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Standard Care Arrangements for CNP's, CNS's and CNM's

Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A.

by Jason J. Haupt, Esq.

What is a Standard Care Arrangement?
  A Standard Care Arrangement (SCA) is a written agreement between a Certified Nurse Practitioners (CNP), Certified Clinical Nurse Specialists (CNS) or Certified Nurse-Midwives (CNM) and a collaborating physician that formally establishes a collaborative practice arrangement.  The SCA serves as a written, formal guideline for the planning and evaluation of a patient’s health care by a CNP, CNC or CNM through collaboration with a physician or podiatrist.  As such, the SCA must be signed by the CNPs, CNSs, CNMs and physicians who are in collaborative practice.  For purposes of a SCA, the concept of “collaboration” refers to the continuous availability of a collaborating physician or podiatrists to communicate with a CNP, CNS or CNM either in person or by radio, telephone, or other form of telecommunication.  

Who needs Standard Care Arrangements?  CNPs, CNSs (except a CNS who does not hold a certificate to prescribe and whose nursing specialty is mental health or psychiatric mental health) and CNMs must, as a condition to practice in the state of Ohio, enter into a SCA with each physician or podiatrist with whom the CNP, CNS or CNM collaborates.  Likewise, physicians and podiatrists in Ohio are required to enter into and fulfill the responsibilities of collaboration enumerated within a SCA with any CNP, CNS or CNM with whom the physician or podiatrist collaborates.

 What elements need to be included in a Standard Care Arrangement? 

complete name, specialty/subspecialty practice area, business address, and business phone number of the CNP, CNS or CNM and the collaborating physician or podiatrist;

2.  A statement of services offered by the CNP, CNS or CNM;

3.  A plan for incorporation of new technologies or procedures consistent with the CNP, CNS or CNM’s scope of practice;

4.  Quality assurance measures including periodic review and re-approval of the SCA on at least an annual basis;

5.  Criteria for referral of a patient by the CNP, CNS or CNM to the collaborating physician or podiatrist or to other physicians or podiatrists (including specialists) and a procedure for regular review of such referrals;

6.  A process for the CNP, CNS or CNM to obtain consultation with the collaborating physician or podiatrists;

7.  A process for chart review in accordance with Ohio Administrative Code §§ 4723-8-04 and 4723-8-05;

8.  A statement regarding health care of infants up to the age of one and recommendations for provider visits through three years of age;

9.  A plan for coverage of patients in instances of emergencies or planned absences of either the CNP, CNS, or CNM or the collaborating physician;

10.  A process for resolution of disputes regarding patient care or management;

11.  An arrangement regarding reimbursement under the medical assistance program and requirements set forth in Ohio Revised Code § 5111.02 and related rules; and

12.  In the case of a CNP, CNS or CNM who holds a certificate to prescribe issued under Ohio Revised Code § 4723.48, provisions to assure timely, face-to-face evaluation of a patient by a collaborating physician or designee, prescribing parameters for off-label prescribing (if applicable), provisions for at least semi-annual review by the collaborating physician and the CNP, CNS or CNM of prescriptions and prescribing practices, and any additional prescribing parameters as allowed by the formulary established by the Committee on Prescriptive Governance and made available by the Ohio Board of Nursing or determined by the CNP, CNS or CNM and the collaborating physician. 

What happens if no Standard Care Arrangement is created?  In the event that a CNP, CNS or CNM practices without having entered into a SCA or does not practice in accordance with the terms of a SCA, the Board of Nursing may deny, revoke, suspend or place restrictions on the nurse’s nursing license or certificate of authority, reprimand or otherwise discipline the nurse, or impose a fine of not more than five hundred dollars per violation.  In the event that a physician or podiatrist collaborates with a CNP, CNS or CNM without having entered into a SCA or fails to fulfill his or her responsibilities of collaboration in accordance with the terms of a SCA, the State Medical Board may limit, revoke or suspend the physician or podiatrist’s certificate of practice, refuse to register the physician or podiatrist, refuse to reinstate the physician or podiatrist’s certificate of practice, or reprimand or place the physician or podiatrist on probation.

Where are Standard Care Arrangements filed?  Although there is no requirement that the SCA be filed with the Ohio Board of Nursing or the State Medical Board, the SCA must be kept on file at each practice site of the CNP, CNS or CNM and must be made available for review upon request by the Ohio Board of Nursing or the Ohio State Medical Board, as the case may be, which review may be carried out periodically to determine compliance with the laws, rules and regulations governing the SCA.  In addition to this requirement, the Ohio Board of Nursing requires as part of its Application for Certificate of Authority to Practice in Ohio that the CNP, CNS or CNM notify the Board of the identity of a collaborating physician or podiatrists not later than thirty days after engaging in practice and notify the Board of any change in the identity of a collaborating physician or podiatrist not later than thirty days after such change takes effectt.

The Krugliak, Wilkins, Griffiths & Dougherty Health Care Practice Group is available to assist with the review of Standard Care Arrangements in your practice, or provide a sample Standard Care Arrangement for use in your practice.  Should you have any questions, or wish to receive a sample Standard Care Arrangement, please contact Attorney Jason F. Haupt at 330-497-0700 or at jhaupt@kwgd.com.

NOTE: This general summary of the law should not be used to solve individual problems since slight changes in the fact situation

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