspended license, approval or permit in another jurisdiction.

(b) Provide for official verification of approval from original state of approval or from a board recognized primary source.

(c) Submit primary source evidence of completion of a medication assistant, certified education program that included theoretical and clinical experience appropriate to the type of program.

(d) Submit a complete electronic application and required fees.

(2) If the applicant for permit by endorsement is issued a permit during the renewal period for that permit type, the permit shall expire at the end of the next permit period.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.07 Renewal Of Permit

(1) The Alabama medication assistant, certified permit shall be valid for two years beginning January 1 of each even-numbered year and expiring December 31 of each odd-numbered year.

(2) Renewal of Permit

(a) The renewal period shall be from 8:00 a.m. on September 1 to 4:30 p.m. on December 31 of the year the permit expires.

(b) Renewal notices may be transmitted electronically.

(c) To be eligible for renewal, the applicant shall:

1. Hold a valid, active Alabama permit.

2. Submit a completed electronic renewal application and required fee(s).

3. Meet continuing education and/or competency validation requirements as determined by the Board.

(3) An active permit is required to practice as a MAC. The licensee shall have evidence of the active permit available for employer inspection by January 1 of the new permit period.

(4) Failure to receive the renewal application or notice shall not relieve the MAC of the responsibility of renewing the permit by the expiration date.

(5) Any MAC not renewed as of December 31 of the renewal period shall lapse. Any individual who practices with a lapsed permit shall be subject to penalties established under Section 610-X-14-.21 of these rules.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.08 Special Provisions For Actively Deployed Medication Assistant, Certified

(1) When an approved MAC who is actively serving in the military is deployed during the biennial renewal period, the permit shall not lapse, provided that the following conditions are met:

(a) The permit was active at the time of deployment.

(b) The licensee provides the Board a copy of the military activation or deployment orders, or other proof of active military service, in advance of deployment.

(c) The license renews the permit within sixty (60) days of return from deployment.

(2) In the event that a licensed MAC fails to notify the Board prior to deployment, the permit shall lapse, if not renewed. However, the permit may be reinstated or renewed without penalty or payment of the reinstatement or late renewal fee(s) under the following conditions:

(a) The permit was active at the time of deployment.

(b) The application for reinstatement or renewal is made while still in the armed services or no later than six months after discharge from active service or return to inactive military status.

(c) A copy of the military activation orders or other proof of active military service accompanies the application.

(d) The renewal fee is paid.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.09 Reinstatement Of A Lapsed Permit

(1) A lapsed permit may be reinstated upon submission of an electronic completed application and compliance with the following:

(a) Payment of current renewal and reinstatement fees, outstanding fees, and fines.

(b) Successful completion of a background check as determined by the Board.

(c) If the reinstatement of a lapsed permit occurs during the renewal period for that permit type, the expiration of the permit shall be the end of the next permit period.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.10 Notice Requirements

(1) The applicant or MAC shall notify the Board in writing of any requested name change. Appropriate legal documents shall be submitted prior to changing the name of the licensee on the permit. The legal documents required for a name change are one of the following:

(a) Marriage certificate.

(b) Divorce decree substantiating the name change

(c) Probate court records effecting a legal name change.

(2) The applicant shall notify the Board office in writing of any change in the reported address. The address of record is the last known address provided by the applicant or MAC.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.11 Verification Of Alabama Permit

(1) The Board obtains primary source verification directly from educational programs or an organization recognized by the United States Department of Education prior to issuing a permit.

(2) Upon receipt of an electronic written request and payment of the required fee, the Board's designee shall provide written verification of an Alabama permit.

(3) The Board provides primary source verification to employers of MACs through an online subscription service and through license/permit look-up services.

(4) Healthcare organizations that employ MACs shall verify permits through the Board website or subscription service

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.12 Fees (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.13 Standards And Scope Of Practice

(1) The Board of Nursing may adopt standards of medication assistant, certified practice and continuing competency.

(2) A Medication Assistant, Certified (MAC) may perform limited medication administration tasks in a licensed healthcare facility (other than a mental health residential community program) or a Board of Nursing-approved health care or educational facility licensed, certified, or operated by this state, only as permitted by this rule.

