A collaborative practice agreement is the written document that lets a psychiatric nurse practitioner prescribe in the 23 states where law requires one — and no board sets its price.
The PMHNP and a licensed physician sign it; what it must contain (chart-review percentages, meeting cadences, even where it is filed) is written state by state.
Here is who signs, what the agreement must say, and what it actually costs.
What a collaborative practice agreement is — and what it is not
A collaborative practice agreement is a signed document between a psychiatric nurse practitioner and a physician that state law requires before the NP can practise — usually prescribe.
It is a creature of statute and board rule: the state legislature writes the nurse practice act, and the state board of nursing (sometimes jointly with the board of medicine) writes the rules beneath it.
It is not a payer rule, not a credentialing requirement, and not a compact rule.
Twenty-three states make it the career-long default — the twelve AANP-classified reduced-practice states (Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, Wisconsin, and West Virginia) and the eleven restricted states (California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia).
Eleven more full-practice states use a version of it temporarily, as a transition-to-practice period; which states require it at all, and which let you exit it, is that article's subject.
This page is about the document itself.
The same instrument travels under many names — a point that matters when you are searching your state's code.
California calls it "standardized procedures," New York and Virginia a "practice agreement," Ohio a "standard care arrangement," Texas a "prescriptive authority agreement," Oklahoma a "supervision agreement," Missouri a "collaborative practice arrangement."
Florida's supervision-to-autonomy ladder runs on different documents and is covered in the tier article.
The contents, not the label, are what bind you.
The names are not standardized, and the law moves
Who signs it — and who can be the collaborating physician
The signatories are always the NP and a licensed physician.
Beyond that, states add parties and screens.
California's standardized procedures must be "developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee" — a three-signature document (Business and Professions Code § 2836.1(b)).
Georgia requires the nurse protocol agreement to be "mutually agreed upon and signed by an advanced practice registered nurse and a physician" and submitted to the Composite Medical Board within 30 days of execution (O.C.G.A. § 43-34-25).
Tennessee requires the collaborating physician — the one with "control and responsibility" for prescriptive services — to be named to the board.
Most states also screen who the physician may be.
Georgia requires a "comparable specialty or field," and the physician must practise in Georgia or within 50 miles of where the protocol is used — a rule that does not relax for telehealth.
Kentucky requires a physician "qualified in the same or a similar specialty."
Mississippi requires a physician "whose practice is compatible."
Ohio's rule is PMHNP-specific: a psychiatric-mental health NP may sign a standard care arrangement with a physician — not a podiatrist — who practises "Psychiatry; Pediatrics; Primary care or family practice" (R.C.
4723.431(A)(2)(c)).
Alabama layers on a credential: the collaborating physician must hold the state's own Qualified Alabama Controlled Substances Certificate, and since January 1, 2024 must complete Board of Medical Examiners-prescribed continuing education on the collaboration rules themselves.
Two design features anticipate the physician leaving.
Pennsylvania's agreement must name "at least one substitute physician" (§ 21.285(a)(1)).
Louisiana allows a designated alternate collaborating physician to serve for at least 30 but no more than 120 days after an unexpected loss, and requires the departing physician to give at least 30 days' notice.
Kentucky's CAPA agreements are rescindable on 30 days' written notice.
In practice the employer — not the NP — usually identifies and pays for the physician; the next sections show what the agreement then has to say.
What the agreement must contain, state by state
There is no national template.
At one end, Wisconsin's statute asks only that the APRN "document such a collaborative relationship."
At the other, Missouri and Tennessee write chart-review percentages, meeting intervals, and site-visit schedules directly into law.
