State by State Requirements
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      3. State by State Requirements

      Collaborating in New York

      Review the requirements for collaborating in New York.

      State Regulations for Nurse Practitioners 


      General 

      • In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
        • Transition to independence/collaboration required. A nurse practitioner who has 3,600 or fewer hours of experience practicing as a licensed or certified nurse practitioner pursuant to the laws of New York or any other state or as a nurse practitioner while employed by the United States Veterans Administration, the United States Armed Forces or the United States Public Health Service shall practice in collaboration with a physician qualified in the specialty involved and in accordance with a written practice agreement and written practice protocols.
        • NPs with the 3,600 hours experience still need “collaborative relationships” evidenced by a form to be provided by the state

      Delegation authority/process:

      • Is an agreement required?
        • Yes, protocols and practice agreements are required.
      • What form of agreement is required and what are the requirements for the substance of the agreement (is use of state template required?)
        • Practice agreements shall include provisions for referral and consultation, coverage for emergency absences of either the nurse practitioner or collaborating physician, resolution of disagreements between the nurse practitioner and collaborating physician regarding matters of diagnosis and treatment, and the review of patient records at least every three months by the collaborating physician; and may include such other provisions as determined by the nurse practitioner and collaborating physician to be appropriate
      • Where must the agreement be stored?
        • Practice agreements and practice protocols shall be maintained in the practice setting of the nurse practitioner and collaborating physician. The Zivian platform will serve as meeting this requirement. 
      • Does the agreement need to be filed with the state?
        • Agreement itself does not need to be filed, but there is a document “Form 4NP” that needs to be filed with the state within 90 days after beginning professional practice.
        • The department in its discretion or upon request of an NP or collaborating physician may review practice protocols for the purpose of insuring that they are in conformance with accepted medical and nursing practice and with the statutes and regulations governing the practice of medicine, nursing, and the prescribing of drugs, and may render an opinion which shall be binding upon the parties to the protocol.
      • Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
        • No requirement.          
      • Who must sign the agreement?
        • No requirement, but sample has both NP and collaborating physician.
      • How often must the agreement be reviewed/reauthorized?
        • Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months.
      • What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
        • The NP must collaborate with a physician who is qualified to collaborate in the NP’s specialty area of practice.
      • What are the qualifications for the NP?
        • See qualifications here
      • Is an alternate collaborating physician required?
        • No requirement.

      Collaboration requirements

      • Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
        • No physician shall enter into practice agreements with more than four nurse practitioners who are not located on the same physical premises as the collaborating physician.
      • Is there an express requirement to review a certain number/percentage of charts?
        • Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months.
      • Is there a requirement to meet and, if so, how often and how?
        • 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.
        • See here. Needs to be filed by NPs with more than 3600 hours of qualifying NP experience who choose to practice and have collaborative relationships, instead of practicing in accordance with a written practice agreement.
      • What are the prescription requirements? (identifying collaborators 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.)
        • See here
        • For NPs practicing under practice agreement, in addition to the requirements of section 6810 of the Education Law, prescription forms used by nurse practitioners shall be printed with the name, nurse practitioner certificate number, office address, and office telephone number of the nurse practitioner.
        • There are specific requirements for orders to dispense HIV prevention drugs. A certified NP may issue a written patient specific order or prescription to a licensed pharmacist to dispense HIV post-exposure prophylaxis drugs pursuant to applicable law. A certified NP may issue a written non-patient specific order and protocol for a licensed pharmacist to dispense up to a seven day supply of HIV post-exposure prophylaxis drugs to prevent HIV infection in persons who have potentially been exposed to HIV, provided:
      • Order and protocol.
        • (i) The non-patient specific order shall include, at a minimum, the following:
          • (a) the name, license number and signature of the certified nurse practitioner who issues the non-patient specific order and protocol;
            • (b) the name and dose of the specific drug(s) to be dispensed;
            • (c) a protocol for dispensing the drug(s) or a specific reference to a separate written protocol for dispensing the drug(s), which shall meet the requirements of subparagraph (ii) of this paragraph;
            • (d) the period of time that the order is effective, including the beginning and ending dates;
            • (e) a description of the group(s) of persons who may receive the dispensed drugs, provided that the group(s) of persons are located in New York State; and
            • (f) the name and license number of each licensed pharmacist authorized to execute the non-patient specific order and protocol or the name and address of the New York State licensed pharmacy that employs or contracts with the licensed pharmacist(s) to execute the non-patient specific order and protocol.
            • (ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the licensed pharmacist to:
              • (a) screen each potential recipient, pursuant to criteria in the protocol, for conditions that would qualify or preclude the potential recipient from receiving the dispensed drugs;
              • (b) offer counseling regarding the need for follow-up care pursuant to criteria in the protocol and provide the counseling if the recipient consents;
              • (c) offer or provide in writing, the names and addresses of hospitals or other health providers that offer follow-up care, which shall be identified in the protocol; and
              • (d) document the pharmacy services provided, including the offer or provision of counseling and referral information described in this subparagraph, and maintain the documentation in accordance with section 29.2(a)(3), section 63.6(b)(7) and section 63.6(b)(8) of Title 8 NYCRR.
      • What are the requirements for controlled substance prescribing?
        • No restrictions other than compliance with general prescribing requirements.  See here

      Sources for Reference