(a) In order to perform limited medication administration tasks, a MAC must successfully complete a Board-approved education program or a comparable program in another state and hold an active Alabama valid medication assistant, certified permit and certification (MACE).

(3) Medication administered by a MAC in a licensed healthcare facility or a Board of Nursing-approved health care or educational facility licensed, certified, or operated by this state may occur only when all of the following conditions are met:

(a) At least one licensed nurse is on the premises of the facility at the time when the MAC limited medication administration task occurs.

(b) A licensed nurse supervises the limited medication administration task performed by the MAC and is available to intervene as needed.

(c) The limited medication administration tasks the MAC performs are based on the patient's/resident's needs, as documented in the comprehensive and/or focused assessment by the registered nurse or licensed practical nurse and the outcome of a comprehensive assessment determines the medications that may safely be administered by a MAC to the patient/resident.

(d) The MAC shall not perform any duties that require the exercise of independent nursing judgment or intervention. Specific tasks that require independent nursing judgment or intervention that shall not be administered by the MAC include, but are not limited to:

1. Administration of injectable medications, with the exception of medications by premeasured auto-injectable devices or premeasured syringes for anaphylaxis, vaccinations, and opioid-related drug overdose.

2. Calculation of medication dosages, other than measuring a prescribed amount of liquid medication or breaking a scored tablet.

3. Receipt of verbal or telephone orders from a licensed prescriber.

4. Administration of medications ordered as needed (PRN), except under the direction of a licensed nurse, which direction shall be provided directly for each separate dose of the PRN medication

5. Administration of controlled substances. The MAC shall not have access to stored controlled substances.

(e) Subject to all other limitations imposed by this rule, routes of medication administration for which the MAC may perform limited medication administration tasks may include eye, ear, nose, oral, topical, inhalant, rectal, or vaginal.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Amended: Published January 31, 2022; effective March 17, 2022.

Ala. Admin. Code r. 610-X-14-.14 Conduct And Accountability

The medication assistant, certified shall:

(1) Have knowledge and understanding of the laws and rules regulating medication assistants, certified in Alabama.

(2) Function within the legal scope of medication assistant, certified practice, as defined in this chapter.

(3) Obtain instruction and supervision from a licensed nurse as necessary, when implementing new or unfamiliar medication administration.

(4) Be responsible and accountable for the quality of medication administration to patients, based on and limited to scope of education, demonstrated competence, and medication assistant, certified experience.

(5) Accept individual responsibility and accountability for judgments, actions, and competency, remaining current with technology and practicing consistent with facility policies and procedures for limited medication administration by the MAC.

(6) Accept individual responsibility and accountability for recognition and appropriate medication administration action by notifying the licensed nurse immediately following a change in the patient's mental or physical status.

(7) Practice in compliance with current CDC Standard Precautions and Infection Control, including aseptic technique.

(8) Practice without discrimination on the basis of age, race, religion, gender, national origin, sexual orientation, patient diagnosis, or disability.

(9) Respect the dignity and rights of patients and their significant others, including, but not limited to:

(a) Privacy.

(b) Safety.

(c) Protection of confidential information, unless disclosure is required by law.

(d) Freedom from exploitation of physical, mental, sexual, or financial boundaries.

(e) Protection of real and personal property.

(f) Behavior that is therapeutic and places the patient's interests before the medication assistant, certified's interests.

(10) Collaborate with other members of the health care team.

(11) Accept individual responsibility and accountability to avoid personal disruptive behaviors that negatively impact patient care and the nursing profession.

(12) Accept individual responsibility and accountability for timely reporting of illegal, substandard, unethical, unsafe, or incompetent medication assistant practice directly to the Board of Nursing.

(13) Accept individual responsibility and accountability for accurate, complete, and legible documentation related to

(a) Patient care records.

(b) Health care employment.

(c) Permit and other credentials.

(d) Continuing education records.

(14) Documentation of medication administration interventions and responses in an accurate, timely, thorough, and clear manner.

(15) Executing medical regimens according to approved medical protocols and standing orders, including administering limited medications administration prescribed by a legally authorized prescriber and according to facility policies.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.15 Documentation Standards

(1) The standards for documentation of medication assistants, certified provided to patients by MACs are based on principles of documentation, regardless of the documentation format.

(2) Documentation of nursing care shall be:

(a) Legible.

