skip header and navigation
HHS Home Bureau of Health Professions Questions? Search
HRSA Home
Photos of Health Professions
HRSA Home
Grants
Student Assistance
National Health Service Corps
National Center for Health Workforce Analysis
Health Professional Shortage Areas
Medicine & Dentistry - Medicine & Dentistry
Medicine & Dentistry
Nursing
Diversity
Area Health Education Center
Public Health
Other Disciplines
Children Hospitals GME
Practioner Data Banks
Practioner Data Banks

 

Comparison of Changes in the Professional Practice of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives:  1992 and 2000

This page: Appendix E. Professional Practice Index Calculations for NPs

Appendix E.  Professional Practice Index Calculations for NPs

This appendix contains a table that documents the detailed calculations used to compute the new professional practice index for NPs for each of the 50 States plus the District of Columbia. The criteria used in the new index include:

Legal Status (Maximum = 35)

Title Protection suggests acceptance and acknowledgement of the skills required to practice as a professional. Legal protection provides a safeguard for both the public and the professional.]

Licensure as NP indicates full recognition as a professional. Licensure as an RN and certification or registration as NP is the second best situation. RN license only is the minimum. Requirements for recognition to practice in an advanced nursing role vary by State and may include the passing of a national certification examination, the obtaining of an advanced degree (at the master or doctoral level), as well as various levels of pharmacology education for prescriptive authority. Licensure to practice may occur independently of certification to prescribe. In some States, the renewals of licensure and prescriptive authority occur in tandem. In others, licensure and prescriptive authority require separate applications and separate criteria.

Autonomous practice possible provides the most expansive practice options.

Legal relationship with physicians indicates the degree of autonomy in practice for the advanced practice nurse. Statutes vary considerably in their requirements for physician involvement in NP practice. In some laws, physician relationship is not mentioned; in some, collaboration with other health professionals is a requirement; in others, laws demand supervision by a physician for the NP. More independent environments are considered the ideal practice situation for NPs to exercise their professional practice. However, NPs function well in all of these configurations.

Regulation by the State Board of Nursing is the most appropriate design for NP management. Control of various aspects of practice by Boards of Medicine, Boards of Pharmacy, Boards of Consumer Affairs, etc. occurs across the States with regularity, but these insert the interests of other professions into the practice arena. Self-regulation is the goal of most professions.

The requirement to have practice agreements approved or legislated review of records at particular intervals removes the autonomy of the nurse and/or physician with whom s/he practices to exercise discretion over practice conditions. Professionals recognize and seek appropriate safeguards to the suitable and safe delivery of care to patients. The ideal would be to have that standard determined on an individual basis by the nurse and collaborating health professional at the practice level.

Hospital privileges, referrals, and the ability to order testing suggest recognition of the skills of the NP. In order to practice as a true primary care provider, these things are necessary to care adequately for the patient.

Reimbursement (Maximum = 35)

In 1997, the Balanced Budget Act, expanded the locations at which Nurse Practitioners could be reimbursed for services. Since this represented a progression in reimbursement from 1992, a score was awarded to every State for direct Medicare payment.

State reimbursement policy for payment of services rendered to Medicaid-eligible patients varies considerably by State and by profession.

The legal right to be included on the provider panels of health maintenance organizations allows NPs to fully provide patient care within their professional practice. Since NPs are trained with a primary care orientation, this is a desirable privilege.

The legal right to be reimbursed for services provided is critical to the autonomy of the NP. Although services might potentially be provided totally by the NP, the inability to bill third parties for payment as an identified provider could preclude that from happening. This could be a barrier to the provision of care.

Prescriptive Authority (Maximum = 30)

When prescriptive authority is granted as part of the licensure process for advanced practice, it implies recognition of NP skill and education. Separate application suggests special requirements for the privilege that are not fundamental to the educational and clinical preparation of the NP.

Although DEA numbers are a requirement for prescribing controlled substances, a separate score was allotted to emphasize the importance of the privilege of prescribing scheduled drugs.

Definition of the prescriptive privilege in law rather than by individual physicians suggests full recognition of the abilities of the professional. Dependence on physician delegation for prescriptive authority limits the nurse practitioner and creates barriers to efficient practice. Review by another health professional of patient needs and the ordering of appropriate medications is certainly a necessary part of practice as a NP; however, the circumstances under which that consultation occurs may best be determined by the advanced practice professional and collaborator and need not be detailed in law.

The ability to receive and distribute sample medications, to independently sign a prescription and to prescribe medical devices indicate recognition of the competencies of NPs.

Continuing education requirements are important for maintaining the skills and updating the competencies of the NP.

The actual point allocations for NPs for the 50 States are presented below.

