A summary of Texas’s collaboration, agreement, filing, supervision, prescribing, and specialty rules for PAs and the physicians who collaborate with them.
Collaborating Physician Required? Yes
Physician Involvement: High
Agreement Name: Prescriptive authority agreement
On-Site Requirements: None
Chart Review: No fixed count
Controlled Substances: Allowed, Schedules III–V only (maximum 90-day supply including refills; refills after consulting the physician). Schedule II only in limited hospital and hospice settings. No separate state controlled-substance registration beyond the federal DEA.
Reduced Supervision / Transition Requirements: None
Texas PA Collaboration Requirements Summary
Texas requires every PA to work under a supervising (collaborating) physician, and there is no independent PA practice. Physician involvement is high, but the physician does not have to be on-site; when the physician is not present, the physician and PA must be able to reach each other easily by phone or another telecommunication device. A PA must send the board a notice of intent to practice before beginning, and the physician who delegates prescribing must register the PA with the board — but the PA may begin once that notice is on file. The written agreement that governs prescribing is called a prescriptive authority agreement, and it must be reviewed, dated, and signed at least once a year. This page covers Texas’s rules on supervision, the collaborative agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.
Source: Tex. Occ. Code § 204.204
Type of Collaborative Relationship
Texas requires PAs to practice under a supervising physician who delegates their medical duties, and physician involvement is high. There is no route to fully independent practice, and no hours- or years-based path to reduced supervision. A PA’s authority comes from what the physician delegates and from the terms of the prescriptive authority agreement.
Source: Tex. Occ. Code § 204.204
What is a PA’s scope of practice in Texas?
A PA’s scope of practice is set by what the supervising physician delegates. The physician and PA must ensure the PA’s scope of function is identified and that delegated tasks match the PA’s level of competence.
Do PAs need a collaborating physician in Texas?
Yes. Every PA in Texas must practice under a supervising physician who delegates their medical duties; there is no independent practice.
Can PAs practice independently in Texas?
No. Texas requires physician supervision at all times, and there is no autonomous or independent practice option for PAs.
How many PAs can a physician collaborate with in Texas?
A physician may enter into a prescriptive authority agreement with up to seven advanced practice providers — nurse practitioners and PAs combined — measured as full-time equivalents (FTEs). This cap does not apply in a practice serving a medically underserved population or in a hospital facility-based practice.
Who can be a collaborating physician in Texas?
Texas sets no specific eligibility requirements for a supervising physician beyond being a licensed physician who delegates to the PA.
Are there proximity or in-person requirements in Texas?
No. Texas does not require the physician to be on-site; when the physician is not present, the physician and PA must be able to easily reach one another by phone or another telecommunication device. Texas sets no geographic or travel requirement.
Collaboration Agreement Requirements
Texas’s written agreement is a prescriptive authority agreement, and the state does not provide a fixed template. Both the PA and the supervising physician sign it, and it must be reviewed, dated, and signed at least once a year. Texas does not require the agreement to be stored on-site.
Source: Tex. Occ. Code § 157.0512
What must be included in a PA collaborative agreement in Texas?
At a minimum, the prescriptive authority agreement must list the parties’ names, addresses, and license numbers; describe the nature of the practice and its locations; and identify the categories of drugs or devices that may or may not be prescribed. It must also include plans for consultation and referral, patient emergencies, and communication between the physician and PA, plus a quality-assurance plan with chart review and monthly meetings.
What is the collaborative agreement called in Texas?
It is called a prescriptive authority agreement.
Who has to sign the collaborative agreement in Texas?
Both the PA and the supervising physician must sign and date it.
How often must the agreement be reviewed or renewed in Texas?
At least once a year. The prescriptive authority agreement and any amendments must be reviewed, dated, and signed annually by the parties.
Is a backup physician required in Texas?
No, naming a backup physician is optional. If used, the agreement may designate one or more alternate physicians who can supervise on a temporary basis and take part in the required quality-assurance meetings.
