Missouri
PMHNP Practice Requirements In Missouri: Scope, Prescribing & Collaboration
Short answer: AANP lists Missouri as restricted practice, so a PMHNP practices and prescribes under a written collaborative practice arrangement with a physician, who reviews 10 percent of charts every 14 days, or 20 percent when controlled substances are prescribed (RSMo 334.104.3). Delegable controlled substances stop at Schedules III through V plus Schedule II hydrocodone, so a PMHNP in a Missouri outpatient practice can’t prescribe Schedule II stimulants (RSMo 334.104.2).
Missouri PMHNP Rules At A Glance
| Topic | Missouri Rule |
|---|---|
| Practice authority | Restricted on the AANP map. APRNs perform delegated medical acts and prescribe only under a collaborative practice arrangement with a physician, and the requirement is career long (RSMo 334.104). |
| Physician agreement | A written arrangement signed by both covering locations, scope, controlled substances, chart review and coverage. The physician must document one month of practice with the APRN continuously present before offsite work (RSMo 334.104.3 and .9). |
| Physician limit | A collaborating physician may hold arrangements with no more than six full time equivalent APRNs, physician assistants or assistant physicians combined, with hospital employees excepted (RSMo 334.104.8). |
| Controlled substances | Delegable prescribing covers Schedules III, IV and V plus Schedule II hydrocodone, with a 120 hour supply and no refill for hydrocodone and Schedule III narcotics; buprenorphine may run 30 days (RSMo 334.104.2). |
| PDMP | Missouri’s statewide PDMP (RSMo 195.600) doesn’t require a prescriber to check before prescribing. The federal SUPPORT Act does require a check before a Schedule II through IV prescription for a MO HealthNet patient. |
| Regulator | Missouri State Board of Nursing in the Division of Professional Registration grants APRN recognition; collaborative practice is a joint rule with the Board of Registration for the Healing Arts (20 CSR 2200-4.200). |
Updated October 5, 2026
Practice Authority
Missouri Practice-Authority Category (Restricted Practice)
The American Association of Nurse Practitioners (AANP) currently classifies Missouri as a restricted practice state. In practice, a PMHNP in Missouri can’t practice fully independent of a physician relationship and generally needs career-long supervision, delegation or a collaborative agreement for at least one element of practice.
Collaboration
Is A Collaborative Or Supervisory Agreement Required?
Before you provide the full scope of care in Missouri, you’ll generally need supervision by, delegation from, or a collaborative agreement with a physician. What that agreement must contain, how it’s documented and how often it’s reviewed all come from state rule.
Prescriptive Authority
Prescriptive Authority And Controlled Substances
Prescriptive authority in Missouri comes once you meet the state’s requirements, and it can include controlled substances when the conditions are met. You’ll also need a separate federal DEA registration for those, and some carry additional conditions. State law and board rule set the scope and documentation. The U.S. Drug Enforcement Administration covers the federal side.
Next Step
Credentialing Is A Separate Track
Scope of practice is only half of it. Getting paid by insurance in Missouri means credentialing, and that track has its own payer rules, Medicaid program and enrollment timelines. Our Missouri credentialing and payer enrollment page walks through it, and the PMHNP credentialing guide covers the national side.
Planning to open on your own? Our guide on how to start a PMHNP practice lays out licensure, collaboration and enrollment step by step. Count the cost early with our guides on what PMHNP credentialing costs and what it costs to start a PMHNP practice.
When you’d rather not chase payer applications yourself, New Provider Credentialing covers five commercial payers for $2,750 per provider, or $550 per payer if you start smaller. For a first practice, First Practice Launch covers the payers plus the EHR, portals and billing for $6,000, or four monthly payments of $1,500.
FAQ
Frequently Asked Questions
Can A PMHNP Practice Independently In Missouri?
No. AANP lists Missouri as restricted, and RSMo 334.104 ties an APRN’s delegated medical acts and prescribing to a collaborative practice arrangement with a physician for the whole career. A 2026 Senate bill (SCS SBs 979 and 1016) that would have ended the arrangement after 2,000 documented hours cleared committee but was not passed into law, so nothing changes on August 28, 2026.
Do I Need A Collaborating Physician In Missouri?
Yes. You need a written collaborative practice arrangement that names the physician, lists every location where you prescribe and spells out which controlled substances you may prescribe (RSMo 334.104.3). The physician documents one month of practice with you continuously present before you work at a site without them, then reviews 10 percent of your charts every 14 days, or 20 percent of charts where you prescribed controlled substances.
Can A PMHNP Prescribe Adderall In Missouri?
No, not in a typical outpatient practice. A collaborative practice arrangement may delegate Schedules III, IV and V plus Schedule II hydrocodone only, so Schedule II stimulants such as Adderall stay with the physician (RSMo 334.104.2). The Schedule II exception for APRNs employed by a certified hospice doesn’t reach a psychiatric clinic.
This is general information, not legal advice. It applies the general nurse practitioner rules in Missouri to PMHNPs. Rules change, so check with the Missouri State Board of Nursing and the AANP State Practice Environment map before you act on it. Last reviewed: September 26, 2026.
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