(b) Accurate.

(c) Complete. Complete documentation includes reporting and documenting on appropriate records a patient's status, including signs and symptoms, responses, treatments, medications, communication of pertinent information to other health team members, and unusual occurrences involving the patient. A signature of the writer, whether electronic or written, is required in order for the documentation to be considered complete.

(d) Timely.

1. Charted at the time or after the care, to include medications. Charting prior to care being provided, including medications, violates principles of documentation.

2. Documentation of medications given that is not in the sequence of the time the care was provided shall be recorded as a “late entry,” including a date and time the late entry was made, as well as the date and time the care was provided.

(e) A mistaken entry in the record by a MAC shall be corrected by a method that does not obliterate, white-out, or destroy the entry.

(f) Corrections to a record by a MAC shall include the name or initials of the individual making the correction.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.16 Medication Administration And Safety

(1) The medication assist, certified shall have knowledge of limited medication administration and safety, and knowledge of when to report concerns to the supervising licensed staff including but not limited to:

(a) Drug action.

(b) Classifications.

(c) Expected therapeutic benefit of medication.

(d) Expected monitoring.

(e) Possible side effects and interventions for same.

(f) Adverse reactions and interventions for same.

(g) Emergency interventions for anaphylactic reactions.

(h) Safety precautions, including but not limited to:

1. Right patient.

2. Right medication.

3. Right time.

4. Right dose.

5. Right route.

6. Right reason.

7. Right documentation.

(i) Interactions with other drugs, foods, or complementary therapies.

(2) The MAC shall exhibit skills when administering medications, including but not limited to:

(a) Physical ability to open medication packaging and access delivery systems.

(b) Read, write, and comprehend English.

(c) Read, write, and comprehend scientific phrases relevant to administration of medication.

(d) Measuring medication dosages in elixir format.

(e) Routes of acceptable administration for the MAC.

(f) Proper usage of technical equipment for medication administration.

(3) Documentation of medication administration shall comply with the principles of documentation and include safety precautions of medication administration, federal and state law, and facility policy.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.17 Patient Care Orders

(1) The MAC shall NOT receive handwritten, verbal, or electronic medical orders from a legally authorized prescriber or relayed by another licensed or registered health care professional, or certified medical assistant.

(2) The MAC shall NOT implement approved medical protocols and standing orders at the direction of a legally authorized prescriber, unless verified by the supervising licensed nurse.

(3) The MAC shall follow the facility policies and procedures regarding limited medication administration duties.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.18 Requirements For Competency Assessment Of Medication Assistant, Certified

(1) Competency assessments for each MAC employed by a facility must be conducted upon initial hire and annually thereafter by a licensed nurse. The licensed nurse must maintain records of the initial and annual competency validation on file at the facility. Competency assessments must include a demonstration of each of the following competency areas and standards:

(a) Maintaining confidentiality; does not share confidential information, except when it affects the recipient's care and is shared only to the appropriate person(s).

(b) Complying with a recipient's right to refuse to take medication; Does not force recipients to take medication. Uses appropriate measures to encourage taking of medications when directed for recipients who are not competent.

(c) Maintaining hygiene and current accepted standards for infection control; utilizes appropriate infection control principles when providing medications.

(d) Documenting accurately and completely; accurately documents all medication provided including the name of the medication, dose, route, and time administered and any refusal of medication, and spoilage.

(e) Providing medications according to the seven rights; provides the right medication, to the right person, at the right time, in the right dose, for the right purpose, and by the right route with correct documentation.

(f) Having the ability to understand and follow instructions; comprehends written or oral directions.

(g) Practicing safety in application of medication procedures; properly:

1. Stores and handles all medication in accordance with facility policy.

2. Intervenes when unsafe conditions of the medication indicate a medication should not be provided.

3. Provides medication to recipients in accordance with their age and condition.

4. Records all medication provided or refused.

(h) Having knowledge of abuse and neglect reporting requirements. identifies-occurrences of possible abuse of a vulnerable adult and reports this information to the appropriate supervising licensed nurse and as required by facility policies.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.19 Supervision/Reporting By Licensed Nurses

(1) The licensed nurse supervising medication administration may, at any time, suspend or withdraw the medication administration assigned to the MAC(s).

