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Review the requirements to successfully collaborate as an NP or PA in South Carolina.
Nurse Practitioner Requirements
Is a collaboration agreement required?
Yes, a written practice agreement.
What form of agreement is required and what are the requirements for the substance of the agreement? Is use of a state template required?
To receive a full breakdown of the required components of a written practice agreement in South Carolina, contact Zivian today!
Where must the agreement be stored?
No requirement.
Does the agreement need to be filed with the state?
No requirement.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
No requirement.
Who must sign the agreement?
The NP and the physician must sign the agreement.
How often must the agreement be reviewed/reauthorized?
The practice agreement and any amendments to it must be reviewed at least annually, dated and signed by the NP and physician, and made available to the Board for review within seventy-two (72) hours of request.
A random audit of the practice agreement must be conducted by the South Carolina Board of Nursing at least biennially.
What are the required qualifications for the collaborating physician?
The collaborating physician must be licensed by the South Carolina Board of Medical Examiners and possess an active, unrestricted, permanent license to practice medicine in the state, and who actively is practicing within the geographic boundaries of this state.
The physician shall not enter into a practice agreement with an NP performing a medical act, task, or function that is outside the usual practice of that physician or outside of the physician’s training or experience. However, the board may approve an exception to this requirement upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained.
What are the required qualifications for the NP?
An Advanced Practice Registered Nurse (APRN) in South Carolina must be trained in an advanced formal education program of nursing in a specialty area that is approved by the board. The categories of APRN are nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist.
The APRN must hold a doctorate, a post-nursing master’s certificate, or a minimum of a master’s degree that includes advanced education composed of didactic and supervised clinical practice in a specific area of advanced practice registered nursing. APRNs must achieve national certification within two years post-graduation. An APRN may perform those activities considered to be the practice of registered nursing or advanced practice consisting of nonmedical acts, such as population health management; quality improvement or research projects within a health care system; and analysis of data and corresponding system recommendations, revisions, developments, or informatics.
Is an alternate collaborating physician required?
No requirement.
Collaboration Requirements
Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
A physician may supervise up to 6 FTE NPs or PAs combined. The Board of Medical Examiners may approve an exception to these requirements upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained.
Is there an express requirement to review a certain number or percentage of charts?
No requirement.
Is there a requirement to meet and, if so, how often and how?
No requirement.
Are there proximity requirements?
No requirement.
Are there location-specific requirements?
The collaborating physician must “be actively practicing medicine within the geographic boundaries of this State.” There are no statutes, regulations, or guidance that would exempt a physician practicing telemedicine within the state from meeting this requirement.
See Frequently Asked Questions on APRN Practice for more details.
The application for NP’s prescriptive authority states that “collaborating physicians must be physically present at a practice site located within the geographic boundaries of SC.”
Is remote supervision allowed, and are there limitations on remote supervision?
Remote supervision is permitted if the collaborating physician is “readily available” for consultation. “Readily available” means the physician who enters into a practice agreement with an NP must be able to be contacted either in person or by telecommunications or other electronic means to provide consultation and advice to the NP performing medical acts.
Physician and NP Filing Requirements
Outside of filing the collaboration agreement, must the physician and/or NP file any separate forms?
NPs must notify the Board of Nursing within fifteen (15) business days of initiating, changing, or terminating a Practice Agreement.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
Authorized prescriptions by an APRN with prescriptive authority:
- Must comply with all applicable state and federal laws and executive orders
- Are limited to drugs and devices utilized to treat medical problems within the specialty field of the nurse practitioner or clinical nurse specialist as prescribed in the practice agreement
- Must be signed or electronically submitted by the APRN with the prescriber’s identification number assigned by the board and all prescribing numbers required by law. Written prescription forms must include the name, address, and phone number of the APRN and physician. Electronic prescription forms must include the name, address, and phone number of the APRN and, if possible, the physician through the electronic system. All prescriptions must comply with the provisions of Section 39-24-40. A prescription must designate a specific number of refills and may not include a nonspecific refill indication;
- Must be documented in the patient record of the practice and must be available for review and audit purposes.
An APRN who holds prescriptive authority may request, receive, and sign for professional samples and may distribute professional samples to patients as listed in the practice agreement, subject to federal and state regulations.
