State by State Requirements
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      3. State by State Requirements

      Collaborating in Arkansas

      Review the requirements for NPs and PAs to collaborate in the State of Arkansas.

      State Regulations for Nurse Practitioners


      General

      • In which category does Alabama fall: NP independent practice, transition to independence, or collaboration required?
        • Transition to independence

      Delegation Authority/Process

      • Is an agreement required?
        • Yes, if the APRN does not have full independence practice authority.
      • Form of agreement and its requirements:
        • According to the Board of Nursing website, the APRN must use the state collaborative practice agreement Found here. Quality assurance plan requirements can be found here.
      • Storage location of the agreement:
        • The state is silent as to where the agreement must be stored.
      • Does the agreement need to be filed with the state?
        • Yes, it must be submitted to the Board of Nursing. It must be approved by the Board of Nursing prior to beginning practice under the agreement.
      • Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
        • The APRN must notify the Board of Nursing in writing within seven (7) days after the CPA is terminated. If the Board of Nursing does not have a current CPA on file, the APRN’s Prescriptive Authority will be inactivated. When a new CPA has been approved by Board staff, Prescriptive Authority is reactivated.
      • Who must sign the agreement?
        • APRN and Collaborating Physician
      • How often must the agreement be reviewed/reauthorized?
        • No requirement. The prescribing protocol must be reviewed/updated at least annually.

      Qualifications

      • What are the qualifications for the collaborating provider?
        • The collaborating physician must have training within the scope, specialty, or expertise of the APRN’s practice/specialty.
        • The collaborating physician must have a current AR license to practice under the Medical Practice Act, § 17-95-201.
        • The collaborating physician must also have an unrestricted DEA registration number for APRNs who prescribe controlled substances.
      • What are the qualifications for the NP?

      Collaboration Requirements

      • Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
        • No restriction.
      • Is there an express requirement to review a certain number/percentage of charts?
        • No restriction.
      • Are there proximity requirements? (e.g., between the NP/collaborator or practice site)
        • No restriction.
      • Are there location-specific requirements? (e.g., that collaborator must go to practice site at some frequency)
        • No restriction.
      • Is remote supervision allowed/are there limitations on remote supervision?
        • No restriction.
      • Physician and NP filing requirements – outside of filing the collab agreement, must the physician and/or NP file any separate forms? (e.g., notice of delegation of prescriptive authority, notice of collaboration, notice to PDMP, etc.) NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc.
        • There are attachment requirements to the collaboration agreement, including the quality assurance plan and prescriptive protocol. Prescribing protocols must be updated at least annually, but do not need to be submitted to the Board, unless requested.
      • What are the prescription requirements?
        • Prescriptive authority is not automatically issued with an APRN license in Arkansas. You may apply online for Prescriptive Authority which includes a separate fee. You cannot submit the application prior to the issuance of an Arkansas APRN license.
      • What are the requirements for controlled substance prescribing?
        • Any categories of controlled substances an APRN can prescribe must be identified and agreed to in the collaborative agreement. The Board of Nursing must approve the collaboration agreement.
        • For more details, refer to AR ST § 17–87–314 and AR ST § 17–87–310.

      Sources for Reference


      State Regulations for Physician Assistants


      General

      • Is the supervising physician responsible for PA’s patients?
      • Yes. PAs shall be considered the agents of their supervising physicians in the performance of all practice-related activities, including, but not limited to, the ordering of diagnostic, therapeutic, and other medical services. The supervising physician is liable for the acts of a PA whom he or she is supervising if said acts of the PA arise out of the powers granted the PA by the supervising physician.
      • A supervising physician will notify the Arkansas State Medical Board within 10 days after notification of a claim or filing of a lawsuit for medical malpractice against a PA whom he supervises.