(2) The licensed healthcare facility has authorized limited medication administration tasks by MACs and has complied with the requirements of this chapter.

(3) The chief nursing officer or, if no such position exists within the licensed healthcare facility, an Alabama-1icensed registered nurse who has oversight responsibility for medication administration in the facility shall:

(a) Develop facility policies and procedures related to limited medication administration tasks to the MAC which define the responsibilities of and required facility training and competency validation for the MAC, congruent with these rules.

(b) Submit, annually or upon request, reports to the Alabama Board of Nursing, in a format specified by the Board, including, but not limited to:

1. Total number of patients/residents served by MACs participating in the limited medication administration program.

2. Total number of MACs that currently participate in the limited medication administration program.

3. Total number of licensed nurses trained in MAC supervision during the reporting year.

4. Total number of medication errors in each category listed below:

(i) Wrong person

(ii) Wrong medication

(iii) Wrong dose

(iv) Wrong time/day

(v) Wrong route

(vi) Wrong purpose

(vii) No documentation

(viii) Identify and implement a quality improvement plan for medication errors.

(c) Provide and document an initial and annual competency validation evaluation of each MAC performing limited medication administration for all routes of administration.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021.

Ala. Admin. Code r. 610-X-14-.20 Grounds For Discipline Or Denial Of An Initial Permit

Any disciplinary process or action involving MAC permit shall be conducted according to the provisions of Chapter 610-X-8 of these rules.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed and Replaced: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.21 Grounds For Discipline Of, Denial Of Renewal Of, Or Denial Of Reinstatement Of A Permit (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.22 Investigation (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.23 Board Action Following Investigation (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.24 Administrative Procedure Act (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.25 Formal Disposition Of Contested Cases (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.26 Informal Disposition Of Contested Cases (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.27 Decisions Of The Board (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.28 Application Following Denial Of A Permit (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.29 Reinstatement Of A Revoked Permit (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.30 Non-Disciplinary Administrative Penalties (Repealed 9/14/2024)

(Repealed)

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published September 30, 2021; effective November 14, 2021. Repealed: Published July 31, 2024; effective September 14, 2024.

Ala. Admin. Code r. 610-X-14-.31 Standards for Approval

(1) All Alabama MAC education programs must be approved by the Alabama Board of Nursing. New MAC education programs established in Alabama on or after May 1, 2026, shall submit an application for Board approval prior to implementation.

(2) The governing institution, MAC program coordinator, and MAC instructor(s) are accountable for selecting and evaluating the teaching methods, delivery modalities, and processes used to achieve expected program outcomes.

(3) The governing institution offering the MAC program shall be one of the following:

(a) A postsecondary education institution recognized by the U.S. Department of Education.

(b) Approved and licensed by the appropriate State of Alabama education agency(ies), as required by law.

(4) The governing institution shall provide support and resources sufficient to ensure achievement of student learning and program outcomes. Resources include, but are not limited to:

(a) Financial.

(b) Education program physical facilities.

(c) Instructional and learning equipment.

(d) Technology.

(e) Administrative, instructional, and support personnel.

(5) The governing institution’s administrator or program coordinator shall notify the Board, in writing, of any substantive changes in the MAC program, including, but not limited to:

(a) MAC program coordinator.

(b) Governing institution administrator, President, CEO, Chancellor, or Provost/Division Dean.

(c) Relocation of the governing institution or MAC education program.

(d) Intent to close a program.

(e) Intent to add additional instructional site(s).

(f) Notification of additional MAC instructor(s) teaching in program.

(6) There shall be an organizational chart that depicts the authority, responsibility, and channels of communication between the MAC program and the governing institution and other comparable programs within the governing institution.

(7) A MAC program shall be administered by a qualified program coordinator who is accountable for the planning, implementation, and evaluation of the program.

(a) Minimum qualifications of a MAC program coordinator shall include:

1. Full-time employee of the governing institution.

2. Completion of the board-approved MAC coordinator training.

(b) If the MAC program coordinator is a registered nurse, then the individual shall hold an active, unencumbered license to practice as a registered nurse in Alabama, or a multistate registered license issued by a party state, as defined in Chapter 4 of the Administrative Code.