Table E-1 Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for AL, AK, AZ, AR, CA, and CO
Scoring Category
Points
Optimal Score
fn
State
AL
AK
AZ
AR
CA
CO
Legal Authority
Title protection
3
3
a
3
3
3
3
3
3
How Licensed
b

Lic as Nurse Practitioner
3
3
3

Lic as Nurse & Cert, Reg or Approved as NP
2
2
b
2
b
2
b
2
b
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
7
7
7
c
7
Relationship with Physicians:
d

No mention of physician in legislation
5
5
5

Collaborative language
4
4
4
4
d
4
d

Supervisory Language
2
2

Electronic communication permitted/Indirect sup.
1
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3
3
3
3

Regulation by State BON with another entity
2
2
e
2
e

Regulation by Board of Medicine or other
1
National certification required
1
1
f
1
1
1
1
1
Master's degree required for licensure
1
1
g
1
1
1
g
Practice Agreements:
h

No written practice agreement required
3
3
3
3
3
h

Written practice agreement avail on site

2
2
h

Written practice agreement filed with reg agency
1
1
1
Ratios > 2 in outpatient settings, or not legislated
1
1
I
1
1
1
I
1
I
1
Review of Records by Physician:
j

No legislated time requirement for review
3
3
3
j
3
3
j
3
j
3
j

Periodic/Regular Reviews
2
2

Strict/Daily
1
Hospital Privileges protected in legislation
1
1
k
1
Can refer directly for health/medical services
2
2
l
2
2
2
2
l
2
2
Can order or perform diagnostic or lab tests
2
2
m
2
2
2
2
Subtotals Legal
35
20
32
33
30
26
29
Reimbursement
Medicare
5
5
n
5
5
5
5
5
5
Legal right to be listed on panels as PCP
5
5
o
5
5
5
o
Medicaid % x 10
10
10
p
10
8
6
p
8
10
p
10
Language permits reimb by 3rd party or HMO
15
15
q
15
15
q
15
15
Subtotals Reimbursement 
35
20
28
31
13
35
30
Prescriptive Authority
How Received:

Automatic
4
4
r

Application or Approval Required
2
2
2
2
2
2
2
Uses Own DEA number
3
3
s
3
3
3
3
3
How defined
t

Defined by Legislation/Phys.agmt.doesn't determine
5
5
5
t
5
t
5
5

Collaborative agreement defines

4

Supervisory agreement defines
3
3

Defined Formulary (inclusive or exclusive)
1
1
Type of Authority
u

Full authority within Scope (II-V and Legend)
12
12
12
12
u
12

Extensive authority (III-V and Legend)
9
9
u
9
u

Limited authority (IV-V and Legend)
6

Restricted (V and Legend)
3

Legends only
1
1
u
Durable medical equipment
1
1
1
1
1
1
Sign for samples
1
1
w
1
1
1
1
1
Distribute samples
1
1
x
1
x
1
1
1
1
NP signs prescription
2
2
y
2
2
2
2
2
y
2
Continuing Ed requirements
1
1
z
1
1
1
1
1
1
Subtotals Prescriptive Authority
30
8
28
28
24
23
27
TOTAL 
100
48
88
92
67
84
86

FOOTNOTES

ALABAMA
b) Certificate of Qualification
e) BOM
x) NP allowed to provide(dispense) drugs within formulary
ALASKA
b) Authorized
j) Not required
t) No involvement
u) NPs can dispense drugs
ARIZONA
b) Certificate to practice
p) NPs may contract with Health Cost Containment System as PCPs
t) Not defined
u) NPs can dispense drugs
ARKANSAS
d) Collaborative agreement for prescriptive privilege
I) For prescriptive authority
j) Not defined
l) Determined by hospital
q) Any Willing Disallowed Provider Law disallowed 1997
u)1000, hours of practice as APN required, 300 hrs Preceptorship training for privilege
CALIFORNIA
b) Scope is RN scope
c) May not order drugs in solo practice
e) Board of Nursing is a part of State and Consumer Service Agency Standardized procedures developed with BOM
h) Standardized procedures guide practice
I) Four
j) Not defined
o) Medi-CAL-cal lists as PCPs
p) Medicaid reimbursement limited to FNP and PNP
u) Dispensing Authority
y) Drs name must appear on drug container label, Effective 2001, NP name as well
COLORADO
b) Registered
d) RN viewed as independent practitioner
g) Master's degree required for prescriptive authority and after 7/1/08, for everyone
h) Collaborative agreement for prescriptive authority must notify BON the name of physician
j) Not defined

