Massachusett NP Collaboration Requirements Summary

Massachusetts nurse practitioners must have a supervising physician to prescribe during their first two years, then may prescribe independently. Massachusetts requires written prescriptive practice guidelines (its collaborative agreement) with a supervising physician specifically for prescribing; non-prescribing practice does not require one. Physician involvement is moderate — ongoing review of the NP’s prescribing, a 96-hour review of the initial Schedule II prescription, and documented reviews — with no fixed meeting cadence or chart count.

Source: Mass. Gen. Laws ch. 112 § 80E

Type of Collaborative Relationship

Massachusetts NPs must have a supervising physician to prescribe during their first two years, then may prescribe independently. The supervision requirement applies to prescriptive practice only, not to non-prescribing practice, and runs through written prescriptive practice guidelines developed with a physician. Physician involvement is moderate — ongoing review and direction of the NP’s prescribing per the guidelines — with no ratio cap (though the physician must be able to adequately supervise), no meeting cadence, and no on-site rule.

Source: Mass. Gen. Laws ch. 112 § 80E(a)

What is an NP’s scope of practice in Massachusetts?

Massachusetts NPs (advanced practice registered nurses) practice within their role, with a supervising physician required specifically to prescribe. For the first two years after certification, prescribing happens under written guidelines with a physician; after that, the NP prescribes independently.

Do NPs need a collaborating physician in Massachusetts?

Yes, to prescribe, for the first two years. Massachusetts NPs must have a supervising physician and written prescriptive practice guidelines to prescribe; after two years of supervised practice, they gain independent prescriptive authority. Non-prescribing practice does not require a physician.

Can NPs practice independently in Massachusetts?

Yes, after two years. An NP who completes at least two years of supervised practice following certification gains independent authority to prescribe, order tests, and order therapeutics without supervision.

How many NPs can a physician supervise in Massachusetts?

No fixed limit. Massachusetts sets no ratio cap, but the supervising physician must be able to adequately supervise each NP, and the Board can disapprove guidelines if the physician cannot.

Who can be a collaborating physician in Massachusetts?

A physician holding an unrestricted full Massachusetts license, with training, board certification, or hospital admitting privileges in a specialty appropriately related to the NP’s area of practice. The physician must also hold a Massachusetts Controlled Substance Registration and a US DEA registration (and, for a psychiatric clinical nurse specialist, must be trained or board-certified in psychiatry).

Are there proximity or in-person requirements in Massachusetts?

No, Massachusetts sets no geographic or travel requirement, though the supervising physician’s proximity and availability are among the factors used to judge whether they can adequately supervise.

Collaboration Agreement Requirements

Massachusetts’s written agreement is called prescriptive practice guidelines, and while there is no state template, the Board provides a checklist. The guidelines must identify the supervising physician and NP, include a process for appointing a back-up supervising physician, describe when consultation or referral is required, describe the nature and scope of the NP’s prescribing (including medication types and limits), include emergency provisions and a mechanism to monitor prescribing, include protocols for IV therapies and Schedule II drugs, and require the initial Schedule II prescription to be reviewed within 96 hours. They must be signed by both clinicians, kept on file at the workplace, and reviewed and re-executed every two years.

Source: 243 CMR 2.10(5)(b)

What must be included in an NP collaborative agreement in Massachusetts?

The prescriptive practice guidelines must identify the supervising physician and NP, include a process for appointing a back-up supervising physician, describe when consultation or referral is required, and describe the nature, scope, and any limits of the NP’s prescribing. They must also cover established procedures for common conditions, emergency provisions, a mechanism to monitor prescribing, protocols for IV therapies and Schedule II drugs, and a 96-hour review of the initial Schedule II prescription.

What is the collaborative agreement called in Massachusetts?

It is called prescriptive practice guidelines. Massachusetts does not provide a template, but the Board of Nursing offers a checklist.

Who has to sign the collaborative agreement in Massachusetts?

Both the NP and the supervising physician must sign the prescriptive practice guidelines. (CRNA guidelines do not need to be signed; nurse practitioner and psychiatric clinical nurse specialist guidelines must be.)

How often must the agreement be reviewed or renewed in Massachusetts?

Every two years. The prescriptive practice guidelines must be reviewed and re-executed at least every two years.

Is a backup physician required in Massachusetts?

No named backup is required, but the guidelines must include a process for appointing a backup supervising physician.

Board Filing Requirements

Massachusetts does not require the prescriptive practice guidelines to be filed — they are kept at the workplace, not submitted — and there are no recurring filing requirements. The one filing obligation comes at the transition to independent prescribing: the NP submits an attestation to the Board that they have completed two years of supervised practice.

