NP · Ohio
Collaborative Practice Agreement for Nurse Practitioners in Ohio
Yes, a written physician agreement is required. Ohio calls it a Standard Care Arrangement (SCA).
No independent-practice pathway exists for NPs in Ohio — confirmed affirmatively via a Feb. 2026 nursing-association status update stating none has been enacted. Active pending bills (SB 258/HB 449/HB 508) propose eliminating the SCA requirement after 2,000 practice hours, but remain in committee, not law.
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
No physical-proximity/mileage requirement is codified — the collaborating physician/podiatrist must be 'continuously available to communicate ... either in person or digitally,' with a required backup/emergency-coverage plan built into the SCA (OAC 4723-8-04).
Supervision ratio
Up to 5 at a time (combined across provider types)
'A collaborating physician may not collaborate with more than five APRNs at the same time in the prescribing component of their practices' (Ohio Rev. Code §4723.431) — raised from 3 to 5 by H.B. 216 (2017). Confirmed directly from the Ohio Board of Nursing's official APRN practice guide (2025). Coded as a shared cap across a physician's combined CNM+CNS+CNP roster based on the statute's 'prescribing component of their practices' phrasing — this shared-vs-per-type reading is this file's own interpretation, not independently confirmed. A stale secondary mirror still showing the old '3' figure was found and disregarded.
Chart review
Not codified — left to the agreement
Meeting cadence
Annually, in person or via telehealth
OAC 4723-8-05 requires 'periodic random chart review... at least annually,' plus 'periodic review, at least semi-annually, of prescriptions written and prescribing patterns,' with a required conference between the collaborating physician (or a designated QA-committee member) and the APRN following each review. NO fixed percentage of charts is specified — a secondary source's claimed '10% monthly / 20% quarterly' figure could not be corroborated against the rule text (confirmed absent via two independent direct fetches) and is likely inaccurate; do not use it. Modality of the post-review conference is unspecified.
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
Ohio Rev. Code §4723.481: prescriptive authority cannot exceed the collaborating physician's own authority. Subject to an 'exclusionary formulary' (OAC 4723-9-10 — may prescribe anything NOT on an excluded list, rather than only from a positive list, since H.B. 216 (2017)). Schedule II: restricted to terminal-condition patients where a physician already initially prescribed the same drug, ≤72-hour supply, UNLESS practicing from specified settings (hospitals, nursing homes, hospice, FQHCs, physician-owned practices, community mental health providers, and outpatient behavioral-health practices with employed-physician collaboration) — expressly excludes convenience-care clinics (§4723.481(C)(2); confirmed no drug-class-based carve-out exists — restrictions apply uniformly). OARRS registration and review required before prescribing (OAC 4723-9-12). All APRNs are barred from prescribing any drug/device to perform or induce an abortion (§4723.151(C)).
Written agreement
Required
Unconditional — Ohio's term is a 'standard care arrangement' (SCA), Ohio Rev. Code §4723.431/§4723.43. This is precisely the requirement the pending SB 258/HB 449/HB 508 bills would eliminate after 2,000 hours — confirming the SCA remains the current, operative requirement today.
Practice ownership (corporate practice of medicine)
Non-licensee ownership permitted — Same no-CPOM-doctrine framework as `pa`. NP-specific: Ohio Rev. Code §4723.16 lets a licensed RN/APRN render nursing services through a corporation (§1701.03(B)), LLC (Ch. 1706), partnership, or professional association (Ch. 1785). §1701.03(B)'s same-profession rule requires a straight nursing PC's shareholders to themselves be licensed to render nursing services — NPs may also join multidisciplinary entities with physicians under §4731.226. No case law or regulatory guidance was found specifically confirming this has been tested/litigated for APRN ownership — an inference from statutory structure, not a directly-stated rule.
Legal sources for these rules (11)
- Ohio Rev. Code §4723.43, §4723.431 — SCA requirement, 5-APRN ratio cap
- Ohio Rev. Code §4723.481 — Prescriptive authority, Schedule II restrictions
- Ohio Rev. Code §4723.151(C) — Abortion-drug prohibition
- OAC 4723-8-04 — SCA content requirements (via Cornell LII mirror, read directly)secondary
- OAC 4723-8-05 — Chart-review/meeting requirements (via Cornell LII mirror, read directly)secondary
- OAC 4723-4-05 — APRN practice standards (via Cornell LII mirror, read directly)secondary
- OAC 4723-9-10 — Exclusionary formulary
- OAC 4723-9-12 — OARRS review requirement
- Ohio Board of Nursing — 'APRN Licensure and Practice in Ohio' (2025, official guide, read in full)
- SB 258 / HB 449 / HB 508 (current General Assembly) — pending 2,000-hour independence pathway, not enacted
- H.B. 216 (2017) — raised SCA ratio from 3 to 5, created exclusionary formulary
What a collaborating physician costs here
Typical monthly cost in Ohio
$500 – $700
Estimate for one Nurse Practitioner. 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.