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Nurse Practitioner State Practice Environment

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last updated 12/6/13

Flag   State stethoscope   Autonomy of Practice Pill   Prescriptive Authority money  Reimbursement
StateAutonomy of PracticePrescriptive AuthorityReimbursement
AlabamaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician NeededNo Legislative Restrictions. Medicaid does not reimburse for services provided in a hospital or ED
AlaskaIndependently Diagnose and TreatIndependent Prescribing80% of Physician's Medicaid Rate. Varies based on insurance plan.
ArizonaIndependently Diagnose and TreatIndependent Prescribing90% of Physician's Medicaid Rate. Varies based on insurance plan.
ArkansasIndependently Diagnose and TreatCollaborative Agreement with Physician Needed80% of Physician's Medicaid Rate. Varies based on insurance plan.
CaliforniaPhysician Supervision NeededCollaborative Agreement with Physician Needed100% of Physician's Medi-Cal Rate. Varies based on insurance plan.
ColoradoIndependently Diagnose and TreatIndependent Prescribing After MentorshipSome managed-care Medicaid companies restrict independent NPs from joining networks. Third-party payers not mandated to credential, empanel, or reimburse APNs
ConneticutCollaborative Agreement with Physician NeededCollaborative Agreement with Physician NeededMedicaid reimbursement under fee-for-service programs. Insurers cannot require supervision or signature by any other healthcare provider as a condition of reimbursement
DelawareCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Varies based on insurance plan.
District of ColumbiaIndependently Diagnose and TreatIndependent Prescribing After Mentorship
FloridaPhysician Supervision NeededNo Prescribing of Controlled Substances. Collaborative Agreement with Physician Needed100% of Physician Medicaid Rate only if on-site physician countersigns chart within 24 hrs. 85% of the physician rate if physician is not on-site and does not countersign. Managed-care companies prohibited from discriminating against reimbursement for NPs.
GeorgiaPhysician Supervision NeededCollaborative Agreement with Physician Needed90% of Physician's Medicaid Rate. Some private insurers reimburse NPs but are not required by law to do so.
HawaiiIndependently Diagnose and TreatIndependent Prescribing75% of Physician's Medicaid Rate. Current law provides direct reimbursement and authorizes insurers to recognize NPs as PCPs. Reimbursement rate ranges from 85%-100%
IdahoIndependently Diagnose and TreatIndependent Prescribing85% of Physician's Medicaid Rate. Considered by third-party payers on an individual basis
IllinoisCollaborative Agreement with Physician Needed. NPs with approved clinical privileges may practice independently without a collaborator agreement in a hospital or ambulatory surgical treatment center.Collaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. NPs receive direct or indirect reimbursement from some third-party payers
IndianaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed85% of Physician’s Medicaid Rate. Medicaid for children does not allow for NP reimbursement. Considered an “any willing provider” state by current law. NPs may receive third-party reimbursement as determined by payers.
IowaIndependently Diagnose and TreatIndependent PrescribingIowa’s Medicaid managed-care and prepaid-service programs reimburse NPs. Third-party reimbursement if the policy or contract would pay for care and treatment when provided by physician or DO
KansasCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed80% of Physician's Medicaid Rate (except for early periodic screening diagnosis and treatment, which receives 100%). Insurance companies are legally required to reimburse all NPs for covered health plan services. Some insurance companies pay 85% of physician rate
KentuckyIndependently Diagnose and TreatCollaborative Agreement with Physician Needed75% of the physician rates under state medical assistance program except in Jefferson County. In Jefferson County, capitated managed-care through healthcare partnership with reimbursement at physician rates. Kentucky is an “any willing provider” state. In April 2003, the U.S. Supreme Court upheld Kentucky law providing that health insurers may not discriminate against providers located within geographic coverage area of the health benefit plan and who meets the terms and conditions for participation established by the health insurer
LouisianaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed80% of Physician's Medicaid Rate. Some immunizations and screening services for children are reimbursed at 100%. The passage of SB 135/Act #106 in 2006 provides that qualified plans shall notexclude direct reimbursement of healthcare
services provided by NPs
MaineIndependently Diagnose and Treat without supervising physician or NP involvement after 24 months of practiceIndependent PrescribingMedicaid reimburses in full, on a fee- for-service basis. 1999 Act to Increase Access to Primary Health Care Services (HP617) requires reimbursement under an indemnity or managed-care plan for patient visits to NPs when referred from a PCP.
MarylandIndependently Diagnose and TreatIndependent Prescribing100% of Physician's Medicaid Rate. All nurses entitled to private third-party and Medicaid reimbursement if practicing within their legal SOP. Several commercial insurers reimburse NPs directly, at a rate of 75% to 85% of a physician’s fee schedule.