REFERENCES
Main Resources

American College of Nurse Midwives, Nurse Midwifery Today, A Handbook of State Laws and Regulations 2000, Washington, DC, 2000.
Buppert C, Nurse Practitioner’s Business Practice & Legal Guide, Aspen Publications, Gaithersburg, Maryland, 1999.
Cooper RA, Multidisciplinary Healthcare Workforce Data Consortium, Meeting, April 2001, Washington, DC.
Henderson T, Chovan T , Removing Practice Barriers of NonPhysician Providers, Intergovernmental Health Policy Project, The George Washington University, February 1994.
Henderson T, Fox-Grage W, Lewis S, Scope of Practice & Reimbursement for Advanced Practice Registered Nurses, Primary Care Resource Center, Intergovernmental Health Policy Project, The George Washington University, December 1995.
Henderson T, Norris S, National Conference of State Legislators, Inc.
National Council of State Boards of Nursing, http://www.ncsbn.org.
National Council of State Boards of Nursing, The Regulation of Advanced Practice Registered Nurses 1997, Chicago, IL, 1998.
Pearson LJ. Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice, The Nurse Practitioner 26(1):7-57.
US Department of Justice, Drug Enforcement Administration, Diversion Control Program, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.
Washburn University School of Law, http://www.washlaw.edu
ALABAMA
Alabama Board of Nursing, http://www.abn.state.al.us
ALASKA
http://www.legis.state.ak.us
Alaska Division of Occupational Licensing: Board of Nursing, http://www.dced.state.ak.us/occ
ARIZONA
Arizona Health Care Cost Containment System, http://www.ahccs.state.az.us
Arizona State Board of Nursing, http://www.azboard of nursing.org
ARKANSAS
Arkansas State Board of Nursing, http://www.accessarkansas.org/nurse
CALIFORNIA
State of California-State and Consumer Services Agency, Board of Registered Nursing www.rn.ca.gov
National Council of State Boards of Nursing, http://www.ncsbn.org
American College of Nurse Midwives, http://www.acnm.org
COLORADO
Colorado Department of Regulatory Agencies, http://www.dora.state.co.us/Nursing

Table E-1, continued Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for CT, DE, DC, FL, GA, and HI
Scoring Category
Points
Optimal Score
fn
State
CT
DE
DC
FL
GA
HI
Legal Authority
Title protection
3
3
a
3
a
3
3
3
a
3
How Licensed
b

Lic as Nurse Practitioner
3
3
3

Lic as Nurse & Cert, Reg or Approved as NP
2
2
2
b
2
2
b
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
c
7
7
7
Relationship with Physicians:
d

No mention of physician in legislation
5
5

Collaborative language
4
4
4
4
4
d
4
d

Supervisory Language
2
2

Electronic communication permitted/Indirect sup.
1
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3

Regulation by State BON with another entity
2
2
e
2
e
2
e
2
e

Regulation by Board of Medicine or other
1
1
e
National certification required
1
1
f
1
1
f
1
1
f
1
1
Master's degree required for licensure
1
1
g
1
1
1
1
g
Practice Agreements:
h

No written practice agreement required
3
3
3
h

Written practice agreement avail on site

2
2
2

Written practice agreement filed with reg agency
1
1
h
1
h
1
h
Ratios > 2 in outpatient settings, or not legislated
1
1
I
1
1
1
1
1
1
Review of Records by Physician:
j

No legislated time requirement for review
3
3
3
j
3
j
3
3
j

Periodic/Regular Reviews
2
2
2
j

Strict/Daily
1
Hospital Privileges protected in legislation
1
1
k
1
1
1
Can refer directly for health/medical services
2
2
l
2
2
2
Can order or perform diagnostic or lab tests
2
2
m
2
2
2
2
2
 
Subtotals Legal
35
27
29
29
22
20
25
 
Reimbursement
Medicare
5
5
n
5
5
5
5
5
5
Legal right to be listed on panels as PCP
5
5
o
5
5
o
Medicaid % x 10
10
10
p
10
10
10
p
8
9
7.5
Language permits reimb by 3rd party or HMO
15
15
q
15
15
15
q
15
 
Subtotals Reimbursement
35
35
30
20
28
14
27.5
 
Prescriptive Authority
How Received:

Automatic
4
4
r
4
4
4
r

Application or Approval Required
2
2
2
2
Uses Own DEA number
3
3
s
3
3
3
How defined
t

Defined by Legislation/Phys.agmt.doesn't determine
5
5
5

Collaborative agreement defines

4
4
4

Supervisory agreement defines
3
3
3

Defined Formulary (inclusive or exclusive)
1
1
Type of Authority
u

Full authority within Scope (II-V and Legend)
12
12
12
12
12
u

Extensive authority (III-V and Legend)
9

Limited authority (IV-V and Legend)
6

Restricted (V and Legend)
3

Legends only
1
1
1
u
Durable medical equipment/devices
1
1
1
1
Sign for samples
1
1
w
1
Distribute samples
1
1
x
1
1
1
1
x
1
NP signs prescription
2
2
y
2
2
2
2
2
y
2
Continuing Ed requirements
1
1
z
1
1
1
1
 