The table below collects the operative requirements from each state's statute or rule; where a state sets no numeric chart-review percentage, none is stated — the absence is the finding, not an omission.
| State | What the agreement must set |
|---|---|
| Alabama | A written standard protocol including a formulary, on file with both the Board of Nursing and the Board of Medical Examiners; quarterly quality assurance with each CRNP; the physician present for 10% of scheduled hours during the CRNP's first two years (4,000 hours); remote sites visited twice a year (r. 540-X-8-.08). |
| Arkansas | An agreement with a physician, on file before prescriptive authority is granted or reactivated (17 CAR § 123-604). |
| California | Standardized procedures approved by physician, NP, and facility administrator; Schedule II–V furnishing limited to the drugs the procedure names, with Schedule II–III under a patient-specific protocol (§ 2836.1); one physician may supervise no more than four NPs at a time (§ 2836.1(e)). |
| Georgia | Protocol signed by both parties, filed with the Composite Medical Board within 30 days; physician within 50 miles; physician reviews and signs 100% of controlled-substance patient records quarterly and 10% of other records annually; delegating physician capped at the "combined equivalent of eight" APRN protocols and PA job descriptions (§ 43-34-25; r. 360-32-.02). |
| Illinois | A written collaborative agreement describing the relationship and the categories of care; the physician's personal presence is explicitly not required; the agreement is not filed — it must be available to IDFPR on request, and the physician has access to the records (225 ILCS 65/65-35). |
| Indiana | The agreement is not valid until prescriptive authority is granted; it must set geographic proximity and coverage, with at least a 5% random sample of charts and prescriptions submitted to the physician within 7 days (848 IAC 5-1-1). |
| Kentucky | Two agreements — a CAPA-NS for non-scheduled drugs and a CAPA-CS on a cabinet form for controlled substances, which "shall state any limits on controlled substances"; the physician in the same or a similar specialty; quarterly meetings in the CAPA-CS's first year to review the APRN's KASPER report, at least biannual for the next three years (KRS 314.042; 201 KAR 20). |
| Louisiana | A collaborative practice agreement on a board form kept at the practice site; guidelines reviewed at least annually; the physician available face-to-face or by phone; no more than two collaborating physicians per site; controlled substances limited to the physician's specialty. |
| Michigan | Controlled-substance prescribing runs on the physician's written authorization, reviewed and updated annually, naming both parties, their licence numbers, and the delegation's limits — and prescriptions carry both names and DEA numbers. |
| Mississippi | A collaborative/consultative relationship with a protocol filed with and approved by the board (§ 73-15-20(3)); a physician "whose practice is compatible"; a formal QA/QI program maintained on site. |
| Missouri | A written collaborative practice arrangement; the physician reviews at least 10% of charts every 14 days and at least 20% of the charts where the APRN prescribed controlled substances every 14 days; the physician present at least once every two weeks; a cap of six full-time-equivalent APRNs, PAs, or assistant physicians per physician (§ 334.104). |
| New Jersey | Joint protocols developed by the physician and APN, reviewed, updated, and signed by both at least annually; charts periodically reviewed by both; the collaborating physician named on prescriptions (N.J.S.A. 45:11-49). |
| New York | (During the transition period.) Records reviewed by the physician no less often than every three months; both names posted in the practice setting; no physician may hold agreements with more than four NPs not on the same premises (Ed. Law § 6902). |
| North Carolina | Continuous availability of physician and NP to each other by direct or telecommunication; the agreement reviewed at least yearly; quality-improvement meetings at least every six months — monthly during the first six months of the agreement (21 NCAC 36 .0810). |
| Ohio | A standard care arrangement retained by the employer — no board approval required; a five-nurse cap on the prescribing component; for PMHNPs, a collaborating physician practising psychiatry, pediatrics, or primary care/family practice (R.C. 4723.431). |
| Oklahoma | A written supervision agreement filed with the initial application and every renewal; changes filed with the board within 30 days (§ 567.4a). |