(8) The governing institution and MAC program coordinator shall provide sufficient numbers of qualified instructors to ensure that curriculum implementation and expected program outcomes are achieved. Minimum qualifications of MAC instructors shall include:

(a) An active, unencumbered Alabama registered nurse license, or a multistate registered nurse license issued by a party state, as defined in Chapter 4 of the Administrative Code.

(b) A minimum of an earned associate degree in nursing.

(c) Completion of the board-approved MAC train-the-trainer course.

(9) Institutional and program policies, procedures, and other publications, whether written or electronic, shall:

(a) Be written, accurate, and consistent as published, and publicly available.

(b) Address students' abilities to assume clinical assignments, including, but not limited to, educational preparedness and physical, mental, and emotional behaviors.

(c) Provide opportunities for students to regularly participate in the development, evaluation, and continuous improvement of the program.

(d) Provide for processes to manage and learn from student near misses and errors.

(e) Provide for student remediation strategies and ensure students are aware of how to seek help.

(f) Programs shall hold students accountable for professional behavior, including honesty and integrity, while in the program of study.

(g) Provide for availability of assistance for students with disabilities.

(10) The curriculum of the MAC program shall:

(a) Enable the student to develop the knowledge, skills, and abilities necessary for the level, scope, and standards of competent MAC practice expected at the level of certification.

(11) Clinical supervision of students shall comply with the standards set forth in this chapter.

(a) The clinical supervisor shall hold an active, unencumbered license to practice as a registered or licensed practical nurse in Alabama, or a multistate registered or practical nurse license issued by a party state, as defined in Chapter 4 of Administrative Code.

(b) The clinical supervisor shall be readily accessible to assign or prescribe a course of action, provide guidance, direction, and evaluation for MAC students engaged in the clinical learning experience.

(c) The clinical supervisor-student ratio in clinical learning experiences shall be collaboratively determined by the MAC program coordinator, MAC instructors/clinical supervisors, and representatives of the clinical agency. Regardless of the clinical setting, the clinical supervisor to student ratio shall not exceed 1:10 during clinical learning experiences.

(d) The MAC education program shall work with clinical agencies for the planning, implementation, and evaluation of clinical experiences.

(e) Clinical learning experiences shall include the development of skills related to the MAC scope of practice.

(f) MAC instructors and clinical supervisors shall maintain responsibility and accountability for planning, implementation, and evaluation of all student clinical learning experiences.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.32 Outcome Standards

(1) MAC program completers shall demonstrate theoretical and clinical competence for entry into practice.

(2) The Board-calculated program certification pass rate for each MAC program shall be published by the Board annually.

(3) Approved MAC Programs shall be evaluated for continuing approval by the Board not less than every five (5) years, but may be evaluated more frequently based on deficiencies, identified areas of concern, or receipt of a complaint.

(a) Additional oversight of new programs shall take place throughout the first five (5) years of operation. This may include requests for progress reports on the numbers of students, trends of certification pass rates, and annual reports as determined by the Board.

(4) MAC programs shall complete the MAC Annual Report in the format indicated by the Board within the specified time frame.

(5) The Board may review and analyze various sources of information regarding program performance, including, but not limited to:

(a) Board survey visits.

(b) Results of ongoing program evaluation.

(c) Other sources of evidence contributing to the achievement of program outcomes, including, but not limited to:

1. Sufficient number of instructors and clinical supervisors.

2. Sufficient clinical learning experiences.

3. Plans for improvement including but not limited to:

(i) Financial.

(ii) Education program physical facilities.

(iii) Instructional and learning equipment.

(iv) Technology.

(v) Administrative, instructional, and support personnel.

4. Program complaints/grievance review and resolution.

(6) Continuing approval will be granted upon the Board’s verification that the program is in compliance with the standards set forth by the Administrative Code in Chapter 610-X-14.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.33 Deficiencies

(1) The Board shall conduct surveys and evaluations as often as necessary to determine compliance with all standards set forth in Administrative Code Chapter 610-X-14.

(a) Warning signs that may trigger a focused site visit include:

1. Complaints from students, instructors, and clinical agencies.

2. Turnover of program coordinators.

3. Decreasing trends in certification pass rates.

(2) The Board shall, upon determining that a program is not in compliance with standards set forth in Administrative Code Chapter 610-X-14, provide to the governing institution administrator and MAC coordinator a written notice of deficiencies that establishes a reasonable time, based upon the number and severity of deficiencies, to correct deficiencies.