An NP who applies for prescriptive authority must:
- Be licensed by the State Board of Nursing as a NP
- Submit a completed application and requisite fee
- Provide evidence of completion of forty-five (45) contact hours of education in pharmacotherapeutics acceptable to the board, within two years before application or during the time of the organized educational program shall provide evidence of prescriptive authority in another state meeting twenty (20) hours in pharmacotherapeutics acceptable to the board, within two years before application
- Provide at least fifteen (15) hours of education in controlled substances acceptable to the board as part of the twenty hours required for prescriptive authority if the NP has equivalent controlled substance prescribing authority in another state; and
- Provide at least fifteen (15) hours of education in controlled substances “acceptable to the board as part of the forty-five contact hours required for prescriptive authority if the NP” initially is applying to prescribe in Schedules II through V controlled substances.
What are the requirements for controlled substance prescribing?
Authorized prescriptions by a nurse practitioner, certified nurse-midwife, or clinical nurse specialist with prescriptive authority:
- May include Schedules III through V controlled substances if listed in the practice agreement and as authorized by Section 44-53-300;
- May include Schedule II non-narcotic substances if listed in the practice agreement and as authorized by Section 44-53-300, provided, however, that each such prescription must not exceed a thirty-day supply;
- May include Schedule II narcotic substances if listed in the practice agreement and as authorized by Section 44-53-300, provided, however, that the prescription must not exceed a five-day supply and another prescription must not be written without the written agreement of the physician with whom the nurse practitioner, certified nurse-midwife, or clinical nurse specialist has entered into a practice agreement, unless the prescription is written for patients in hospice or palliative care or for patients residing in long-term care facilities;
- May include Schedule II narcotic substances for patients in hospice or palliative care, or for patients in long-term care facilities, if listed in the practice agreement as authorized by Section 44-53-300, provided, however, that each such prescription must not exceed a thirty-day supply;
Sources for Reference
S.C. Code Ann. § 40-33-34
S.C. Code Ann. § 40-33-20
S.C. Code Ann. § 40-47-195
Frequently Asked Questions Regarding New Law Governing APRN Practice (2018)
Alerts for APRNs: Prescriptive Authority and Recertifications
State Regulations for Physician Assistants:
General:
The supervising physician is responsible for all aspects of the PA’s practice.
Is an agreement required?Yes, “written scope of practice guidelines”. The guidelines shall include at a minimum the:
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- (1) name, license number, and practice addresses of all supervising physicians;
- (2) name and practice address of the PA;
- (3) date the guidelines were developed and dates they were reviewed and amended;
- (4) medical conditions for which therapies may be initiated, continued, or modified;
- (5) treatments that may be initiated, continued, or modified;
- (6) drug therapy, if any, that may be prescribed with drug-specific classifications; and
- (7) situations that require direct evaluation by or immediate referral to the physician, including Schedule II controlled substance prescription authorization.
Does the agreement need to be filed with the state?
Yes. Also must submit Supervisory Agreement Form and Scope of Practice Guidelines Addendum Form. This is all included in the agreement provided by Zivian.
The physician must notify the board, in writing, of the proposed supervisory relationship and include the proposed scope of practice guidelines for the relationship. The PA may begin clinical practice with the named supervising physician and alternate physicians ten business days after the scope of practice guidelines have been submitted to the board and until a final determination is made by the board. Here are instructions: https://llr.sc.gov/med/pascope.aspx.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
A supervising physician may determine that there are additional medical acts, tasks, or functions for which a PA under the physician’s supervision needs additional training or education to meet the needs of the physician’s practice and that the physician would like to incorporate into the PA’s scope of practice guidelines. The physician must determine, in consultation with the PA, the means of educating the PA, which may include training under the direct supervision of the physician, education, or certification of proposed practices or other appropriate educational methods. The physician must notify the board in writing of the requested changes to the PA’s scope of practice guidelines and must provide documentation to the board of the competence of the PA to perform the additional medical acts, tasks, or functions. The PA may incorporate these additional medical acts, tasks, or functions into practice ten business days after the proposed changes have been submitted to the board and until a final determination is made by the board.
Who must sign the agreement?
PA, supervising physician, and alternate supervising physician.
How often must the agreement be reviewed/reauthorized?