| Pennsylvania | The agreement identifies the collaborating physician and at least one substitute, specifies how often the physician will personally see the patient, is kept at the primary practice location with a copy filed with the Bureau of Professional and Occupational Affairs, and is reviewed by the parties at least every two years (§ 21.285). |
| South Carolina | Reviewed at least annually, dated and signed by both parties, producible to the board within 72 hours of a request; random board audits at least biennially; the physician capped at the equivalent of six full-time NPs, PAs, CNMs, or CNSs combined (§§ 40-33-34, 40-47-195). |
| Tennessee | Protocols reviewed and updated biennially under Board of Medical Examiners rules; the physician personally reviews and certifies the chart within 30 days whenever a controlled drug has been prescribed, reviews at least 20% of charts every 30 days, and visits remote sites at least every 30 days — up to ten of the annual visits may be by HIPAA-compliant electronic means (Rule 0880-06-.02; § 63-7-123). |
| Texas | A prescriptive authority agreement registered with the Texas Medical Board; a quality-assurance plan with chart review — the number of charts set by the parties — and meetings at least monthly; reviewed at least annually; a combined cap of seven APRNs and PAs, which does not apply in practices serving medically underserved populations or hospital facility-based practices (§ 157.0512). |
| Virginia | A practice agreement with a "patient care team physician" providing for periodic records review "in the manner and at the frequency determined by" the parties; a physician may serve at most six APRNs — ten when they are all psychiatric-mental health APRNs (§§ 54.1-2957, 54.1-2957.01). |
| West Virginia | Mutually agreed written guidelines or protocols for prescriptive authority, periodic joint evaluation of prescriptive practice, and periodic joint review and updating of the protocols; verification filed with the board (§ 30-7-15b). |
| Wisconsin | From September 1, 2026 (2025 Wis. Act 17): practice in collaboration with a physician or dentist, documented by the APRN — working together "in each other's presence when necessary"; employers may impose additional requirements (§ 441.09). |
Notice what is absent.
No state read requires a fee term, a payment provision, or any compensation language in the agreement.
Illinois forbids an agreement (absent employment) from restricting patient categories, payors, or the geographic area of practice.
And several states keep the entire document out of the board's hands until someone asks for it — Illinois and Ohio by design, South Carolina on 72 hours' notice.
The PMHNP-specific wrinkles: specialty matching and the stimulant carve-outs
Generic NP advice undersells how much of this map is shaped around psychiatric practice.
Ohio writes the PMHNP's collaborator into statute — psychiatry, pediatrics, or primary care/family practice, never a podiatrist.
Virginia counts psychiatric-mental health APRNs differently: a physician may team with six APRNs generally but ten when all are psychiatric-mental health — the one ratio on the books that expands because of the specialty.
And Ohio adds the bluntest scope rule of any state read: an NP's "prescriptive authority shall not exceed the prescriptive authority of the collaborating physician or podiatrist" (R.C.
4723.481(B)).
That principle — the agreement transmits the physician's scope, not just permission — recurs wherever controlled substances are at stake.
Louisiana limits the agreement's controlled-substance coverage to the collaborating physician's own specialty, so the physician's practice defines the PMHNP's.
North Carolina requires the physician to hold DEA registration covering a schedule "equal to or greater than the nurse practitioner's" (21 NCAC 36 .0809(b)(2)(C)).
Kentucky lets the CAPA-CS state controlled-substance limits "more stringent" than the statute's.
Then there is the stimulant layer.
Five states — Alabama, Georgia, Missouri, Oklahoma, and Texas — bar NPs from prescribing Schedule II stimulants in ordinary outpatient practice altogether; the state-by-state detail, including the narrow exceptions, is on the tier page.
Around that bar sit carve-outs that only a PMHNP can use: Ohio's Schedule II limits do not apply at community mental health services providers or qualifying outpatient behavioral-health practices, where the APRN collaborates with a physician employed by that practice; Kentucky allows a 30-day psychostimulant supply only when the APRN is certified in psychiatric-mental health nursing and practises in a KRS Chapter 216B facility or a KRS Chapter 210 regional program; Arkansas lets the APRN continue a stimulant only when a physician initiated it, evaluated the patient within the previous six months, and the APRN treats the same condition — a rule that binds even Arkansas's fully independent NPs.
