PMHNP Practice Requirements In Texas: Scope, Prescribing & Collaboration

Practice Authority

What Is Texas NP Practice Authority?

The American Association of Nurse Practitioners (AANP) lists Texas as a restricted practice state on its State Practice Environment map. A nurse practitioner in Texas doesn’t practice fully independently. State law requires delegated authority from a physician for the medical aspects of patient care, typically through a written agreement, and PMHNPs, as APRNs, fall under the same framework.

Two bodies govern your license and your prescribing. The Texas Board of Nursing licenses and regulates APRNs, and the Texas Medical Board addresses the physician side of delegation. The rules themselves sit in the Texas Occupations Code and the boards’ rules.

Collaboration & Agreements

Do Nurse Practitioners Need A Supervising Physician In Texas?

Yes, if you prescribe. Texas law provides for a prescriptive authority agreement (PAA), a written agreement in which a physician delegates prescribing authority to an APRN or physician assistant. Each one is written for one specific practice relationship, so a template from another practice won’t necessarily fit yours. Tex. Occ. Code §157.0512(e) sets the minimum contents:

• It’s written, signed and dated, with both parties’ names, addresses and professional license numbers.
• It states the nature of the practice and the practice locations or settings.
• It lists the types or categories of drugs or devices you can prescribe, or the ones you can’t.
• It gives a general plan for consultation and referral and a plan for patient emergencies.
• It describes how you and the physician share patient information and names any alternate physicians.
• It describes a quality assurance and improvement plan with chart review, where you and the physician set the number of charts, and periodic meetings.

Those meetings have to be documented and held at least once a month, in a manner you and the physician choose. They cover patient care, needed changes to care plans, referrals and patient care improvement. The agreement and any amendments are reviewed, dated and signed at least once a year. You keep a copy until two years after it ends, and you produce it within three business days if the Texas Medical Board or the Board of Nursing asks.

One physician can hold PAAs with up to seven APRNs and physician assistants, or their full-time equivalent. That cap doesn’t apply in a hospital facility-based practice or a practice serving a medically underserved population. You and your delegating physician register the delegation with the Texas Medical Board before you start, and the physician notifies that board within 30 days of any change in the scope of the delegation. The Texas Board of Nursing publishes the current PAA requirements, including how to register your delegating physician.

Prescribing

Can Nurse Practitioners Prescribe Schedule II Drugs In Texas?

Only in two settings. Under Tex. Occ. Code §157.0511(b-1), a physician can delegate Schedule II prescribing in a hospital facility-based practice, under policies approved by the hospital’s medical staff, for a patient admitted for an intended stay of 24 hours or more or a patient in the hospital’s emergency department. The other setting is hospice, as part of the plan of care for a patient with a written certification of terminal illness who’s receiving hospice treatment from a qualified hospice provider. The Board of Nursing says a freestanding emergency department affiliated with a hospital doesn’t qualify.

That’s a real limit for PMHNPs, since PMHNP formularies frequently include stimulants. The Texas Department of State Health Services lists amphetamine, methylphenidate and lisdexamfetamine in Schedule II, so a PMHNP in a Texas outpatient psychiatric practice can’t prescribe them.

Schedules III To V And The PMP

With a valid PAA, you can prescribe Schedule III, IV and V controlled substances within the categories your delegating physician authorized. Each prescription, refills included, is capped at a 90-day supply. Refills beyond the first 90 days need a consultation with your delegating physician, noted in the patient’s chart, and so does a controlled substance prescription for a child under two. You also need a prescription authorization number from the Board of Nursing (22 TAC §222.2) and your own federal DEA registration.

Before you prescribe an opioid, benzodiazepine, barbiturate or carisoprodol, Texas law requires you to check the patient’s history in the Prescription Monitoring Program, which the Texas State Board of Pharmacy runs (Health and Safety Code §481.0764). Benzodiazepines are on that list, so build the check into your prescribing routine.

Next Step

Credentialing Is A Separate Track

Practice authority decides what you can do in Texas. It doesn’t get you paid. Payer enrollment runs on its own track, with its own payer rules, Medicaid program and timelines, and our Texas credentialing and payer enrollment guide covers it. For the national picture, read the PMHNP credentialing guide.

If you’re opening your own practice, order matters. Our guide on how to start a PMHNP practice walks through licensure, collaboration and enrollment in sequence. The PMHNP hub has the rest of our billing, credentialing and operations guides.

Before you sign a lease or a PAA, see what PMHNP credentialing costs and what it costs to start a PMHNP practice. If you’re opening your own practice, First Practice Launch sets up the payers, EHR, portals and billing together for $6,000, or four monthly payments of $1,500.

FAQ

Texas PMHNP: Frequently Asked Questions

References

Official Texas Sources

Every rule on this page comes from the official sources below, which we checked on October 4, 2026.

• Texas Occupations Code Chapter 157, §157.0511 (Schedule II and Schedules III to V), §157.0512 (prescriptive authority agreements and the seven-APRN limit) and §157.054 (hospital facility-based practice) (checked October 4, 2026).
• Texas Board of Nursing Rules, 22 TAC Chapter 222, §222.2 (prescription authorization number), §222.5 (agreements and monthly meetings) and §222.8 (controlled substances) (checked October 4, 2026).
• Texas Board of Nursing APRN practice FAQ (Schedule II settings, freestanding emergency departments and registering a delegation) (checked October 4, 2026).
• Texas Medical Board, Prescribing and Supervision (delegation registration, the 30-day change notice and the physician limit) (checked October 4, 2026).
• Texas Health and Safety Code §481.0764 and the Texas State Board of Pharmacy PMP page (required PMP checks) (checked October 4, 2026).
• Texas Department of State Health Services Schedules of Controlled Substances, 2025 republication (Schedule II stimulants) (checked October 4, 2026).
• AANP Texas state fact sheet (the restricted practice category is AANP’s own classification) (checked October 4, 2026).