A state's practice authority rules settle three questions about a PMHNP hire: whether a physician has to be involved, what that physician must do, and which patients the NP can treat with controlled medications. For the state-by-state view, use our practice authority map and our license guide for each state, such as the Florida guide. The rest of the hiring process is in our guide on how to hire a PMHNP.
The rules below are current as of October 2026. They change often, so confirm them with the state board of nursing before you make an offer. This article is general information and does not replace legal advice.
As of October 2026, whether a PMHNP needs a physician in the arrangement depends on each patient's state and sometimes on the NP's practice hours. In full practice states, as the American Association of Nurse Practitioners classifies them, the NP practices and prescribes, including controlled substances, under the licensure authority of the state board of nursing alone, although some of those states first require a transition period: a set number of hours or years under a collaborative agreement, supervision or mentorship. In reduced and restricted practice states, state law requires a collaborative agreement with, or supervision by, another health provider, usually a physician, for at least part of the NP's practice. For telehealth, the NP must be licensed in the state where the patient is located (NLC FAQs).
The Three Practice Authority Levels
The American Association of Nurse Practitioners (AANP) groups states into three levels on its State Practice Environment page, and our map uses the same classifications.
| Level | How AANP defines it | What it means for an employer |
|---|---|---|
| Full practice | State law lets NPs evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatment, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing | No physician agreement once any transition period is complete |
| Reduced practice | State law requires a career-long collaborative agreement with another health provider in order for the NP to provide patient care, or limits the setting of one or more elements of NP practice | Arrange a collaborating physician before the NP starts, and keep one in place |
| Restricted practice | State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care | Arrange a supervising physician and the written protocols the state requires |
The level is a starting point, because some rules change with experience. Oklahoma, for example, lets an APRN apply to the Oklahoma Board of Nursing for independent prescriptive authority after completing at least 6,240 clinical practice hours with prescriptive authority supervised by a physician. The board's other requirements include a current APRN license in good standing in a CNP, CNS or CNM role, and 45 contact hours of continuing education or 3 academic credit hours in pharmacotherapeutic management from the three years before the application. APRNs approved for that authority no longer need a supervising physician or a supervising physician agreement. The board also says applicants who live in full practice states get no exemption from the hours requirement (Oklahoma Board of Nursing FAQ).
What a Collaborative or Supervisory Agreement Covers
Whether the state calls it a collaborative agreement, supervisory protocol or written practice agreement, it typically addresses four areas:
- Prescriptive authority: which drugs or categories of drugs the NP may prescribe.
- Chart review: how often the physician reviews records or sees patients.
- Availability: who covers when the physician is away, and how many sites one physician can oversee.
- Written protocols: where the documents are kept and how often they are reviewed.
Three examples from state law:
- Pennsylvania. A prescribing CRNP's collaborative agreement must be written and signed by the CRNP and the collaborating physician, name at least one substitute physician, identify the drug categories the CRNP may prescribe, specify the circumstances and how often the physician will personally see the patient, be kept at the CRNP's primary practice location, be reviewed and updated at least once every two years, and state the amount of professional liability insurance covering the CRNP (49 Pa. Code 21.285).
- New York. Until an NP has practiced more than 3,600 hours, practice follows a written practice agreement and written practice protocols. The agreement must include explicit provisions for resolving disagreements with the collaborating physician, and must provide for that physician to review patient records "in no event less often than every three months" (Education Law 6902).
- Florida. Unless an APRN is registered and practicing under the autonomous practice statute, s. 464.0123, the APRN works within an established protocol that "must be maintained on site" at each location where the APRN practices (Fla. Stat. 464.012). Where an APRN works at an office other than the supervising physician's primary practice location, with no supervising physician onsite, the physician may supervise no more than four such offices in addition to the primary practice location for primary care, or two for specialty care, and must post in each office a current schedule of the regular hours the physician is present and the hours the office is open while the physician is not present. These office rules do not apply to services in hospitals and other facilities licensed under chapter 395, rural and federally qualified health centers, or several other listed settings (Fla. Stat. 458.348).