Subtotals Prescriptive Authority
30
24
27
26
12
11
9
 
TOTAL
100
86
86
75
62
45
61.5

FOOTNOTES

CONNECTICUT
a) APRN for Prescriptive privilege only
c) Prescribe "under direction" of physician in statute
e) BON is located in the Department of Public Health
DELAWARE
e) If NP practices under guidelines or protocols governed by BON, if NP practices and prescribes independently governed by Joint Practice Committee (BON and BOM)
f) Master's required if no national certifying exam is available
h) Submit collaborative agreement for prescriptive authority
j) Not defined
DISTRICT OF COLUMBIA
b) Certificate to practice
e) BON and Department of Consumer and Regulatory Affairs
h) Not required
j) Not defined
o) Redesignated PCPs
p) Medicaid managed care, NPs excluded
u) Non refillable prescriptions for controlled substances
FLORIDA
e) BON and BOM joint committee approves protocols
f) National certification for initial certificate only
h) Filed for prescriptive privilege
q) Any Willing Provider Law
GEORGIA
a) RN only
b) Authorization to practice
d) Scope of practice is collaborative, prescriptive authority is supervisory and delegatory
j) Not defined
x,y) Written protocols define privilege on delegated medical authority of physician in restricted locations
r) May administer, order or dispense but may not prescribe
HAWAII
b) Recognition
d) For prescriptive authority
e) BON , BOME and Department of Commerce and Consumer Affairs define prescriptive authority
g) Master's required for prescriptive authority only
h) For prescriptive authority
j) Joint and periodic evaluation of services
u) APRNs can prescribe legend drugs independently and controlled substances under physician direction only

REFERENCES
Main Resources

American College of Nurse Midwives, Nurse Midwifery Today, A Handbook of State Laws and Regulations 2000, Washington, DC, 2000.
Buppert C, Nurse Practitioner’s Business Practice & Legal Guide, Aspen Publications, Gaithersburg, Maryland, 1999.
Cooper RA, Multidisciplinary Healthcare Workforce Data Consortium, Meeting, April 2001, Washington, DC.
Henderson T, Chovan T , Removing Practice Barriers of NonPhysician Providers, Intergovernmental Health Policy Project, The George Washington University, February 1994.
Henderson T, Fox-Grage W, Lewis S, Scope of Practice & Reimbursement for Advanced Practice Registered Nurses, Primary Care Resource Center, Intergovernmental Health Policy Project, The George Washington University, December 1995.
Henderson T, Norris S, National Conference of State Legislators, Inc.
National Council of State Boards of Nursing, http://www.ncsbn.org.
National Council of State Boards of Nursing, The Regulation of Advanced Practice Registered Nurses 1997, Chicago, IL, 1998.
Pearson LJ. Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice, The Nurse Practitioner 26(1):7-57.
US Department of Justice, Drug Enforcement Administration, Diversion Control Program, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.
Washburn University School of Law, http://www.washlaw.edu
CONNECTICUT
Connecticut Department of Public Health, http://www.state.ct.us/dph
DELAWARE
State of Delaware, Delaware Administrative Code, http://www.state.de.us
DISTRICT OF COLUMBIA
Lexis Nexis, 198.187.128.12/dc
FLORIDA
Online Sunshine, State of Florida, http://www.leg.state.fl.us
GEORGIA
State Government of Georgia, http://www.ganet.org
HAWAII
Hawaii State Legislature, http://www.capitol.hawaii.gov
Hawaii State Government, Department of Commerce and Consumer Affairs, http://www.state.hi.us

Table E-1, continued Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for ID, IL, IN, IA, KS, and KY
Scoring Category
Points
Optimal Score
fn
State
ID
IL
IN
IA
KS
KY
Legal Authority
                              
Title protection
3
3
a
3
3
3
3
3
3
How Licensed
b

Lic as Nurse Practitioner
3
3
3
b
3

Lic as Nurse & Cert, Reg or Approved as NP
2
2
b
2
b
2
b
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
c
7
c
c
7
7
7
Relationship with Physicians:
d

No mention of physician in legislation
5
5

Collaborative language
4
4
4
4
4
d
4

Supervisory Language
2
2
d

Electronic communication permitted/Indirect sup.
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3
3
e
3
3
3
3
e

Regulation by State BON with another entity
2

Regulation by Board of Medicine or other
1
National certification required
1
1
f
1
1
1
1
1
Master's degree required for licensure
1
1
g
1
g
g
g
1
g
Practice Agreements:
h

No written practice agreement required
3
3
3
2
3

Written practice agreement avail on site

2
2
h

Written practice agreement filed with reg agency
1
1
h
1
h
Ratios > 2 in outpatient settings, or not legislated
1
1
I
1
1
I
1
1
1
1
I
Review of Records by Physician:
j

No legislated time requirement for review
3
3
3
3
j

Periodic/Regular Reviews
2
2
j
2
j
2
j
2
j

Strict/Daily
1
Hospital Privileges protected in legislation
1
1
k
1
k
Can refer directly for health/medical services
2
2
l
2
2
2
2
2
2
Can order or perform diagnostic or lab tests
2
2
m
2
2
2
2
Subtotals Legal
35
29
31
19
30
29
29
Reimbursement
Medicare
5
5
n
5
5
5
5
5
5
Legal right to be listed on panels as PCP
5
5
o
5
o
5
5
Medicaid % x 10
10
10
p
8.5
7
8.5
8
8
7.5
Language permits reimb by 3rd party or HMO
15
15
q
15
q
15
q
15
15
15
q
Subtotals Reimbursement
35
33.5
12
28.5
33
28
32.5
Prescriptive Authority
How Received:

Automatic
4
4
r
4
4
4

Application or Approval Required
2
2
2
2
Uses Own DEA number
3
3
s
3
3
3
3
3
How defined
t

