---
title: "What Is a Collaborative Practice Agreement? NPs and PAs"
description: "A collaborative practice agreement ties an NP or PA to a physician where state law requires it. What it contains and how Cuvo Health applies scope."
canonical: "https://cuvo.co/glossary/collaborative-practice-agreement"
last-updated: "Oct 26, 2026"
---
**Definition:** A collaborative practice agreement is a written agreement, required by some states, between a physician and a nurse practitioner or physician assistant that sets out the care the clinician provides and how the physician is available for consultation.

# What is a collaborative practice agreement?

In states that do not grant nurse practitioners or physician assistants independent practice, a written agreement with a physician is a condition of treating patients at all. For a telehealth visit, the requirement follows the patient's state, not the clinician's. Cuvo Health applies each state's scope to every visit, so a brand never has to know which license may prescribe what in which state.

Published Oct 26, 2026. Facts reviewed Oct 26, 2026.

A collaborative practice agreement is a written agreement between a physician and a nurse practitioner or physician assistant that sets out the categories of care the clinician provides and how the collaborating physician is available for consultation. Where a state requires one, it is a condition of practice: the American Association of Nurse Practitioners defines a reduced practice state as one whose law requires a career-long regulated collaborative agreement with another health provider. Illinois, for example, requires a written collaborative agreement for physician assistants (225 ILCS 95/7.5) and for nurse practitioners until they qualify for full practice authority (225 ILCS 65/65-35). On Cuvo Health, each license type practices within the scope its state grants it, and Cuvo's routing respects that scope automatically.

**At a glance**
- What it is: A written agreement between a physician and a nurse practitioner or physician assistant
- What it sets: The categories of care, treatment or procedures, and how the physician is reached for consultation
- Physician presence: Not required on site in Illinois; consultation may be by telecommunications
- Where it applies: The state where the patient is located, under that state's statute
- A Texas variant: A prescriptive authority agreement delegating prescribing (Occupations Code 157.0512)
- On Cuvo: Each state's scope applied to every visit by Cuvo's routing

**What an Illinois written collaborative agreement for a nurse practitioner covers (225 ILCS 65/65-35, checked October 26, 2026)**

| Element | What the statute says | Why it matters for telehealth |
| --- | --- | --- |
| **Relationship** | Describes the relationship with the collaborating physician | Names who the nurse practitioner consults |
| **Scope** | Describes the categories of care, treatment or procedures provided | Sets which visits the nurse practitioner may take |
| **Presence** | Does not require the physician's personal presence where care is given | Allows remote collaboration |
| **Communication** | Consultation in person or by telecommunications or electronic communications, as the agreement sets out | Fits a virtual clinic |
| **Limits** | Absent employment, may not restrict patient categories, payors or practice location in the state | Keeps the agreement from fencing the clinician in |

## 01. Why does a collaborative agreement matter for telehealth?

The requirement follows the patient. A nurse practitioner who treats patients in several states may practice independently in one, need a collaborative agreement in another, and need physician supervision in a third, all on the same day. A program that employs its own nurse practitioners or physician assistants therefore needs collaborating physicians who meet each state's rules, agreements that match each statute, and a way to keep both current as states amend them.

## 02. How is a collaborative agreement different from supervision?

AANP separates the two. Reduced practice requires a regulated collaborative agreement; restricted practice requires supervision, delegation or team management by another health provider, a closer form of physician oversight. The words are not used the same way everywhere: Texas lets a physician delegate prescribing to a nurse practitioner or physician assistant acting under adequate physician supervision through a prescriptive authority agreement (Texas Occupations Code 157.0512). The statute in the patient's state, not the label, decides what the agreement must contain.

## 03. Does the collaborating physician need to be on site?

Not in Illinois. Its statutes say the collaborative relationship does not require the physician's personal presence where services are rendered, and that consultation may run in person or by telecommunications or electronic communications as the agreement sets out. Other states add their own terms. A Texas prescriptive authority agreement must include a quality assurance and improvement plan with chart review and periodic meetings, and a physician may generally hold such agreements with no more than seven nurse practitioners and physician assistants or their full-time equivalents (Texas Occupations Code 157.0512). Each state's statute is read before a program staffs visits there.

## 04. Does a telehealth brand sign collaborative agreements itself?

No. The statutes name the physician and the nurse practitioner or physician assistant as the parties, not the company that markets the care. On Cuvo, providers practice through a physician-owned professional entity inside the MSO structure Cuvo builds and maintains, each license type practices within the scope its state grants it, and the brand never has to know which license may prescribe what in which state.

## Frequently asked questions

**Q: What is a collaborative practice agreement?**

A: It is a written agreement between a physician and a nurse practitioner or physician assistant that sets the care the clinician provides and how the physician is available for consultation, required where state law calls for one. On Cuvo, each license type practices within the scope its state grants it.

**Q: Collaborative practice agreement vs supervision: what is the difference?**

A: A collaborative agreement is the arrangement AANP associates with reduced practice states, while supervision, delegation or team management marks restricted practice states and means closer physician oversight. Cuvo Health's routing applies whichever rule the patient's state sets.

**Q: Does a nurse practitioner need a collaborating physician for telehealth?**

A: Only if the patient's state requires one, since the rule follows where the patient is located. On Cuvo, every visit routes to a provider licensed in the patient's state and practicing within that state's scope.

**Q: What is a prescriptive authority agreement?**

A: It is the Texas instrument through which a physician delegates prescribing to a nurse practitioner or physician assistant acting under adequate physician supervision, under Texas Occupations Code 157.0512. On Cuvo, prescribing follows the rules of the state where each patient is located.

**Q: Does a telehealth brand need collaborative practice agreements?**

A: A brand that employs its own nurse practitioners or physician assistants needs them wherever its patients' states require them. On Cuvo Health, the providers, their scope and the physician-owned professional entity they practice through are in place before launch, at $25 per completed consult.

**Related pages**

- [Full practice authority](/glossary/full-practice-authority): When a nurse practitioner needs no physician agreement
- [Nurse practitioner full practice authority states](/compliance/nurse-practitioner-full-practice-authority-states): Full, reduced and restricted, state by state
- [Illinois telehealth requirements](/compliance/illinois): The state used as the example here
- [Management services organization (MSO)](/glossary/management-services-organization): The structure the professional entity sits inside
- [The 50-state provider network](/provider-network): 300+ board-certified MDs, NPs and PAs
- [Telehealth glossary](/glossary): Every term a telehealth founder meets

Canonical page: https://cuvo.co/glossary/collaborative-practice-agreement