Across healthcare, organizations are scaling NP- and PA-integrated care models to deliver high-quality care to more patients, in more markets, more efficiently. At the same time, they’re encountering a compliance environment that few organizations are fully prepared to manage.

Organizations must file, renew, and actively maintain collaboration agreements across dozens of states. They must track ongoing collaboration compliance—like chart review, meetings, and quality oversight activities—across distributed teams that often lack centralized visibility. When a collaborating physician changes, organizations must rebuild those relationships from the ground up. The NP and PA regulatory landscape has become one of the most operationally demanding—and most underestimated—constraints on growth.

This report provides a comprehensive reference to NP and PA collaboration laws and practice authority frameworks across all 50 states. It explains how physician and NP/PA relationships are structured, what ongoing requirements they create, how they impact healthcare operations, and how the regulatory landscape continues to evolve.

What This Report Covers

This report is written for the senior operators inside healthcare enterprises who manage NP and PA care teams day to day: Chief Medical Officers, VP and Director-level clinical operators and workforce leaders, compliance officers, General Counsel, and credentialing teams. It is particularly relevant for organizations operating across multiple states, scaling NP and PA-integrated care models, or entering new markets where collaboration requirements are unfamiliar.

This report covers:

• Collaboration agreement components: the core elements required in NP and PA collaboration agreements across the US, including scope of practice, prescriptive authority, physician availability, chart review requirements, and board filing obligations
• Ongoing compliance obligations: the recurring oversight activities that follow a collaboration agreement, including chart reviews, meeting requirements, attestations, and agreement renewals
• Zivian’s Regulatory Spectrum: a proprietary framework that evaluates physician and NP/PA relationships across three dimensions: Collaboration Type, Physician Involvement, and Vicarious Liability, offering a more operationally useful view of state-level differences than traditional practice authority categories alone
• 50-state reference tables: a state-by-state breakdown of NP and PA collaboration compliance requirements, organized using the Regulatory Spectrum framework
• Regulatory watch: recent and upcoming legislative and regulatory changes that materially affect how organizations structure and deploy NP- and PA-integrated care models today, including states expanding independent practice authority and states tightening collaboration requirements

After reading this report, you will be able to evaluate your state-level collaboration obligations with greater clarity, identify where your existing agreements may need to be updated, understand how the Regulatory Spectrum applies to your specific geographic footprint, and anticipate regulatory changes that could affect how you structure NP and PA collaborations going forward.

About Zivian Health

Zivian is the operating system for a compliant, connected, and high-performing healthcare workforce. Zivian helps healthcare enterprises navigate the operational complexity of NP and PA collaboration laws across the United States — including agreement execution, physician matching, ongoing compliance tracking, and regulatory monitoring.

By transforming fragmented regulatory requirements into structured workflows and real-time oversight, Zivian enables organizations to scale clinical teams, maintain audit-ready documentation, and deploy advanced practice providers with confidence across states.

This report reflects the regulatory intelligence that powers our solutions and our ongoing research into the laws that shape how modern care teams operate.