Collaborative Practice Agreement · NP
Missouri Collaborative Practice Arrangement (CPA) for Nurse Practitioners
Required. The Collaborative Practice Arrangement (CPA) is the written instrument Missouri law names for a Nurse Practitioner working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
Missouri has no full-independent-practice tier for APRNs — a written collaborative practice arrangement is mandatory for as long as the NP practices (§ 334.104). The often-cited '1,000 hours' figure only gates a controlled-substance prescriptive-authority certificate — it does not end collaboration.
What a Missouri Collaborative Practice Arrangement (CPA) must contain
Governed by the Missouri State Board of Nursing and the Missouri Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Nurse Practitioner shall practice pursuant to a written Collaborative Practice Arrangement ("CPA") with the Physician, as required by Mo. Rev. Stat. § 334.104. The Physician and the Nurse Practitioner need not maintain a fixed mileage distance, but shall not be so geographically distanced as to impede effective collaboration. The CPA shall list every practice location where the Nurse Practitioner is authorized to prescribe, and a disclosure statement shall be posted at each site informing patients that they may be seen by a Nurse Practitioner and have the right to see the collaborating physician.
Source: Mo. Rev. Stat. § 334.104
The Nurse Practitioner shall submit at least ten percent (10%) of patient charts to the Physician for review every fourteen (14) days, or at least twenty percent (20%) of charts reflecting controlled-substance prescriptions every fourteen (14) days. Where the CPA involves diagnosis or treatment of acutely or chronically ill patients, the Physician shall be on-site at least once every two (2) weeks for chart review and medical direction, except as the Parties document a specific exception. A physician may not have Collaborative Practice Arrangements in effect with more than six (6) full-time-equivalent Nurse Practitioners, Physician Assistants, and assistant physicians combined, as provided under § 334.104.8.
Source: Mo. Rev. Stat. § 334.104
- The Collaborative Practice Arrangement (CPA) on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- Mo. Rev. Stat. § 334.104statute
Nurse Practitioner Collaborative Practice Arrangement requirements, chart-review percentages, on-site frequency, and the 6-FTE collaboration cap.
- Mo. Rev. Stat. § 334.735statute
Physician Assistant Collaborative Practice Arrangement requirements, filing of the collaborating-physician form, and the 6-FTE collaboration cap.
- Mo. Rev. Stat. § 338.010statute
Definition of the practice of pharmacy, including administration of drugs pursuant to a physician's order, standing order, or protocol.
- Mo. Rev. Stat. § 338.198statute
Pharmacist participation in dispensing/administering medications under a Nurse Practitioner's or Physician Assistant's Collaborative Practice Arrangement.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
Available remotely (no on-site requirement)
§ 334.104 requires the collaborating physician and APRN to 'maintain geographic proximity,' with no numeric mileage in the current statutory text (a pre-2024 75-mile rule was reportedly rescinded — secondary-sourced, verify before relying on it). A statutory correctional-center exception permits 200 miles by road, but that carve-out's sunset date (August 28, 2025) has already passed as of this writing — its current status is unconfirmed. Rural health clinics may waive proximity up to 28 days/year; telehealth arrangements in shortage areas reportedly waive it further (secondary-sourced).
Supervision ratio
Up to 6 at a time (combined across provider types)
Shares the same 6-FTE combined cap (APRNs/PAs/assistant physicians together) as the `pa` entry (§ 334.104).
Chart review
10% of charts · As needed (every 14 days)
10% of all charts, every 14 days (§ 334.104); 20% for controlled-substance charts.
Meeting cadence
As needed
Physician presence at least once every 2 weeks for chart review/medical direction (§ 334.104). Separately, a new APRN must complete a minimum one-month period of practice with the collaborating physician continuously present before working with reduced/periodic presence — this is an onboarding step, not a path to full independence; the biweekly-presence and chart-review rules continue indefinitely afterward.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III/IV/V plus Schedule II hydrocodone framework as `pa`, 120-hour cap (30 days for buprenorphine). Requires ≥1,000 hours of practice in the applicable APRN category (secondary-sourced figure, not independently re-verified against current rule text) before applying for the controlled-substance certificate — this threshold gates the Rx certificate only, not exit from the collaborative practice arrangement itself.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same traditional corporate-practice-of-medicine framework as the `pa` entry (RSMo Chapter 356 professional corporations) — exact section numbers for APRN-specific ownership eligibility were not confirmed this research pass; treat as an open item.
Not independently verified against primary source this research pass.
Legal sources for these rules (4)
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.