(3) A MAC education program that receives a Notice of Deficiency from the Board shall establish a written plan within the specified time and provide reports to the Board, as requested, to document progress in resolving deficiency(ies).

(4) The Board may initiate action regarding any program that fails to correct identified deficiencies within the time specified by the Board, either through a formal hearing or Board-approved informal disposition. The Board may:

(a) Withdrawal of Board approval from the MAC education program, results in the program being ineligible to admit new students. Students admitted to programs without Board approval will be ineligible to apply for the certification exam.

(b) Continue approval of the MAC education program for a specified time period.

(c) MAC program coordinator must notify students in writing of the Board’s decision.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.34 Establishing a New Program

(1) A governing institution that plans to establish a new MAC education program shall submit to the Board a minimum of three (3) months in advance of the expected opening date:

(a) A letter of intent identifying the governing institution.

(b) A completed MAC education program application with supporting documents.

(c) The Board shall review the letter of intent, application, and supporting documentation for completeness and compliance with rules and regulations and may provide guidance regarding forward progress of the plan.

(2) A survey may be conducted to amplify, clarify, and verify information in the application.

(3) If all standards for approval are met, the program shall receive approval.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.35 Addition of an Off-campus Instructional Site

1. Governing institutions may elect to partner with healthcare facilities to offer off-campus MAC courses.
2. Governing institutions seeking to add off-campus instructional sites must submit a letter of intent to offer off-campus courses at least 30 days prior to the planned implementation.
3. Letters of intent shall include the following: 1. Name of healthcare facility. 2. Location of healthcare facility where courses will be conducted. 3. Healthcare facility point-of-contact. 4. Planned implementation date. 5. Roster of MAC instructor(s) assigned to teach MAC courses at the off-campus site.
4. All off-campus instructional sites must comply with all standards set forth in this Chapter including annual reports. Approved off-campus instructional sites are subject to Board visits to ensure compliance with the rules set forth in this Chapter.
5. Failure to notify the Board of new off-campus instructional sites may result in students being ineligible to apply for the MAC exam.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.36 Closing A Program/Off-campus Instructional Site

(1) A MAC program may be closed due to withdrawal of Board approval or may close voluntarily.

(2) A governing institution seeking to close a MAC program shall submit written notification to the Board at least three (3) months prior to the planned closing date.

(3) An acceptable MAC program closure plan shall be developed and submitted to the Board for approval within thirty days of MAC program closure notification. The governing institution shall ensure that all standards for MAC education programs are maintained, and all necessary courses are taught until the last student has completed.

(4) The governing institution shall secure and provide for the permanent custody and storage of records of students and completers. The Board shall be notified of the location and method of retrieving information from these records.

(5) Any MAC program under a closure plan shall submit to the Board confirmation, in writing, that the closure plan has been fully implemented when the closure plan has been completed.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.37 MAC Education Program Hearing

(1) The Board may utilize a hearing officer to conduct a hearing prior to withdrawing approval or denying approval of a MAC education program. MAC education program hearings shall be conducted in compliance with the provisions of the Alabama Administrative Procedure Act, as may be amended from time to time.

(2) The MAC education program may present written or oral evidence for the Board's consideration at any Board hearing.

(3) The MAC education program may appeal the Board’s withdrawal of program approval to the Montgomery County Circuit Court.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.

Ala. Admin. Code r. 610-X-14-.38 Withdrawal of Board Approval

(1) If the Board withdraws approval from a MAC education program following an administrative hearing, the governing institution shall submit to the Board:

(a) Within thirty (30) days of the effective date of the Board’s Order, a report detailing the teach out of students currently enrolled in the program.

(b) Specific arrangements for the secure storage and access to academic records and transcripts.

(2) The governing institution shall notify students accepted and enrolled in the program, in writing, of the Board’s withdrawal of approval within thirty (30) days of the effective date of the Board’s Order.

History

• Author: Alabama Board of Nursing
• Authority: Code of Ala. 1975, §34-21-2.1.
• New Rule: Published May 29, 2026; effective July 13, 2026.