Collaborative practice agreement
A collaborative practice agreement is the written contract, required in reduced- and restricted-practice states, that defines how a physician collaborates with or supervises a nurse practitioner or physician assistant — covering scope, prescriptive authority, chart review, availability, and the ratio of clinicians per physician.
- Required in reduced and restricted states
- Contents set by state law; boards audit
- One agreement per state; physician must be licensed there
- Ratio limits commonly 3–7 clinicians per physician
What the agreement has to contain
State law dictates the contents, and boards audit them. The common elements: the scope of services and the protocols or guidelines the NP or PA follows; which drug schedules are delegated; how much chart review happens and how often; how the physician is available; ratio limits; and, in some states, in-person meeting or site-visit requirements. Several states require the agreement or a notice of it on file before the first prescription.
- Scope and protocols
- Prescriptive authority by schedule
- Chart-review sample and cadence
- Availability, proximity, and ratio rules
- Filing and renewal requirements
The multi-state problem
One agreement covers one state, and the physician must be licensed there. A telehealth practice serving fifteen restricted or reduced states needs fifteen compliant agreements with physicians licensed in each, ratio limits tracked across all of them, and chart-review logs a board can inspect. Practices usually start with a physician colleague, add a marketplace, and drift into an untracked stack — which is why multi-state programs tend to run the physician layer through a medical group.
Compliance handled, so you can build
Lithos runs the clinicians, pharmacies, and 50-state rules behind your care program — one API.
Frequently asked questions
What is the difference between collaboration and supervision?
Terminology varies by state. Collaboration generally means a consultative relationship with defined protocols; supervision implies more direct oversight, sometimes with proximity or in-person requirements. Both are documented in a written agreement.
What happens if the collaborating physician leaves?
In most restricted states the NP’s prescriptive authority lapses until a new agreement is executed and, where required, filed. Agreements should include a replacement clause and a bench of covering physicians.
Does the agreement need to be filed with the board?
In some states yes, before prescribing; in others it must be available on request. Check the specific board’s rule.