MassachusettsIndependently Diagnose and TreatCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Effective Jan. 2009, all health insurers required to recognize NPs as PCPs and include them in provider directories for consumer choice
MichiganPhysician Supervision NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. BlueCross/BlueShield directly reimburses all NPs
MinnesotaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Minnesota law prohibits HMOs and private insurers from requiring a physician’s cosignature when NPs orders a lab test, X-ray,
or diagnostic test
MississippiCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed90% of Physician's Medicaid Rate. Insurance law specifies that any service within the SOP of a NP working under the supervision of a physician is entitled to reimbursement. Reimbursement increased to 100% for NPs providing services after 5 p.m
MissouriCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Current law states that any health insurer shall reimburse a claim for services provided by NPs if such services are within the SOP
MontanaIndependently Diagnose and TreatIndependent Prescribing85% of Physician's Medicaid Rate. 85% of the
physician payment from BlueCrossC/BlueShield
NebraskaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Some NPs refused recognition as a providers due to no state legislation mandating third-party reimbursement for NPs. BlueCross/BlueShield reimburses NPs at 85% of physician rate
NevadaIndependently Diagnose and TreatIndependent Prescribing85% of Physician's Medicaid Rate. Reimbursement from privateinsurance at the same rate as physician payment
New HampshireIndependently Diagnose and TreatIndependent Prescribing100% of Physician's Medicaid Rate. All insurance companies, hospital service corporations, medical service corporations, and nonprofi t health service corporations must reimburse NPs when for any service legally performed
New JerseyIndependently Diagnose and TreatCollaborative Agreement with Physician Needed85% of Physician's Medicaid Rate. Reimbursement by private insurers is generally at 85% of the physician rate
New MexicoIndependently Diagnose and TreatIndependent Prescribing85% of Physician's Medicaid Rate. Reimbursement not legally mandated for NP services. NPs continue to meet resistance in being listed as PCPs with some companies
New YorkCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rates when billed under the physician provider, 85% of the Physician Rate when billed directly as an NP provider. NPs ncluded in the NYSHIP Empire Plan, offered by 2 largest State Employees Unions
North CarolinaPhysician Supervision NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rates. NPs enrolled as psych/mental health providers receive 85% of physician rate. Third-party reimbursement for NPs provides direct reimbursement to NPs for services within their scope
North DakotaIndependently Diagnose and TreatIndependent Prescribing75% of Physician's Medicaid Rate. Blue Cross Blue Shield of North Dakota reimburses based on lesser of the provider’s billed charges or 75% of the BlueCross/BlueShield physician payment system
OhioCollaborative Agreement with Physician NeededCollaborative Agreement with Physician NeededOhio’s Medicaid program recognizes NPs certified in family, adult, acute care, geriatric, neonatal, pediatric, and women’s health/OB. Managed-care organizations vary on empanelment.
OklahomaIndependently Diagnose and TreatPhysician Supervision NeededOklahoma’s Medicaid plan includes NPs as primary care managers. State law does not mandate reimbursement of NPs. Oklahoma State and Education Employees Insurance Company does recognizes NPs as providers. Negotiation continues with other 3rd-party insurers.
OregonIndependently Diagnose and TreatIndependent Prescribing100% of Physician's Medicaid Rate. NPs are entitled by law to reimbursement by third-party payers
PennsylvaniaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rates for certain services. The State Department of Health allows HMOs to recognize CRNPs as primary care gatekeepers.
Rhode IslandIndependently Diagnose and TreatIndependent PrescribingNPs practicing in collaboration with or employed by a physician, receive third-party reimbursement
South CarolinaPhysician Supervision NeededPhysician Supervision Needed85% of Physician's Medicaid Rate.Approximately 23 payers recognize,enroll, and directly reimburse APRNs for services provided.
South DakotaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician NeededState law mandates NPs must be reimbursed on same basis as other medical providers, assuming that the service is covered under the policy
TennesseeIndependently Diagnose and TreatPhysician Supervision Needed100% reimbursement to primary care NPs in the TennCare program and most BlueCross/BlueShield programs. Managed-care antidiscrimination law prevents discrimination against NPs. Not all organizations are credentialing and accepting NPs into their network.
TexasPhysician Supervision NeededPhysician Supervision Needed100% of Physician's Medicaid Rate. Under certain circumstances, physicians in the Texas Medicaid Program may bill for NP services
at 100%. Programs such as Texas Health Steps reimburse all providers at the same rate. NPs are listed in the Texas Insurance Code as practitioners that must be reimbursed by indemnity health insurance plans
UtahIndependently Diagnose and TreatCollaborative Agreement with Physician Needed for Scheduled Drugs100% of Physician's Medicaid Rate. State insurance code has a nondiscrimination code; nothing prohibits reimbursement
VermontIndependently Diagnose and Treat after 2 yrs/2,400 hrs.Independent Prescribing100% of Physician's Medicaid Rate. Legislation requiring or prohibiting third-party reimbursement does not exist. Insurance companies may erimburse NPs depending on policies
VirginiaPhysician Supervision NeededPhysician Supervision Needed100% of Physician's Medicaid Rate.
WashingtonIndependently Diagnose and TreatIndependent Prescribing100% of Physician's Medicaid Rate. Labor and Industry reimbursement is at 90% of physician payment.
West VirginiaCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. State law requires insurance
companies reimburse nurses forservices commonly reimbursed for other providers
WisconsinCollaborative Agreement with Physician NeededCollaborative Agreement with Physician Needed100% of Physician's Medicaid Rate. Reimbursement up to the maximum allowed for physicians billing for the same services
WyomingIndependently Diagnose and TreatIndependent Prescribing100% of Physician's Medicaid Rate. May receive third-partypayment. Policies differ among third-party payers. WSBN has no say in reimbursement policies