Defined by Legislation/Phys. agmt. doesn't determine
5
5
5
5

Collaborative agreement defines

4
4
4
4

Supervisory agreement defines
3
3
t

Defined Formulary (inclusive or exclusive)
1
Type of Authority
u

Full authority within Scope (II-V and Legend)
12
12
12
12
12
12

Extensive authority (III-V and Legend)
9

Limited authority (IV-V and Legend)
6

Restricted (V and Legend)
3
3
u

Legends only
1
1
Durable medical equipment/devices
1
1
1
1
1
Sign for samples
1
1
w
1
1
1
w
Distribute samples
1
1
x
1
1
1
1
1
x
NP signs prescription
2
2
y
2
2
2
2
2
2
Continuing Ed requirements
1
1
z
1
1
1
1
1
1
Subtotals Prescriptive Authority
30
27
17
24
29
27
15
TOTAL
100
89.5
60
71.5
92
84
76.5

FOOTNOTES

IDAHO
b) Licensed as an NP, authorized as an NP prescriber
c) "May perform …direct management of acute and chronic illness
d) Supervisory, collaborative and consultative language. Supervision "means designation of a course of action or provision of guidance"
j) BOM rules for physicians require periodic review of a sample of records
o) Blue Cross has NPs on preferred provider list
q) Any Willing Provider Law(CNM confirms)
ILLINOIS
c) Not practice without direction from physician but no employment relationship is required
e) Advanced Practice Nursing Board
g) Legislated in 1998, effective from 2001
I) No specific number but not "excessive" number
j) Periodic
u) Schedule lll-V but delegated authority only-- may prescribe, dispense and administer
INDIANA
b) APN recognition, only necessary for prescriptive authority(CNMs different)
c) Collaboration with licensed practioner required, other APNs do not qualify as collaborators
g) Complete a "graduate program or a certificate program"
h) Only if applying for prescriptive authority
j) Review of a sample of charts when prescriptions are written must occur within 7 days
q) Any Willing Provider Law
IOWA
b) Registration for prescriptive authority only
g) Masters not required, may be one of qualifications fulfilled
k) Hospital Fairness Act, 1999-2000
I) Not legislated
p) Amendment to medical program, telemedicine pilot project pays for ARNP services
KANSAS
b) Certificate of Qualification issued
d) Collegial
g) Law passed in 2000, effective from 2002
h) Written protocol defines prescriptive authority
j) Periodic
t) Written protocol between physicians and NP defines classes of drugs Dispensing, except for samples is prohibited
KENTUCKY
b) Registration and designation
e) Advanced Registered Nurse Practice Council and BON
h) Effective from 1997 for prescriptive authority
I) Not legislated
j) Not defined
q) Any Willing Provider Law
w,x) Non scheduled legend drugs

REFERENCES
Main Resources

American College of Nurse Midwives, Nurse Midwifery Today, A Handbook of State Laws and Regulations 2000, Washington, DC, 2000.
Buppert C, Nurse Practitioner’s Business Practice & Legal Guide, Aspen Publications, Gaithersburg, Maryland, 1999.
Cooper RA, Multidisciplinary Healthcare Workforce Data Consortium, Meeting, April 2001, Washington, DC.
Henderson T, Chovan T , Removing Practice Barriers of NonPhysician Providers, Intergovernmental Health Policy Project, The George Washington University, February 1994.
Henderson T, Fox-Grage W, Lewis S, Scope of Practice & Reimbursement for Advanced Practice Registered Nurses, Primary Care Resource Center, Intergovernmental Health Policy Project, The George Washington University, December 1995.
Henderson T, Norris S, National Conference of State Legislators, Inc.
National Council of State Boards of Nursing, http://www.ncsbn.org.
National Council of State Boards of Nursing, The Regulation of Advanced Practice Registered Nurses 1997, Chicago, IL, 1998.
Pearson LJ. Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice, The Nurse Practitioner 26(1):7-57.
US Department of Justice, Drug Enforcement Administration, Diversion Control Program, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.
Washburn University School of Law, http://www.washlaw.edu
IDAHO
Idaho State Board of Nursing, http://www2.state.id.us/adm
ILLINOIS
Illinois General Assembly, http://www.legis.state.il.us
Illinois Bar Journal, http://www.illinoisbar.org
National Council of State Boards of Nursing, http://www.ncsbn.or/files/npa/wholenpas/ilnpa.asp
INDIANA
Indiana Health Professions Bureau, http://www.IN.gov/hpb/boards
Indiana State Board of Nursing, http://www.state.in.us/hpb/boards
IOWA
Iowa Board of Nursing, http://www.state.ia.us/nursing
KANSAS
Kansas Legislative Services, http://www.accesskansas.org/legislative
KENTUCKY
Kentucky Legislature, http://www.lrc.state.ky.us/kar
Kentucky Board of Nursing, http://www.kbn.state.ky.us

Table E-1, continued Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for LA, ME, MD, MA, MI, and MN
Scoring Category
Points
Optimal Score
fn
State
LA
ME
MD
MA
MI
MN
Legal Authority
Title protection
3
3
a
3
a
3
3
3
3
3
How Licensed
b

