ASBN - Collaborative Practice Arkansas Department of Health

ASBN - Collaborative Practice

Guidelines for Collaborative Practice Agreements

An Advanced Practice Registered Nurse (APRN) with Prescriptive Authority must have a current updated Collaborative Practice Agreement (CPA) on file with the Board of Nursing. APRNs should keep their original CPA and submit a copy (PDF) to the Arkansas State Board of Nursing (ASBN) through the Arkansas Nurse Portal message center. The APRN is responsible for ensuring this requirement is met. After review of any new CPA, the APRN will be contacted through the Nurse Portal that the CPA has been approved or it has been denied and the reason for the denial. You may NOT practice under a CPA until you receive an approval letter.

Collaborative Practice Agreement

The APRN must notify the Board in writing within seven (7) days after the CPA is terminated. If the Board does not have a current CPA on file, the APRN’s Prescriptive Authority will be inactivated. When a new CPA has been approved by Board staff, Prescriptive Authority is reactivated.

The Collaborative Practice Agreement must meet the following criteria:

Must be complete and legible and on the current, unmodified form.
The collaborating physician must have a current AR license to practice under the Medical Practice Act, § 17-95-201. The collaborating physician must also have an unrestricted DEA registration number for APRNs who prescribe controlled substances.
The collaborating physician must have training within the scope, specialty, or expertise of the APRN’s practice/specialty.
A provision addressing the availability of the collaborating physician for consultation and/or referral.
Method of management of the collaborative practice (include a statement regarding protocols for Prescriptive Authority)
Plans for coverage of the health care needs of the patient in the emergency absence of the APRN or collaborating physician.
Provision for quality assurance (attach a separate Quality Assurance Plan that has been signed by the APRN and the collaborating physician).
Signatures with dates of both the APRN and the collaborating physician.
License numbers and certification specialties of both the APRN and the collaborating physician.
Address and phone number of the APRN’s and physician’s practice site(s).
The APRN and collaborative physician must both initial the requested category of controlled substances.

Mediation-Assisted Treatment

The SUPPORT Act of 2018 gives practitioners more flexibility in providing medication-assisted treatment (MAT) and extends the privilege of prescribing buprenorphine in office-based settings to qualifying advanced practice nurses until October 1, 2023. The Comprehensive Addiction and Recovery Act (CARA) was signed into law in 2016 to help address the opioid epidemic. The Act endorses the use of MAT for the treatment of opioid use disorder (OUD) and amends the Controlled Substances Act. This law authorizes the nurse practitioner to seek a DATA Waiver to offer buprenorphine for the treatment of OUD.

In order to be eligible for the prescribing waiver, the APRN must complete at least 24 hours of initial training which is offered through organizations such as the American Association of Nurse Practitioners and Substance Abuse and Mental Health Services Administration (SAMHSA).

Recent Practice Guidelines have allowed qualified APRNs to forego the required training when treating up to 30 patients for OUD. Practitioners utilizing this training exemption are limited to treating no more than 30 patients at any one time and apply only to the prescription of Schedule III, IV, and V drugs or combinations of such drugs.

Qualified practitioners who undertake the required training can treat up to 100 patients using buprenorphine for the treatment of OUD in the first year if they possess a DATA 2000 Waiver and meet certain conditions. More information on treating up to 100 patients can be found here.

APRNs who have an approved Notification of Intent (NOI) Buprenorphine Waiver from SAMHSA or have completed the 24 hours of required training may seek to obtain the DATA 2000 Waiver. The APRN must submit a copy of their approval email from SAMHSA or evidence of 24 hours buprenorphine waiver training, DATA 2000 collaborative practice agreement, and supply evidence that your collaborating physician also has a DATA Waiver. The ASBN will notify the Drug Enforcement Administration (DEA) once the criteria are met and the DEA will then assign a special identification number to be included on all buprenorphine prescriptions for opioid dependency treatment. This is in addition to the APRN’s regular DEA number.

In order to qualify, the Arkansas APRN must:

Submit a Buprenorphine Notification of Intent Application through SAMHSA
Have an approval letter from SAMHSA indicating waiver level and certification date or have completed the 24 hours of required training
Hold prescriptive authority through the Arkansas State Board of Nursing
Have a DATA 2000 Waiver collaborative practice agreement with a practicing physician who is licensed under the Arkansas Medical Practices Act and holds a DATA 2000 Waiver
Hold an active, unrestricted DEA registration
Only prescribe to populations included in the APRN’s area of education and certification
Address medication-assisted treatment for opioid use disorder in prescribing protocols

Please submit a copy of the waiver to the Arkansas State Board of Nursing Advanced Practice Department via the Arkansas Nursing Portal.

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