Finding and Structuring a Collaborating Physician
Common sources are a physician already on staff or in an affiliated group, a local physician who contracts for the role, and services that match NPs with collaborating physicians. Choose a physician whose practice covers the medications and patients the NP will manage, then settle these points in writing:
- Payment. Who pays the physician, the fee and the payment schedule. Our guide to the cost to hire a PMHNP covers this cost alongside the rest of a hiring budget.
- Backup coverage. A substitute for vacations and departures. Pennsylvania's rule requires at least one.
- Exit plan. Where prescribing depends on an agreement, a gap between agreements is a gap in prescribing. Line up a replacement first and file any required notice, such as Pennsylvania's rule that a CRNP must notify the State Board of Nursing in writing whenever a prescriptive authority collaborative agreement is updated or terminated (49 Pa. Code 21.285(b)).
- Insurance and review. Malpractice coverage for the NP and the physician's collaborative role, and a review by health care counsel.
Transition Periods Before Independent Practice
Some states let an NP practice independently only after a transition period: a set number of hours or years under a collaborative agreement, supervision or mentorship. A practice that hires an NP who has not finished that period, such as a new graduate, needs to arrange what the state requires until the period ends. Look up each patient state on the practice authority map and in its license guide. Two examples:
- New York. The agreement and protocols above apply until the NP has practiced more than 3,600 hours. After that, the current version of Education Law 6902(3)(b) says the NP "shall not be required to comply" with the requirements for collaboration with a physician, a written practice agreement and written practice protocols, and that version is effective until July 1, 2030. From July 1, 2030, a replacement version still lets an NP past 3,600 hours practice without the written agreement and protocols, and instead requires collaborative relationships with one or more licensed physicians qualified to collaborate in the specialty involved, or with a hospital (Education Law 6902).
- Minnesota. A nurse practitioner who qualifies for APRN licensure must practice at least 2,080 hours "within the context of a collaborative agreement" and submit written evidence to the board "with the application, or upon completion of the required collaborative practice experience" (Minn. Stat. 148.211, subd. 1c). A 2026 amendment lets that agreement be with a licensed physician, or with a Minnesota-licensed APRN who has at least three years of APRN practice, as long as the collaborator has experience caring for patients with the same or similar medical problems. The amendment also removed the rule that these hours be worked in a hospital or integrated clinical setting. A setting rule remains, in new subdivision 1d, only for NPs who provide services other than primary care or mental health services in their first 2,080 hours, so a PMHNP providing mental health services is outside it (Laws 2026, chapter 115, article 11). As of October 2026, the Revisor's page for section 148.211 shows the 2026 text, with subdivision 1c as amended and the new subdivision 1d.
Our New York and Minnesota license guides have the details.
Controlled Substance Prescribing
Controlled substance authority is a separate question, and it matters in psychiatry because amphetamine, methylphenidate and lisdexamfetamine are Schedule II drugs (21 CFR 1308.12). A state can let an NP prescribe independently and still bar a schedule, as Oklahoma does.
- DEA registration. DEA requires a separate registration in each state where a practitioner practices, and relies on the state licensing board to determine which schedules the practitioner may prescribe (DEA registration Q&A).
- Oklahoma. The board says APRNs granted independent prescriptive authority still cannot prescribe Schedule II controlled dangerous substances, because the 2025 law "did not change what APRNs are allowed to prescribe" (Oklahoma Board of Nursing FAQ).
- Florida. The APRN formulary must cap Schedule II prescriptions at a 7-day supply, except psychiatric medications prescribed by psychiatric nurses, and must restrict psychiatric mental health controlled substances for children younger than 18 to psychiatric nurses (Fla. Stat. 464.012). A psychiatric nurse is an APRN licensed under s. 464.012 who has a master's or doctoral degree in psychiatric nursing, a national advanced practice certification as a psychiatric mental health advanced practice nurse, and 1 year of post-master's clinical experience under the supervision of a physician (Fla. Stat. 394.455(36)), so a PMHNP who has not completed that year does not yet meet the definition.