Lic as Nurse Practitioner
3
3
3
b

Lic as Nurse & Cert, Reg or Approved as NP
2
2
b
2
b
2
b
2
b
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
c
7
7
Relationship with Physicians:
d

No mention of physician in legislation
5
5
5
4

Collaborative languageSupervisory Language
4
4
4
2
2
d
2
d

Electronic communication permitted/Indirect sup.
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3
e
3

Regulation by State BON with another entity
2
2
e
2
e
2
e
2
e

Regulation by Board of Medicine or other
1
National certification required
1
1
f
1
1
1
1
1
1
Master's degree required for licensure
1
1
g
1
1
g
Practice Agreements:
h

No written practice agreement required
3
3
3
h

Written practice agreement avail on site

2
2
2

Written practice agreement filed with reg agency
1
1
1
Ratios > 2 in outpatient settings, or not legislated
1
1
I
I
1
I
1
I
1
I
Review of Records by Physician:
j

No legislated time requirement for review
3
3
3
j
3
j
3
j

Periodic/Regular Reviews
2
2
j
2
2
j

Strict/Daily
1
Hospital Privileges protected in legislation
1
1
k
Can refer directly for health/medical services
2
2
l
2
2
2
l
2
2
Can order or perform diagnostic or lab tests
2
2
m
2
2
2
m
2
2
Subtotals Legal
35
21
28
20
18
25
30
Reimbursement
Medicare
5
5
n
5
5
5
5
5
5
Legal right to be listed on panels as PCP
5
5
o
5
5
5
o
Medicaid % x 10
10
10
p
8
10
10
10
10
9
Language permits reimb by 3rd party or HMO
15
15
q
15
15
q
15
15
15
q
15
Subtotals Reimbursement
35
28
35
35
35
30
29
Prescriptive Authority
How Received:

Automatic
4
4
r
4
4

Application or Approval Required
2
2
2
2
2
r
Uses Own DEA number
3
3
s
3
3
3
3
3
How defined
t

Defined by Legislation/Phys.agmt.doesn't determine
5
5
5
5

Collaborative agreement defines

4
4
4

Supervisory agreement defines
3
3

Defined Formulary (inclusive or exclusive)
1
1
Type of Authority
u

Full authority within Scope (II-V and Legend)
12
12
12
12
12
12

Extensive authority (III-V and Legend)
9

Limited authority (IV-V and Legend)
6

Restricted (V and Legend)
3
3
u

Legends only
1
1
Durable medical equipment/devices
1
1
1
1
1
Sign for samples
1
1
w
1
1
1
1
Distribute samples
1
1
x
1
1
1
1
1
NP signs prescription
2
2
y
2
2
2
2
2
2
Continuing Ed requirements
1
1
z
1
1
1
Subtotals Prescriptive Authority
30
13
28
23
24
17
27
TOTAL
100
62
91
78
77
72
86

FOOTNOTES

LOUISIANA
a) Under violations in law
b) Licensed as an Advanced Practice Registered Nurse
e) BON with BOME for prescriptive authority
I) No more than two
j) Frequency determined by APRN and collaborating physician
q) Any Willing Provider Law
MAINE
b) Licensed as RN, approved APRN
c) At initial certification must practice for 24 months under supervising physician then allowed independence and prescriptive authority
e) APRN Committee and BON
g) Passed in 2000, effective from 2006
j) Not defined
MARYLAND
b) Certified
e) Joint Committee appointed by BON and BOM
I) Not defined
l,m) Determined by collaborative agreement
MASSACHUSETTS
b) Licensed RN, Authorized in Expanded role
d) Direction, Supervision, Collaboration and Consultation
e) Prescriptive authority regulated by BON with Board of Regulations in Medicine and Board of Regulations in Pharmacy, also Advisory Committee of APNs
j) Every three months, if schedule ll drugs are prescribed, record must be reviewed in 96 hours
o) Mass. Medicaid PCP
MICHIGAN
b) Speciality certification
d) No requirement for physician supervision or collaboration but a physician may delegate at their discretion (Beauport)
e) Department of Commerce licenses
h) Not required
I) Not legislated
j) Not defined
q) Attorney General's opinion
u) Schedule lll-V and legend but "delegated medical task"
MINNESOTA
b) Certification
I) Not legislated
j) Not defined
r) 1999 law requires fee and proof that criteria for prescriptive authority are met

