Finding a Collaborating Physician in Kentucky
For nurse practitioners (NPs) aspiring to establish their practice in Kentucky, finding the right collaborating physician is a pivotal step towards professional growth and success.
In Kentucky, a nurse practitioner is required to have a collaborating physician. Kentucky is classified as a Reduced Practice Authority state.
Navigating the process of identifying a suitable collaborating physician can be both challenging and rewarding. We’ve created a guide for identifying and establishing a compliant collaboration with a physician in the Bluegrass State.
Read on to learn more!
What Is the Practice Environment for NPs in Kentucky?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
If an APRN is not prescribing medication, no collaboration is required. Once the APRN has completed 4 years of prescribing practice as an APRN in their population focus, the APRN may discontinue or be exempt from a Collaborative Agreement for the Advanced Practice Registered Nurse Prescriptive Authority for Nonscheduled Legend Drugs (CAPA-NS).
An APRN whose license is in good standing at that time with the Kentucky Board of Nursing and who will be prescribing nonscheduled legend drugs without a CAPA-NS shall notify that board that the four (4) year requirement has been met and that he or she will be prescribing nonscheduled legend drugs without a CAPA-NS;
The APRN will no longer be required to maintain a CAPA-NS and shall not be compelled to maintain a CAPA- NS as a condition to prescribe after the four (4) years have expired, but an APRN may choose to maintain a CAPA- NS indefinitely after the four (4) years have expired; and
If the APRN 's license is not in good standing, the CAPA-NS requirement shall not be removed until the license is restored to good standing.
An APRN wishing to practice in Kentucky through licensure by endorsement is exempt from the CAPA-NS requirement if the APRN:
Has met the prescribing requirements in a state that grants independent prescribing to APRNs; and
Has been prescribing for at least four (4) years.
An APRN wishing to practice in Kentucky through licensure by endorsement who had a collaborative prescribing agreement with a physician in another state for at least four (4) years is exempt from the CAPA-NS requirement.
Delegation Authority and Process
Is an agreement required?
Yes, a collaboration is required for prescribing.
What form of agreement is required and what are the requirements for the substance of the agreement?
To learn more about the required components of a Kentucky collaboration agreement, contact us!
Where must the agreement be stored?
A copy of the completed collaborative agreement shall be available at each site where the APRN is providing patient care.
Does the agreement need to be filed with the state?
No, but notification needs to be made to the state.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)?
No restriction.
Who must sign the agreement?
The APRN and collaborating physician.
How often must the agreement be reviewed / reauthorized?
No restriction.
What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
The board shall consider the facts of each particular situation and the scope of the APRN's and the physician's actual practice.
What are the qualifications for the NP?
“Advanced practice registered nursing” means the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program that prepares the registered nurse for one (1) of the four (4) APRN roles; who are certified by the American Nurses’ Association or other nationally established organizations or agencies recognized by the board to certify registered nurses for advanced practice registered nursing as a certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, or clinical nurse specialist; and who certified in at least one (1) population focus.
Is an alternate collaborating physician required?
No restriction.
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.
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?
CAPA-NS notification for non-scheduled prescribing: available here.
CAPA-CS notification for scheduled prescribing: available here.
Rescission Forms must be provided to the KBN, if an APRN is discontinuing a CAPA-NS or CAPA-CS.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
No additional requirements for NPs.
What are the requirements for controlled substance prescribing?
See the CAPA-CS requirements above. Within thirty (30) days of obtaining a Controlled Substance Registration Certificate from the United States Drug Enforcement Administration, and prior to prescribing controlled substances, the advanced practice registered nurse shall register with the electronic system for monitoring controlled substances established by KRS 218A.202 and shall provide a copy of the registration certificate to the board.
Before engaging in the prescribing of controlled substances, the APRN shall:
Have been licensed to practice as an APRN for one (1) year with the Kentucky Board of Nursing; or
Be nationally certified as an APRN and be registered, certified, or licensed in good standing as an advanced practice registered nurse in another state for one (1) year prior to applying for licensure by endorsement in Kentucky.
APRNs may issue prescriptions for but not to dispense Schedules II through V controlled substances, subject to the requirements below:
Prescriptions issued by APRNs for Schedule II controlled substances classified under KRS 218A.060, except hydrocodone combination products as defined in KRS 218A.010, shall be limited to a seventy-two (72) hour supply without any refill.
Prescriptions issued by APRNs for hydrocodone combination products as defined in KRS 218A.010 shall be limited to a thirty (30) day supply without any refill.
Prescriptions issued under this subsection for psychostimulants may be written for a thirty (30) day supply only by an APRN certified in psychiatric-mental health nursing who is providing services in a health facility as defined in KRS Chapter 216B or in a regional services program for mental health or individuals with an intellectual disability as defined in KRS Chapter 210.
Prescriptions issued by APRNs for Schedule III controlled substances classified under KRS 218A.080 shall be limited to a thirty (30) day supply without any refill. Prescriptions issued by APRNs for Schedules IV and V controlled substances classified under KRS 218A.100 and 218A.120 shall be limited to the original prescription and refills not to exceed a six (6) month supply.
Sources
APRN Collaborative Agreement Prescriptive Authority
KRS 314.011.
KRS 314.042.
201 KAR 20:057.
