CNM · Ohio
Collaborative Practice Agreement for Certified Nurse-Midwives in Ohio
Yes, a written physician agreement is required. Ohio does not name a specific instrument.
No independence pathway exists regardless of tenure — same mandatory SCA framework as `np`/`cns`. Ohio currently licenses midwifery ONLY through the CNM/APRN nursing pathway; non-nurse (direct-entry) midwives have no state licensure and operate in a legal gray area. A pending bill (H.B. 224) would create separate non-nurse licensure categories — not enacted; don't conflate.
Independent practice requires: Same SCA framework as `np` (Ohio Rev. Code §4723.431/§4723.43(A)) — no hours- or experience-based exit exists; an SCA is required for the CNM's entire career, with a PHYSICIAN specifically (not a podiatrist, unlike `cns`).
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
Same as `np` — no codified proximity/mileage standard; continuous in-person-or-digital availability plus an SCA-required backup/emergency-coverage plan.
Supervision ratio
Up to 5 at a time (combined across provider types)
Same shared cap as `np` (Ohio Rev. Code §4723.431).
Chart review
Not codified — left to the agreement
Meeting cadence
Annually, in person or via telehealth
Same annual/semiannual chart-review-plus-conference cycle as `np` (OAC 4723-8-05).
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
Same Schedule II/exclusionary-formulary/OARRS/abortion-drug-prohibition framework as `np` (§4723.481, §4723.151(C)). CNM-specific: prescribing tied to obstetric/gynecologic/reproductive-health scope (§4723.43(A)) — antepartum, intrapartum, postpartum, gynecological care, and immediate newborn care. CNMs are barred from version, breech/face delivery, forceps use, and obstetric operations, and from treating abnormal conditions except in emergencies.
Written agreement
Required
Unconditional — written SCA required with a collaborating PHYSICIAN specifically (Ohio Rev. Code §4723.43(A)/§4723.431) — unlike `cns`, a podiatrist cannot serve as the CNM's collaborator.
Practice ownership (corporate practice of medicine)
Non-licensee ownership permitted — Same framework as `np` (§4723.16, §1701.03(B)) — a CNM (an RN with added certification, not a separate license) may hold equity in a nursing-scope entity.
Distinguish from Ohio's pending, not-yet-enacted non-nurse midwifery licensure categories (H.B. 224) — this entry covers only the nurse-based CNM pathway.
Legal sources for these rules (5)
- Ohio Rev. Code §4723.43(A), §4723.431 — CNM scope, SCA requirement
- Ohio Rev. Code §4723.481, §4723.151(C) — Prescriptive authority, abortion-drug prohibition
- OAC 4723-8-04, 4723-8-05 — SCA content, chart-review requirements (via Cornell LII mirror)secondary
- Ohio Board of Nursing — 'APRN Licensure and Practice in Ohio' (2025, read in full — CNM content unaffected by H.B. 52)
- H.B. 224 (current General Assembly) — pending non-nurse 'certified midwife'/'licensed midwife' categories, status as of today unconfirmed, not enacted
What a collaborating physician costs here
Typical monthly cost in Ohio
$500 – $600
Estimate for one Certified Nurse-Midwife. This state's rules add a restrictive-tier premium.
About Ohio's rules
Ohio recently relaxed CRNA supervision from 'immediate presence' to facility-wide 'collaboration' (H.B. 52, eff. 6/8/2026, now current law), and will loosen RN laser-delegation rules similarly (H.B. 377, eff. 8/25/2026 — NOT yet law as of this file's date). No independent-practice pathway exists for NP/PMHNP/PA despite active pending reform bills (a 2,000-hour NP threshold, PA proximity removal) — none enacted. Ohio has no corporate-practice-of-medicine doctrine (State Medical Board, 2012). Non-nurse midwifery has no current licensure pathway.
Other clinicians in Ohio: see the state overview.