Board Filing Requirements
Texas does not require the agreement itself to be filed, but a PA must send the board a notice of intent to practice before beginning, and the delegating physician must register the PA with the board. The PA may begin practicing once the required notice is on file — no separate board approval is needed. When a supervising physician changes or the delegation ends, the board must be notified within 30 days.
Source: Tex. Occ. Code § 204.201
Do you have to file the collaborative agreement with the board in Texas?
No, the agreement itself does not have to be filed. Before beginning practice, though, a PA must submit a notice of intent to practice that names the supervising physician, and a physician who delegates prescribing must register the PA’s name and license number with the board within 30 days of the delegation.
Can a PA start practicing as soon as they file in Texas?
Yes. The physician’s delegation notification is valid upon filing, so a PA may begin practicing once the required notice is on file. Texas does not require separate board pre-approval.
What are the termination and notice requirements in Texas?
The PA must notify the board of any change in, or addition to, a supervising physician within 30 days, and the delegating physician (or the PA on the physician’s behalf) must notify the board in writing of a termination within 30 days.
Collaboration Compliance
Once the collaboration is active, the physician and PA must hold documented monthly meetings, carry out chart review under a quality-assurance plan, and keep the required records. The physician does not have to be on-site, but the physician and PA must stay easily reachable to one another.
Source: Tex. Occ. Code § 157.0512(f)
How many charts must a collaborating physician review in Texas?
There is no fixed chart count. The prescriptive authority agreement’s quality-assurance plan must include chart review, but the number of charts is set by the physician and the PA together.
How often must a PA and collaborating physician meet in Texas?
At least once a month. The physician and PA must hold monthly meetings, and those meetings must be documented.
How long must collaboration records be kept in Texas?
The prescriptive authority agreement must be kept for two years after it is terminated. The monthly meetings must also be documented.
Prescribing Rules
PAs in Texas may prescribe drugs and devices delegated by the supervising physician, including controlled substances in Schedules III through V. Schedule II is off-limits except in narrow hospital and hospice situations, and controlled-substance prescribing is not independent of the physician.
Source: Tex. Occ. Code § 157.0511
Can a PA prescribe controlled substances in Texas?
Yes, but generally only Schedules III through V. These prescriptions are limited to a maximum 90-day supply including refills, and any refill must be authorized after consulting the physician.
Can a PA prescribe Schedule II drugs in Texas?
Generally no. Schedule II prescribing is allowed only in narrow situations — a hospital facility-based practice for certain admitted or emergency-department patients, or as part of hospice care for a patient who has certified a terminal illness.
What schedule drugs can a PA prescribe in Texas?
PAs may prescribe drugs in Schedules III, IV, and V, along with non-controlled medications. Schedule II is limited to the narrow hospital and hospice situations described above.
Does a PA need a DEA license in Texas?
Texas does not require a separate state-level controlled-substance registration for PAs. A PA still needs a federal DEA registration to prescribe controlled substances, but Texas does not add its own state DEA or controlled-substance registration on top of it.
Can a PA prescribe independently (without physician sign-off) in Texas?
No. Prescribing flows from the physician’s delegation through the prescriptive authority agreement, and refills of controlled substances require consultation with the physician, so it is not independent.
Specialty & Telehealth Requirements
Texas sets no specific telehealth or telemedicine requirement for PAs in its master rules. It does have a separate set of board rules that govern a physician’s delegation to providers who are not advanced practice providers.
Source: 22 Tex. Admin. Code ch. 169, subch. E
Are there telehealth or telemedicine requirements for PAs in Texas?
No, Texas sets no specific telehealth or telemedicine requirement for PAs.
Are there specialty-specific requirements for PAs in Texas?
Yes. A physician’s delegation to providers who are not advanced practice providers is governed by a separate set of board rules; standard PA supervision, agreement, and prescribing rules apply otherwise.
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