OAAPN Standard Care Arrangement Template

Update:  1-23-14:  Our SCA template is temporarily unavailable due to recent changes implemented by the Ohio Board of Nursing

 A revised template will be available by March 1, 2014

Model Standard Care Arrangement



1. What is a Standard Care Arrangement?
A Standard Care Arrangement is a written agreement between an Advanced Practice Nurse(s) and collaborating physician(s) that formally establishes a collaborative practice arrangement, mandated by Ohio Revised Code Section 4723-.431and Ohio Administrative Code 4723-8-04, 4723-8-05.
2. Who needs a Standard Care Arrangement?   
All CNMs, CNSs and CNPs must have an SCA.  Only Psychiatric/ Mental Health CNSs who do not plan on prescribing are exempt from developing an SCA.
3. Does the Standard Care Arrangement need to be filed with the Ohio Board of Nursing?
No.  The Standard Care Arrangement must be kept on file at EACH practice site.  The SCA must be available at all times upon request by the Board of Nursing or other parties.  While the Board of Nursing has the right to review the SCA at any time for compliance, it does not need to approve the Standard Care Arrangement in advance.
4. Who needs to sign the Standard Care Arrangement?
Clinical Nurse Specialists, Certified Nurse Practitioners, and Certified Nurse Midwives who are in collaborative practice need to sign the Standard Care Arrangement.  All physicians who collaborate with the Advanced Practice Nurse must also sign the Standard Care Arrangement.
5. What must be included in the Standard Care Arrangement?

A. The signature of the Advanced Practice Nurse and each physician who is engaged in the collaborative practice arrangement.


B. The complete name and specialty practice area, business address, and business phone number where the individuals who have signed may be reached.


C. A statement of services offered by the Certified Nurse Midwives, Certified Nurse Practitioners or Clinical Nurse Specialists.


D. A plan for incorporation of new technologies or procedures consistent with the applicant’s scope of practice.


E. Quality assurance measures including a periodic review and re-approval of the Standard Care Arrangement on at least an annual basis.


F. Criteria for referral of a client by the Certified Nurse Midwife, Certified Nurse Practitioner, or Clinical Nurse Specialist to the collaborating physician or podiatrist.


G. A procedure for regular review of referrals made by the Certified Nurse Midwife, Certified Nurse Practitioner, or Clinical Nurse Specialist to other health care professionals.


H. A process for chart review in accordance with the Ohio Administrative Code, 4723-8-04 (C) (5), and 4723-8-05.


I. A statement regarding health care of infants up to the age of one and recommendations for provider visits through three years of age must be included. 


J. A plan for coverage of clients in instances of emergencies or planned absence of either the Advanced Practice Nurse or the collaborating physician.


K. A process for resolution of disagreements regarding clinical matters of patient management.


L. An arrangement regarding reimbursement in accordance with Section 5111.02 (D) of the Ohio Revised Code (law) and related rules.


**Additional SCA Components for CTP-Externship and CTP Holders**


M. Provisions to assure timely face-to-face evaluation of a patient by a collaborating physician or designee.


N. Prescribing parameters, if applicable, for off-label prescribing.


O. Provisions for at least semi-annual review of prescriptions by the APN and collaborating physician.


P. Any additional prescribing parameters determined by the APN and collaborating physician.
6. Do Certified Registered Nurse Anesthetists need to have a Standard Care Arrangement?

No.  Certified Registered Nurse Anesthetists practice under the supervision of the Surgeon, Dentist, or Podiatrist.  Therefore, they do not need to engage in a Standard Care Arrangement.
7. What is a Model Standard Care Arrangement prepared by the Ohio Association of Advanced Practice Nurses?

The Model Standard Care Arrangement is an overview of the key components required in a Standard Care Arrangement as outlined in the Ohio Revised Code and related rules.  It is recommended that all components listed above be included in the Standard Care Arrangement   adopted for your clinical practice.   It is important to understand that the Standard Care Arrangement prepared by the Ohio Association of Advanced Practice Nurses is a model and a reference only.  You will need to customize the Standard Care Arrangement to meet the needs of your particular clinical practice.
8. Does the Standard Care Arrangement have to be endorsed by a Notary Public?

No, it does not.
9. Can more than one Advanced Practice Nurse in a group practice sign the same Standard Care Arrangement?

Yes.  Groups of Advanced Practice Nurses working with the same collaborating physician(s) may have a joint Standard Care Arrangement. 
10. What does the travel time component of the Standard Care Arrangement mean?
Only SCAs of prescribing Certificate of Authority holders must address this item. The requirement for an SCA was first adopted in 1997 after SB 154 (title protection and recognition) became law.  At that time there were no provisions made for travel time.  During the negotiation of HB 241, the medical community asked that information be included in the SCA indicating a response time (travel time) in which a physician must be available to personally evaluate a patient if indicated.  Since every clinical practice differs in patient volume and acuity, you must develop this response time with your physician in light of what is safe and comfortable for your practice.  For example, a Nurse Midwife would probably need to have a quicker response time from an Obstetrician than someone who is working in Rheumatology or Pulmonary medicine.
11. When must a Standard Care Arrangement be completed and signed?

The Standard Care Arrangement must be completed prior to starting practice.  It must be reviewed and signed at least annually, and revised if necessary.