The practical reading for a job search or a business plan: in these states, choosing the collaborating physician is choosing the formulary.
Ask what the physician is board-certified in and what schedules their DEA registration covers before you sign anything else.
What a collaborative practice agreement costs
The direct answer: no public source sets the price.
No state board read publishes, caps, or surveys what a collaborating physician charges, and no fee schedule for the agreement itself exists in any statute or rule reviewed for this article.
The fee — where one exists at all — is a private contract between the NP or the employer and the physician, shaped by the chart-review and meeting workload the table above assigns the physician.
Any per-state list of "collaborating physician fees" you encounter on aggregator sites is unsourced; treat it accordingly.
What is documented are the costs around the agreement.
Federal: an NP registers with the DEA as a "mid-level practitioner" (21 CFR 1300.01) at $888 per three-year registration cycle (21 CFR 1301.13(e)) — a cost that exists in every state, agreement or not.
Alabama adds a state layer: the Qualified Alabama Controlled Substances Certificate costs $60 annually (r.
540-X-18-.06), is obtained "annually … for each collaborative practice agreement," and requires twelve months of active practice under a collaborative agreement plus eight hours of controlled-substance instruction and four hours of advanced pharmacology before it issues.
Alabama also bills the other side — collaborating physicians have been required to complete BME-prescribed continuing education on collaboration rules since January 1, 2024.
The heavier cost is time, and the statute prices it in hours, not dollars: Missouri's physician reviewing a fifth of controlled-substance charts every two weeks, Tennessee's 30-day site visits, Texas's monthly meetings.
No survey reviewed quantifies what that physician time is worth, so no honest figure can be printed here — but it is the mechanism behind the private fee, and it is why employers, not individual NPs, usually carry it.
If a site quotes a fee by state, ask for the rule
If you employ PMHNPs: standing the agreement up
For employers, the agreement is an operations problem with a statutory checklist attached.
The sequence below assumes a reduced or restricted state; in full-practice states no agreement is legally required, though employer policy often imposes one anyway — the workforce data on that is in the tier article.
- Qualify the physician before you post the role: Ohio requires psychiatry, pediatrics, or primary care/family practice for a PMHNP's collaborator; Georgia requires a comparable specialty within 50 miles; Kentucky requires the same or a similar specialty; Alabama requires the physician to hold a QACSC and, since 2024, the BME's collaboration CME.
- Draft to your state's required contents — the chart-review percentages, meeting cadence, and scope language in the table above — not to a generic template.
- File or retain as your state directs: Georgia files within 30 days, Alabama keeps copies with both boards, Mississippi files for board approval, Oklahoma files with each application and on changes, Pennsylvania copies the Bureau, Wisconsin documents the relationship; Illinois, Ohio, Michigan, and Louisiana instead keep the document on site, producible on request (South Carolina: within 72 hours).
- Calendar the recurring statutory duties — Pennsylvania's and Tennessee's biennial protocol reviews, New Jersey's and South Carolina's annual reviews, Texas's monthly meetings, North Carolina's six-monthly QI meetings (monthly for the first six months), Missouri's 14-day chart reviews — or the agreement fails its own terms.
- Name the backup on day one: Pennsylvania requires at least one substitute physician in the agreement; Louisiana's alternate serves 30–120 days after an unexpected loss; Kentucky and Louisiana require 30 days' notice to end the arrangement.
- Watch the exit thresholds: several career-long states let an experienced NP shed the agreement — the hours and years are catalogued in the full-practice-authority article.
Employers hiring for the role can see how the licence itself is scoped across the market by browsing open psychiatric nurse practitioner jobs — the agreements travel with the offers.
This article is general career information, not legal, clinical, or medical advice, and it is not guidance for anyone seeking treatment. Collaborative practice requirements are set by state legislatures, boards of nursing, boards of medicine, and the DEA, and all of them change — confirm the current rules with your state boards before relying on any of it.