REFERENCES
Main Resources

American College of Nurse Midwives, Nurse Midwifery Today, A Handbook of State Laws and Regulations 2000, Washington, DC, 2000.
Buppert C, Nurse Practitioner’s Business Practice & Legal Guide, Aspen Publications, Gaithersburg, Maryland, 1999.
Cooper RA, Multidisciplinary Healthcare Workforce Data Consortium, Meeting, April 2001, Washington, DC.
Henderson T, Chovan T , Removing Practice Barriers of NonPhysician Providers, Intergovernmental Health Policy Project, The George Washington University, February 1994.
Henderson T, Fox-Grage W, Lewis S, Scope of Practice & Reimbursement for Advanced Practice Registered Nurses, Primary Care Resource Center, Intergovernmental Health Policy Project, The George Washington University, December 1995.
Henderson T, Norris S, National Conference of State Legislators, Inc.
National Council of State Boards of Nursing, http://www.ncsbn.org.
National Council of State Boards of Nursing, The Regulation of Advanced Practice Registered Nurses 1997, Chicago, IL, 1998.
Pearson LJ. Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice, The Nurse Practitioner 26(1):7-57.
US Department of Justice, Drug Enforcement Administration, Diversion Control Program, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.
Washburn University School of Law, http://www.washlaw.edu
LOUISIANA
Louisiana State Board of Nursing, http://www.lsbn.state.la.us
MAINE
Maine Legislature, http://janus.state.me.us/legis
MARYLAND
Maryland General Assembly, http://mlis.state.md.us
Maryland Board of Nursing, http://dhmh.state.md.us
MASSACHUSETTS
Commonwealth of Massachusetts, http://www.state.ma.us/legis
MICHIGAN
National Council of State Boards of Nursing, http://www.michiganlegislature.org/law Michigan Legislature, http://www.michiganlegislature.org/law
MINNESOTA
State of Minnesota Board of Nursing, http://www.nursingboard.state.mn.us
Minnesota Office of the Revisor of Statutes, http://www.revisor.leg.state.mn.us

Table E-1, continued Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for MS, MO, MT, NE, NV, and NH
Scoring Category Points Optimal Score fn State
MS MO MT NE NV NH
Legal Authority
                              
Title protection
3
3
a
3
3
3
3
3
a
3
a
How Licensed
b

Lic as Nurse Practitioner
3
3
3
3

Lic as Nurse & Cert, Reg or Approved as NP
2
2
b
2
b
2
b
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
7
c
7
Relationship with Physicians:
d

No mention of physician in legislation
5
5
5
5

Collaborative language
4
4
d
4
d
4
4
d

Supervisory Language
2

Electronic communication permitted/Indirect sup.
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3
e

Regulation by State BON with another entity
2
2
e
2
e
2
e
2
e
2
e

Regulation by Board of Medicine or other
1
National certification required
1
1
f
1
1
1
1
1
1
Master's degree required for licensure
1
1
g
1
g
1
g
1
1
g
1
g
Practice Agreements:
h

No written practice agreement required
3
3
3
3

Written practice agreement avail on site

2
2

Written practice agreement filed with reg agency
1
1
1
h
1
Ratios > 2 in outpatient settings, or not legislated
1
1
I
1
I
1
I
1
1
1
I
1
Review of Records by Physician:
j

No legislated time requirement for review
3
3
3
j
3
j
3

Periodic/Regular Reviews
2
2
j
2
j

Strict/Daily
1
1
j
Hospital Privileges protected in legislation
1
1
k
Can refer directly for health/medical services
2
2
l
2
2
2
2
2
2
Can order or perform diagnostic or lab tests
2
2
m
2
2
2
Subtotals Legal
35
20
19
31
31
19
32
Reimbursement
Medicare
5
5
n
5
5
5
5
5
5
Legal right to be listed on panels as PCP
5
5
o
5
o
Medicaid % x 10
10
10
p
9
10
8.5
10
8.5
10
Language permits reimb by 3rd party or HMO
15
15
q
15
15
q
15
15
15
Subtotals Reimbursement
35
29
30
33.5
15
28.5
30
Prescriptive Authority
How Received:

Automatic
4
4
r
4
4
4

Application or Approval Required
2
2
2
2
Uses Own DEA number
3
3
s
3
3
s
3
How defined
t

Defined by Legislation/Phys.agmt.doesn't determine
5
5
5
5

Collaborative agreement defines

4
4
t

Supervisory agreement defines
3
3
t
3
t

Defined Formulary (inclusive or exclusive)
1
1
Type of Authority
u

Full authority within Scope (II-V and Legend)
12
12
12
u
12
u
12
u

Extensive authority (III-V and Legend)
9

Limited authority (IV-V and Legend)
6

Restricted (V and Legend)
3

Legends only
1
1
1
1
u
Durable medical equipment/devices
1
1
1
Sign for samples
1
1
w
1
Distribute samples
1
1
x
1
x
1
x
1
1
1
1
NP signs prescription
2
2
y
2
2
2
2
Continuing Ed requirements
1
1
z
1
1
1
1
1
1
Subtotals Prescriptive Authority
30
10
11
27
26
11
24
TOTAL
100
59
60
91.5
72
58.5
86

