Reacting to the current and predicted increased shortage of primary care physicians, the Ohio General Assembly enacted House Bill 216, signed by Governor Kasich on January 4, 2017, and effective April 7, 2017.
The new law modifies Ohio Revised Code, Chapter 4723 (Ohio’s Nurse Practice Act) by expanding the authority and independence of nurse practitioners, clinical nurse specialists, and certified nurse midwives. No longer will advanced practice nurses with designations of CNPs, CNSs, or CNMs act under their respective certificates of authority (COA) with a certificate to prescribe (CTP) or certificate to prescribe externship (CTP-E). Instead, they all will be licensed as advanced practice registered nurses (APRNs) with specialty designations. The APRN license is distinct from an RN license and must be obtained and renewed separately. Nurses who wish to continue functioning as nurse practitioners, clinical nurse specialists, and nurse midwives have until December 31, 2017, to obtain an APRN license.
Nurse practitioners, clinical nurse specialists, and nurse midwives will continue to practice within the scope of their nursing specialty — consistent with their education and rules adopted by the Board of Nursing — according to their Standard Care Arrangement with one or more Collaborating Physicians. Under the old law, nurse practitioners, clinical nurse specialists, and nurse midwives could prescribe or furnish certain drugs and therapeutic devices either under a certificate to prescribe (CTP) or certificate to prescribe externship (CTP-E), which required direct and indirect physician supervision of at least 1,500 hours.
The new APRN license eliminates the CTP and CTP-E and confers prescriptive authority to APRN license holders with DEA certification. APRNs who currently hold a certificate of authority (COA) with a CTP or CTP-E will be grandfathered into the new APRN license. However, all APRNs must successfully complete an advanced pharmacology course before the December deadline.
The extent of prescriptive authority is subject to the APRN Drug Formulary, which is “exclusionary” in nature, meaning it specifies those drugs and therapeutic devices that an APRN is not authorized to prescribe or furnish. The new law permits APRNs to prescribe samples and schedule II controlled substances under certain, specified conditions. APRNs also must periodically run OARRS reports.
House Bill 216 further modifies Standard Care Arrangements by increasing the number of APRNs with whom a physician may collaborate from three to five. Standard Care Arrangements no longer must contain a process for regularly reviewing referrals by an APRN to other health care professionals or a process for reviewing care outcomes for a random sample of all patients the APRN sees in the practice.
The former law required that a copy of the Standard Care Arrangement be maintained on file at each site where the APRN practices, which could be cumbersome for practices with multiple locations. Now, the Standard Care Arrangement only needs to be kept by the employing physician/practice at one site. If the Collaborating Physician terminates the APRN before the Standard Care Arrangement expires, the APRN may under the new law continue to practice according to the existing Standard Care Arrangement without a Collaborating Physician for up to 120 days, provided: (1) the Collaborating Physician gives the APRN written or electronic notice of termination; (2) the APRN notifies the Nursing Board of the termination as soon as possible by sending the Board a copy of the termination notice; and (3) the 120 day period starts from the date the APRN submits the notice of termination to the Board.
It is advisable for physician practices to review and revise their employment contracts and Standard Care Arrangements with their nurse practitioners, clinical nurse specialists, and nurse midwives to assure uninterrupted transition to APRN status and ongoing legal compliance.
Joe Feltes is an attorney with Buckingham, Doolittle & Burroughs in Canton, Ohio, and a member of its Health & Medicine Practice Group. He is also the Managing Partner of Buckingham Canton. For more information about the law firm, go to www.bdblaw.com or email Feltes at JFeltes@BDBLAW.com.