PMHNP Practice Authority in Texas: Independence, Physician Agreements and Schedule II

AANP's May 2026 map puts Texas in its restricted tier.

The label is AANP's advocacy classification; the legal fact behind it is that Texas prescriptive authority for an APRN is delegated by a physician, under adequate physician supervision, through a prescriptive authority agreement.

The APRN licence comes from the Board of Nursing, but the agreement with a physician is what lets a PMHNP prescribe.

Texas has no hours or years threshold after which a PMHNP stops needing a delegating physician.

The prescriptive authority agreement is career-long, so a new graduate and a PMHNP with twenty years in practice work under the same structure.

If you are weighing Texas against a job offer elsewhere, count the agreement as a permanent cost of practice, not a start-up phase.

A physician may enter prescriptive authority agreements with at most seven APRNs and PAs combined, or the full-time equivalent of seven.

The cap does not apply in a practice serving a medically underserved population or in a hospital facility-based practice.

The agreement must include a quality-assurance plan with chart review, the number of charts set by the physician and APRN, and periodic meetings at least once a month.

It must be reviewed at least annually, and the physician registers the delegation with the Texas Medical Board.

For a PMHNP starting a practice, the physician's time for those meetings and reviews is part of the budget.

Schedule II can be delegated only in two settings: a hospital facility-based practice, for a patient admitted for an intended stay of 24 hours or more or seen in the emergency department, and hospice care for a patient who has certified a terminal illness.

In ordinary outpatient psychiatry that rules out Schedule II ADHD stimulants, which have to be prescribed by a physician.

Schedules III to V can be delegated up to a 90-day supply including refills; going past 90 days, or prescribing for a child under two, requires consulting the delegating physician and noting it in the chart.

The prescription monitoring program must be checked before prescribing opioids, benzodiazepines, barbiturates or carisoprodol.

A separate state controlled-substance registration was not located in the sources read.

A PMHNP registers with the DEA as a mid-level practitioner, and that registration covers only what the state lets the NP prescribe.

A DEA form that lists Schedules II to V does not override the Texas Schedule II rule.

The same goes for telehealth: the DEA and HHS telemedicine flexibilities, extended through December 31, 2026, let registered practitioners prescribe remotely without an in-person visit, but they do not lift any Texas limit.

Texas has not enacted the APRN Compact.

The compact takes effect only once seven states enact it, and as of September 2026 five had (Delaware, North Dakota, South Dakota, Utah and Wyoming), so no APRN holds a multistate APRN licence today.

The Nurse Licensure Compact is an RN compact and gives no nurse practitioner authority in another state.

To practise as a PMHNP in Texas you need a Texas APRN licence and a Texas prescriptive authority agreement.

Section 157.0511 was last amended in 2013 by SB 406, and the Board of Nursing's controlled-substance rule, 22 TAC § 222.8, has been in its current form since September 1, 2019.

Whether a full-practice bill was filed in the 2025 session was not researched, so check the Texas Legislature before assuming the rules are unchanged.