FOOTNOTES

MISSISSIPPI
b) Certified / registered
d) Collaboration, consultative language but "supervising" physician in reimbursement statute
e) Rules jointly promulgated by BON and BOM
g) Effective from 1998 " a graduate program"
I) Not legislated
j) Not defined
t) Protocol defines
x) "Dispense" in regulations
MISSOURI
b) Document of Recognition
d) Can not be geographically distant ( 30 miles by road or 50 miles in HPSA)
e) Regulations by BON and Board of Healing Arts and Board of Pharmacy
g) 1998 I) No more than three
j) Review every two weeks
q) BC/BS statutory non discriminatory policy
t) Protocol
x) Limited to 72hr supply
MONTANA
b) Certificate
e) Department of Commerce administers licenses, prescriptive authority administered by BON, BOME and BOP
j) Quarterly by peers or physicians
o) 1997 Bill 519 workers COMP, PCP
u) Quality assurance process for prescriptive authority
NEBRASKA
b,h) Integrated practice agreement may be waived if nurse will practice in a Geographic Health Shortage Area
d) Board of Advanced Practice
g) For prescriptive authority
j) Not defined
u) Schedule ll, 72 hour prescription only
NEVADA
a) APN
b) Certificate of Recognition
d) Nursing regulations, collaborative language
e) BON, BOM, BOP
g) Required after 6/1/05
I) No more than 3
j) Periodic/ monthly(BOM) review
s) DEA for dispensing and administering only, if privilege approved
t) Pharmacy regulations supervisory in language
u) APNs may dispense controlled substances under certain circumstances when a pharmacy exam has been passed
NEW HAMPSHIRE
 a) ARNP
e) APRN committee on BON, Joint Committee of BON, BOM and BOP for prescriptive authority, formulary
u) Plenary authority from a formulary established by Joint Health Council of BON

REFERENCES
Main Resources

American College of Nurse Midwives, Nurse Midwifery Today, A Handbook of State Laws and Regulations 2000, Washington, DC, 2000.
Buppert C, Nurse Practitioner’s Business Practice & Legal Guide, Aspen Publications, Gaithersburg, Maryland, 1999.
Cooper RA, Multidisciplinary Healthcare Workforce Data Consortium, Meeting, April 2001, Washington, DC.
Henderson T, Chovan T , Removing Practice Barriers of NonPhysician Providers, Intergovernmental Health Policy Project, The George Washington University, February 1994.
Henderson T, Fox-Grage W, Lewis S, Scope of Practice & Reimbursement for Advanced Practice Registered Nurses, Primary Care Resource Center, Intergovernmental Health Policy Project, The George Washington University, December 1995.
Henderson T, Norris S, National Conference of State Legislators, Inc.
National Council of State Boards of Nursing, http://www.ncsbn.org.
National Council of State Boards of Nursing, The Regulation of Advanced Practice Registered Nurses 1997, Chicago, IL, 1998.
Pearson LJ. Annual Legislative Update: How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice, The Nurse Practitioner 26(1):7-57.
US Department of Justice, Drug Enforcement Administration, Diversion Control Program, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html.
Washburn University School of Law, http://www.washlaw.edu
MISSISSIPPI
Lexis Nexis, 198.187.128.12/mississippi
Mississippi State Board of Nursing, http://www.msbn.state.ms.us/laws
MISSOURI
Missouri General Assembly, http://www.moga.state.mo.us/statutes
Missouri Department of Economic Development, Board of Nursing, http://www.ecodev.state.mo.us/pr/nurising
MONTANAMontana Department of Commerce, Board of Nursing, http://www.com.state.mt.us/License
Montana State Documents Online, http://statedocs.msl.state.mt.us
NEBRASKA
National Council of State Boards of Nursing, http://www.ncsbn.org/serach/documents
NEVADANevada Legislature, www.leg.state.nv. us/NRS
Nevada Legislature, www.leg.state.nv.us/nac
National Council of State Boards of Nursing, www.ncsbn.org/search/documents/actsand regs/nv
NEW HAMPSHIRE
New Hampshire Board of Nursing, www.state.nh.us/nursing
National Council of State Boards of Nursing, www.ncsbn.org/search/documents/actsand regs/nh

Table E-1, continued Professional Practice Index Scoring Criteria for Nurse Practitioners in 2000 New Index for NJ, NM, NY, NC, ND, and OH
Scoring Category
Points
Optimal Score
fn
State
NJ
NM
NY
NC
ND
OH
Legal Authority
                              
Title protection
3
3
a
3
3
3
3
3
3
How Licensed
b

Lic as Nurse Practitioner
3
3
3
3

Lic as Nurse & Cert, Reg or Approved as NP
2
2
b
2
b
2
2
b

RN license only
1
Autonomous practice possible
7
7
c
7
7
7
c
7
c
Relationship with Physicians:
d

No mention of physician in legislation
5
5
5

Collaborative language
4
4
d
4
4
d
4
4

Supervisory Language
2

Electronic communication permitted/Indirect sup.
1
Regulated by:
e

State Board of Nursing Alone/or Board of APN
3
3
3
3
e
3

Regulation by State BON with another entity
2
2
e
2
e

Regulation by Board of Medicine or other
1
1
e
National certification required
1
1
f
1
f
1
f
1
f
1
1
Master's degree required for licensure
1
1
g
1
1
1
g
1
g
1
Practice Agreements:
h

No written practice agreement required
3
3
3

Written practice agreement avail on site

2
2
h
2
2
h

Written practice agreement filed with reg agency
1
1
1
h
Ratios > 2 in outpatient settings, or not legislated
1
1