- Telemedicine. The DEA and HHS fourth temporary extension lets DEA-registered practitioners prescribe controlled substances by telemedicine without a prior in-person evaluation through December 31, 2026. As of October 27, 2026, the Federal Register showed no replacement. Our DEA telehealth guide covers how to prepare.
Telehealth Across State Lines
For telehealth, the license follows the patient. The Nurse Licensure Compact's FAQ says nurses "are required to be licensed in the state where the patient is located at the time service is provided," that the compact "pertains to RN and LPN/VN licenses only," and that "an APRN must hold an individual APRN license in each state of APRN practice" (NLC FAQs).
As of February 2024, the separate APRN Compact was not yet in effect: NCSBN said it would be implemented once seven states enacted it, and South Dakota had just become the fourth, joining Delaware, North Dakota and Utah (NCSBN). At its 2026 APRN Roundtable, NCSBN said its board had charged staff to work with boards of nursing to redesign the compact (transcript).
Each license carries its own state's rules, as the Oklahoma example shows. Our multi-state licensure guide and multi-state DEA guide cover the steps.
Employer Checklist
- Map every patient state on the practice authority map, read our license guide for each, and confirm with the board of nursing.
- Verify credentials: the APRN license and prescriptive authority in each state, plus DEA registration wherever the NP will prescribe controlled substances.
- Count hours where a state ties independence to them, and ask how they are documented.
- Name the physician and a backup before the start date wherever an agreement is required.
- Draft to the state's list, covering prescribing scope, chart review, coverage and protocols, then store the agreement where the state requires and calendar each review date.
- Settle payment in writing and have health care counsel review the terms.
- Plan the exit if the physician or the NP leaves, including any notice to the board.
- Match prescribing limits to your schedule before booking children or patients on Schedule II medications.
- Recheck regularly. The DEA telemedicine flexibilities end December 31, 2026 unless replaced, and state laws can change every legislative session.
Sources
- AANP, State Practice Environment: https://www.aanp.org/advocacy/state/state-practice-environment
- 49 Pa. Code 21.285: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/s21.285.html
- New York Education Law 6902: https://www.nysenate.gov/legislation/laws/EDN/6902
- Florida Statutes 464.012: https://www.flsenate.gov/Laws/Statutes/2026/464.012
- Florida Statutes 458.348: https://www.flsenate.gov/Laws/Statutes/2026/458.348
- Florida Statutes 394.455: https://www.flsenate.gov/Laws/Statutes/2026/394.455
- Minnesota Statutes 148.211: https://www.revisor.mn.gov/statutes/cite/148.211
- Minnesota Session Laws 2026, chapter 115, article 11: https://www.revisor.mn.gov/laws/2026/0/Session+Law/Chapter/115/
- Oklahoma Board of Nursing, HB 2298 FAQ (November 4, 2025): https://oklahoma.gov/content/dam/ok/en/nursing/documents/hb2298%20faq.pdf
- 21 CFR 1308.12: https://www.ecfr.gov/current/title-21/section-1308.12
- DEA, registration Q&A: https://www.deadiversion.usdoj.gov/faq/registration-faq.html
- DEA and HHS, fourth telemedicine extension (December 31, 2025): https://www.govinfo.gov/content/pkg/FR-2025-12-31/html/2025-24123.htm
- Nurse Licensure Compact FAQs: https://www.nursecompact.com/FAQs.page
- NCSBN, South Dakota Enacts APRN Compact (February 9, 2024): https://www.ncsbn.org/news/south-dakota-enacts-aprn-compact
- NCSBN, 2026 APRN Roundtable transcript: https://www.ncsbn.org/public-files/videos/Transcript_2026aprn_nlivanos.pdf
Post Your PMHNP Role
When you are ready to hire, post the role on PMHNP Hiring. In the listing, name the states where the NP will see patients, say whether you provide and pay a collaborating physician, and say whether you will consider new graduates, so candidates can judge fit before they apply. Our PMHNP job description template shows how to describe supervision and collaboration in a posting, and current rates are on our pricing page.