Source: 244 CMR 4.07(2)(a)

Do you have to file the collaborative agreement with the board in Massachusetts?

No. The prescriptive practice guidelines are kept on file at the workplace rather than filed with the Board.

Can an NP start practicing as soon as they file in Massachusetts?

There is no agreement to file to begin prescribing, so this does not apply in the usual sense. Prescribing begins under the guidelines and the NP’s controlled-substance registrations; moving to independent prescribing later requires submitting an attestation to the Board.

What are the termination and notice requirements in Massachusetts?

Massachusetts sets no termination-notice requirement for the guidelines. After completing two years of supervised (or independent) prescriptive practice, the NP may amend their Massachusetts Controlled Substance Registration to remove supervision by signing an attestation.

Collaboration Compliance

Massachusetts’s ongoing obligation is prescribing oversight, not fixed counts. The supervising physician must review and provide ongoing direction for the NP’s prescribing per the written guidelines, review the initial Schedule II prescription within 96 hours, and keep documentation of those reviews (which the Board can request at any time). There is no set meeting cadence, chart-review count, or chart co-signing.

Source: 243 CMR 2.10(4)(a)

How many charts must a collaborating physician review in Massachusetts?

There is no fixed number. Massachusetts sets no chart-review count and does not require chart co-signing. The physician must, however, review the NP’s prescribing practice as set out in the guidelines and review the initial Schedule II prescription within 96 hours.

How often must an NP and collaborating physician meet in Massachusetts?

There is no set cadence. Massachusetts does not require scheduled meetings. The physician provides ongoing review and direction of the NP’s prescribing as necessary under the guidelines.

How long must collaboration records be kept in Massachusetts?

Massachusetts does not set a fixed retention period, but the guidelines must be kept on file at the workplace, and documentation of the physician’s review of the NP’s prescribing must be available for the Board on request.

Prescribing Rules

Massachusetts NPs may prescribe, including controlled substances such as Schedule II, and must hold both a Massachusetts Controlled Substance Registration (MCSR) and a US DEA registration. During the first two years, prescribing follows the written guidelines, which govern Schedule II protocols and require the initial Schedule II prescription to be reviewed within 96 hours; a specific procedure also applies to prescribing non-abuse-deterrent extended-release hydrocodone.

Source: 243 CMR 2.10(3)

Can an NP prescribe controlled substances in Massachusetts?

Yes. Massachusetts NPs may prescribe controlled substances once they hold a Massachusetts Controlled Substance Registration (MCSR) and a US DEA registration; during supervised practice, the written guidelines govern controlled-substance prescribing.

Can an NP prescribe Schedule II drugs in Massachusetts?

Yes. Massachusetts NPs may prescribe Schedule II drugs; during the supervised period, the guidelines must include Schedule II protocols and the initial Schedule II prescription must be reviewed by the supervising physician within 96 hours.

What schedule drugs can an NP prescribe in Massachusetts?

Massachusetts NPs may prescribe controlled substances, including Schedule II, plus non-controlled prescription drugs, under their Massachusetts Controlled Substance Registration and US DEA registration. A specific procedure applies before prescribing non-abuse-deterrent extended-release hydrocodone.

Does an NP need a DEA license in Massachusetts?

Yes, plus a state registration. Massachusetts explicitly requires a US DEA registration to prescribe controlled substances, together with a Massachusetts Controlled Substance Registration (MCSR) from the Department of Public Health.

Can an NP prescribe independently in Massachusetts?

Yes, after two years. Once an NP completes two years of supervised practice and attests to it, they prescribe independently; Massachusetts does not require a physician to co-sign individual prescriptions at any point, though initial Schedule II prescriptions require a 96-hour review during supervision.

Specialty & Telehealth Requirements

Massachusetts sets no telehealth-specific or general specialty-specific collaboration requirements. The one specialty-related rule is that a physician supervising a psychiatric clinical nurse specialist must be trained or board-certified in psychiatry.

Source: 243 CMR 2.10(3)

Are there telehealth or telemedicine requirements for NPs in Massachusetts?

No, Massachusetts sets no telehealth-specific collaboration requirements.

Are there specialty-specific requirements for NPs in Massachusetts?

No general specialty-specific requirement applies, though a physician supervising a psychiatric clinical nurse specialist must be trained or board-certified in psychiatry, and every supervising physician’s specialty must be appropriately related to the NP’s area of practice.