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

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

The label is AANP's advocacy classification; the legal fact behind it is the practice-agreement requirement in § 54.1-2957(C).

Read the subsection whole: the same two sentences that require the agreement also define the exit, because an NP who meets subsection I may practice without one.

So the statute does not frame the restriction as career-long: it ends when the NP meets subsection I and can practise on an attestation, which is the transition this page walks through next.

The licence underneath is joint: the Boards of Medicine and Nursing jointly prescribe the APRN regulations, and practising as an APRN without that joint licence is unlawful (§ 54.1-2957(B)).

The gate is the equivalent of at least three years of full-time clinical experience, as the Boards determine; upon receipt of an attestation, the statute permits practice without an agreement in the practice category in which the NP is certified and licensed (§ 54.1-2957(I)).

That experience means postgraduate delivery of health care directly to patients pursuant to a practice agreement with a patient care team physician.

The attestation comes from either the patient care team physician or an attesting nurse practitioner who assumed management and leadership of an NP under subsection G and has met the subsection I requirements for at least three years, stating the qualifying-agreement team practice, the attester's routine practice within the NP's certified population and category, and its length.

It goes to the Boards with a fee; failing that, the Boards may accept other evidence under their regulations.

Endorsement applicants may attest to the equivalent of three years under their prior state's laws (E).

The three-year figure dates to HB 971 (eff.

2024-07-01, SECONDARY); the prior figure is not stated in the sources read.

Practice agreements must provide for periodic review of health records, possibly with site visits, at a manner and frequency the parties determine, plus provider input in complex cases and emergencies and for referrals.

The APRN keeps evidence of the agreement for the Boards on request, and a hospital or health-system APRN may satisfy the requirement through clinical-privileges documents.

Collaboration and consultation may be delivered by telemedicine.

The ratio is the PMHNP-specific fact: six APRNs per physician, ten for psychiatric-mental health APRNs.

If the physician dies, retires or otherwise cannot serve and no new practice agreement is possible, G buys time: on notice to the Boards, 60 days of continued practice on previously authorized drugs with access to appropriate provider input; the designee shall grant a second 60 days on evidence the NP seeks a new physician and physician input; then the Boards may permit practice under the management and leadership of an NP who meets subsection I, routinely practised in the NP's certified category, and has been authorized to practise without an agreement for at least three years.

Say it plainly: an outpatient Virginia PMHNP can prescribe Schedule II ADHD stimulants.

Section 54.1-2957.01(A) gives every licensed APRN authority to prescribe Schedule II through Schedule VI controlled substances and devices, and no Schedule II days-supply cap or stimulant-specific restriction appears in the statutes read.

The condition is the agreement: an NP who does not yet meet subsection I may prescribe controlled substances only as the practice agreement authorizes, and every agreement shall include the controlled substances the APRN is or is not authorized to prescribe — it may restrict that authority.

The agreement must be signed by the physician or clearly state the physician's name, and the NP must give the Boards evidence of being party to it at the time of writing a prescription.

Once the NP is authorized under subsection I to practise without an agreement, prescribing no longer rides on one.

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 Virginia lets the NP prescribe: a DEA form listing Schedules II to V does not override the practice agreement's list or any other state condition.

The DEA and HHS telemedicine flexibilities, extended through December 31, 2026, let registered practitioners prescribe Schedules II to V remotely without a prior in-person evaluation, and they lift no Virginia requirement — an NP practising by telehealth still works inside a practice agreement until the subsection I designation issues.

Virginia's own statute is telehealth-friendly on the collaboration side: the collaboration and consultation the practice agreement requires may be provided through telemedicine, as described in § 38.2-3418.16.

Re-check the federal layer near the end of 2026, when the extension expires.

Virginia 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 Virginia you need the joint APRN licence from Virginia's Boards of Nursing and Medicine — and because the compact is not in effect, remote work into Virginia rests on Virginia licensure, not on any multistate credential.

HB 971 (2024 Acts c.

404), effective July 1, 2024, reduced the clinical practice requirement to three years and, under subsection G's circumstances — a patient care team physician who can no longer serve and no new physician agreement possible — let an NP who has held the autonomous practice designation for at least three years assume management and leadership of another NP, per a Virginia Board of Nursing executive director's message (SECONDARY, reposted by VaCNS); the research labels the 2024 date secondary, and the pre-2024 figure is not stated in any source read.

Two 2025 chapters also amended § 54.1-2957: c.

557, which was read, concerns certified nurse midwives, independent practice and organized medical staff — not the nurse practitioner practice-agreement rules — and c.

544 was not read.

The code's own history line records all three: 2024, c.

404; 2025, cc.

544, 557.