Page 6 - Part 2 Collaborating with Advanced Practice Providers - An Overview of State Rules

SVMIC Collaborating with Advanced Practice Providers

protocol is meant to define the role of the APP and not unduly restrict

his or her services. It should be as specific as possible without setting up

such a highly detailed protocol that adherence is difficult or the protocol
gets in the way of patient management. APPs may encounter a patient

whose condition falls outside of the approved protocols. In such cases,

the APP may consult with the supervising physician or refer the patient

to another facility equipped to provide appropriate care. The APP should

document the consultation and/or referral and these cases may trigger

review by the supervising physician. Most protocols and CPAs require
pre-approval by the state board. Protocols and CPAs are required to be

available at the practice site. Protocols and CPAs should be reviewed

and updated at least every other year (annually in Arkansas).

Notice of any change or termination of a protocol or collaborative
agreement must be given to the applicable boards within a defined time

period which is found on the state board website.

In 2018, the state of Virginia passed legislation that eliminates the

requirement for a practice agreement with a patient care team physician

for a licensed nurse practitioner who has completed the equivalent of at

least five years of full-time clinical experience and submitted an
attestation from his patient care team physician stating (i) that the

patient care team physician has served as a patient care team physician

on a patient care team with the nurse practitioner pursuant to a practice

agreement; (ii) that while a party to such practice agreement, the patient

care team physician routinely practiced with a patient population and in
a practice area included within the category for which the nurse

practitioner was certified and licensed; and (iii) the period of time for

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