No requirement.
What are the qualifications for the supervising physician (licensure, same scope, active practice in state, etc.)?
A physician or medical staff who are engaged in practice with a PA, NP, CNM, or CNS must:-
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- (i) hold permanent, active, and unrestricted authorization to practice medicine in SC and be actively practicing medicine within the geographic boundaries of SC; or
- (ii) hold an active, unrestricted academic license to practice medicine in this State and be actively practicing medicine within the geographic boundaries of SC.
- State guidance states that this requirement is also applicable to PAs practicing via telemedicine.
- a PA may not practice out of scope.
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Supervision requirements
Are there ratios/limits on the number of PAs that a supervising physician may supervise?
A physician cannot enter into scope of practice guidelines with more than the equivalent of six full-time PAs, NPs, CNMs, or CNSs.
The board may approve an exception to these requirements upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained.
Is there an express requirement to review a certain number/percentage of charts?
No, but the supervising physician or alternate must review, initial, and date the offsite physician assistant’s charts periodically as specified in the written scope of practice guidelines to ensure quality of care and patient safety
Is there a requirement to meet and, if so, how often and how?
No requirement.
Are there proximity requirements? (e.g., between the PA/physician or practice site)
No, but geographic proximity is taken into account when the board is evaluating written guidelines.
Are there location-specific requirements? (e.g., that physician must go to practice site at some frequency)
A PA who has less than two years continuous practice or who is changing specialties may not practice at a location off site from the supervising physician until the PA has 60 days clinical experience on-site with the supervising physician. This 60-day requirement, or a portion thereof, may be waived by the supervising physician in writing on a form approved by the board and submitted to the board.
Is remote supervision allowed/are there limitations on remote supervision?
The supervising physician of a limited licensee physically must be present on the premises at all times when the limited licensee is performing a task. Supervision must be continuous but must not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where the services are rendered, except as otherwise required for limited licensees.
Are there patient notice requirements?
A PA must clearly identify himself as a PA to ensure that the PA is not mistaken or misrepresented as a physician. A PA shall wear a clearly legible identification badge or other adornment of at least one inch by three inches in size bearing the PA’s name and the words ‘Physician Assistant’, ‘PA-C’, or ‘PA’.
Physician and PA filing requirements – outside of filing the delegation agreement, must the physician and/or PA file any separate forms?
See forms referenced above. See also Primary Supervisor Termination Notice Form.
What are the prescription requirements? (identifying physician on rxs, restrictions on certain categorizes of drugs that may or may not be scheduled [one area of concern right now is abortion-inducing medications], etc.)- The written scope of practice guidelines must authorize the PA to prescribe. If so:
- (1) prescriptions for authorized drugs and devices shall comply with all applicable state and federal laws;
- (2) prescriptions must be limited to drugs and devices authorized by the supervising physician and set forth in the written scope of practice guidelines;
- (3) prescriptions must be signed or electronically submitted by the PA and must bear the PA’s identification number as assigned by the board and all prescribing numbers required by law. The preprinted prescription form shall include both the PA’s and physician’s name, address, and phone number, and, if possible, the physician through the electronic system, and shall comply with the provisions of Section 39-24-40;
- (4) drugs or devices prescribed must be specifically documented in the patient record;
- (5) the PA may request, receive, and sign for professional samples of drugs authorized in the written scope of practice guidelines and may distribute professional samples to patients in compliance with appropriate federal and state regulations and the written scope of practice guidelines.
- What are the requirements for controlled substance prescribing?
- The PA must obtain controlled substance prescribing authority from the board.
- There are restrictions on prescribing Schedule II controlled substances orally and parenterally in S.C. Code Ann. § 40-47-965. See also PA FAQ August 2019.
- PA FAQ August 2019
- S.C. Code Ann. § 40-47-195
- S.C. Code Ann. § 40-47-910
- S.C. Code Ann. § 40-47-938
- S.C. Code Ann. § 40-47-950
- S.C. Code Ann. § 40-47-955
- S.C. Code Ann. § 40-47-960
- S.C. Code Ann. § 40-47-965
- S.C. Code Ann. § 40-47-970
- S.C. Code Ann. § 40-47-990
- S.C. Code Ann. § 40-47-995