      Delegation Authority/Process

      • Is an agreement required?
        • Yes.
      • What form of agreement is required and what are the requirements for the substance of the agreement (is use of state template required?)
        • The state approved form can be found here is strongly recommended.
        • The delegation agreement as completed by the PA and the supervising physician will include the following:
          • (1) area or type of practice;
          • (2) location of practice;
          • (3) geographic range of supervising physician;
          • (4) the type and frequency of supervision by the supervising physician;
          • (5) the process of evaluation by the supervising physician;
          • (6) the name of the supervising physician;
          • (7) the qualifications of the supervising physician in the area or type of practice that the physician assistant will be functioning in;
          • (8) the type of drug prescribing authorization delegated to the physician assistant by the supervising physician;
          • (9) the name of the back-up supervising physician(s) and a description of when the back-up supervising physician(s) will be utilized.
      • Where must the agreement be stored?
        • A copy of the approved delegation agreement must be kept at the practice location of the PA.
      • Does the agreement need to be filed with the state?
        • Yes, must be submitted to the Board of Medicine and approved prior to beginning services.
        •  The supervising physician for a PA must fill out a form provided by the Board prior to him becoming a supervising physician. Said supervising physician must provide to the Board his name, business address, licensure, his qualifications in the field of practice in which the physician assistant will be practicing and the name(s) of the PA(s) he intends to supervise.
      • Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
        • A supervising physician will notify the Arkansas State Medical Board within 10 days after notification of a claim or filing of a lawsuit for medical malpractice against a PA, whom he supervises.
      • Who must sign the agreement?
        • The supervising physician and PA.
      • How often must the agreement be reviewed/reauthorized?
        • Annually.

      Qualifications

      • What are the qualifications for the supervising physician?
        • The supervising physician must be licensed in Arkansas.
        • The supervising physician must be skilled and trained in a similar scope of practice as the tasks that have been assigned to and will be performed by the PA that they will supervise.
      • Is an alternate supervising physician required?
        • The law is not 100% clear as to whether a back-up physician is required or optional, but it appears that it is optional to designate a back-up supervising physician.

      Collaboration Requirements

      • Are there ratios/limits on the number of PAs that a supervising physician may supervise?
        • A supervising physician may have authority over multiple PAs but may only provide direct supervision for up to 3 PAs at one time.
      • Is there an express requirement to review a certain number/percentage of charts?
        • No requirement. However, the state delegation agreement says that 10% of charts per month shall be reviewed.
      • Is there a requirement to meet and, if so, how often and how?
        • No requirement. However, the state delegation agreement includes quarterly meetings with the PA.
      • Are there proximity requirements? (e.g., between the PA/physician or practice site)
        • No requirement. However, the delegation agreement requirements include setting forth the “geographic range of the supervising physician” without saying what that requires.
      • Is remote supervision allowed/are there limitations on remote supervision?
        • Remote supervision is permitted. The constant physical presence of the supervising physician is not required so long as the supervising physician and physician assistant are or can be easily in contact with one another by radio, telephone, electronic, or other telecommunication device.
      • Are there patient notice requirements?
        • PAs must hold themselves out as a PA to patients.
      • Physician and NP filing requirements – outside of filing the collab agreement, must the physician and/or NP file any separate forms? (e.g., notice of delegation of prescriptive authority, notice of collaboration, notice to PDMP, etc.) NOTE: timing/frequency should be noted because the state may have requirements for initial filing and/or filing for updates, terminations, etc.
        • A form must be submitted to request authority from the Board of Medicine for the PA to prescribe Schedule II or Biologics.
        • The supervising physician for a PA must fill out a form provided by the Board prior to him becoming a supervising physician. Said supervising physician must provide to the Board his name, business address, licensure, his qualifications in the field of practice in which the physician assistant will be practicing and the name(s) of the PA(s) he intends to supervise.
        • A PA shall notify the Arkansas State Medical Board of any changes or additions in supervising physicians within ten (10) calendar days.
      • What are the prescription requirements? (identifying physicians on rxs, restrictions on certain categories of drugs that may or may not be scheduled [one area of concern right now is abortion-inducing medications], etc.)
        • A PA must be authorized by his supervising physician to prescribe legend drugs and scheduled medication for patients. Said authorization must be stated in the delegation agreement and the request approved by the Board.
        • Prescriptions/orders written by a PA must contain the name of the supervising physician on the prescription.
        • The PA will make an entry in the patient chart noting the name of the medication, the strength, the dosage, the quantity prescribed, the directions, the number of refills, together with the signature of the PA and the printed name of the supervising physician for every prescription written for a patient by the PA.
        • A supervising physician shall not delegate to a physician assistant the duty or responsibility to perform or induce an abortion.

      Sources for Reference:

      • 060 01 CARR 001, Rule No. 24
      • A.C.A. § 17-105-101
      • A.C.A. § 17-105-107
      • A.C.A. § 17-105-108
      • A.C.A. § 17-105-109
      • A.C.A. § 17-105-110
      • A.C.A. § 17-105-111
      • [1] A.C.A. § 17-105-108(a)-(b)
      • [2] 060 01 CARR 001, Rule No. 24
      • [3] We can contact the board anonymously to understand their interpretation if a PA would like to prescribe additional Schedule II controlled substances (which the law indicates is permitted). Pursuant to the rules of statutory construction, the more permissive statute should govern.