State

Physician Involvement Requirement (for Prescription)

On-Site Oversight Requirement

Quantitative Requirements for Physician Chart Review

Maximum NP-to-Physician Ratio

Texas

MD Delegation Required

For sites serving medically underserved populations: at least once every 10 days (no duration specified). 10% for designated alternative practice sites.

10% of all charts

3 NPs or FTE - 1 MD (for alternative practice sites, 4 - 1; can be waived up to 6 - 1)

Utah

MD Collaboration Required**

None

No

None stated

Vermont

MD Collaboration Required

None

Yes (percentage left to MD & NP discretion)

None stated

Virginia

MD Supervision Required

MD must “regularly practice” at location where

NP practices Yes - periodic review (percentage left to MD & NP discretion)

4 NPs - 1 MD

Washington

None

None

No

N/A

West Virginia

MD Collaboration Required

None

Periodic and joint review of Rx practice (no percentage specified)

None stated

Wisconsin

MD Collaboration Required

None

No

None stated

Wyoming

None

None

No

None stated

NOTES: For the purposes of this chart, “collaboration” includes all collaboration-like requirements (such as “collegial relationship,” etc.).

FTE = full-time equivalent; MD = medical doctor; NP = nurse practitioner; PT = part time; Rx = prescription.

* This requirement will be altered pending new rules in 2011.

** For controlled substance schedules II-III only.

SOURCE: NNCC, 2009. Reprinted with permission from Tine Hansen-Turton, NNCC. Copyright 2009 NNCC.

REFERENCE

NNCC. 2009. NNCC’s state-by-state guide to regulations regarding nurse practitioner and physician practice 2009. http://www.nncc.us/research/ContractingToolkit/contractingtoolkitgrid.pdf (accessed December 6, 2010).



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