A reduced practice authority states list different state-groups by how much a nurse practitioner can do without a physician. There are three categories: full, reduced, and restricted. Reduced practice means an NP needs a collaborative agreement with a physician for part of that scope, usually prescribing. Florida falls into this category for most specialties, and the list continues to shift as more states move toward full practice authority.

What Qualifies a State as Reduced Practice

The American Association of Nurse Practitioners (AANP) sorts states into three tiers based on the requirements of each state’s statutes for NP prescribing and practice decisions. The classification hinges on one trigger: whether a physician must sign off on any part of an NP’s scope, most often controlled-substance prescribing. States enforce that trigger differently, through a formal collaborative agreement, ongoing chart review, or a set supervision ratio, but any version of it places a state in the reduced tier.

• Full practice authority: An NP can evaluate, diagnose, treat, and prescribe without a mandated physician relationship.
• Reduced practice authority: State law requires a collaborative agreement, supervision arrangement, or other regulated relationship with a physician for at least one element of practice, typically prescribing.
• Restricted practice authority: State law requires physician supervision or delegation for the NP to provide patient care at all, not just for one element.

Two reduced practice states can require very different collaborative agreements, so the actual compliance work starts with reading your state’s specific statute, not the category name.

States Currently Classified as Reduced Practice

States in this tier typically require a written collaborative agreement that names a supervising physician and defines the NP’s prescriptive scope, even when the NP otherwise practices independently. Alabama, Arkansas, Indiana, Kentucky, Pennsylvania, and West Virginia are commonly cited examples, though classifications shift as legislatures act. You can check AANP’s state practice environment map for the current list. It updates as states pass new scope-of-practice laws, which happens more often than most published lists account for.

Florida’s Position on the List

Florida runs two tracks for NP practice: standard collaborative practice and autonomous practice. Only one applies to most med spas, and confusing the two is the fastest way to end up with a noncompliant agreement. Here is how each one works.

• Standard collaborative practice (2025 Florida Statutes 464.012): An NP practices under a written collaborative agreement, called an established protocol, with a supervising physician who reviews prescribing and treatment decisions, and it applies to most specialties, including aesthetic and cosmetic services.
• Autonomous practice (2025 Florida Statutes 464.0123): A qualifying NP may practice without a physician relationship in primary care only after logging 3,000 supervised clinical hours over the past five years and completing the required coursework in differential diagnosis and pharmacology.

Autonomous registration does not extend to cosmetic work. Botox administered for migraines in a primary care setting can qualify as primary care. The same injection given for wrinkle reduction in a med spa does not, so most Florida med spas still need a compliant collaborative agreement.

Why This List Changes

Legislatures reclassify states through three main mechanisms: ordinary session votes, veto overrides, and sunset clauses. Each one can move a state forward or backward without warning. Florida NPs need to watch all three, not just headline bills.

• Session votes: Standard legislative sessions pass or reject full practice authority bills every year, and momentum has favored expansion for the past decade.
• Veto overrides: Oklahoma lawmakers overrode a 2025 governor veto to grant NPs independent prescriptive authority, effective November 2025.
• Sunset clauses: New York’s pandemic-era practice authority expires July 1, 2026, unless the legislature makes it permanent, which means a state can revert to reduced or restricted status even without a new bill.

A reduced practice authority states list needs a live source behind it, so check AANP’s tracker before finalizing any compliance decision tied to your state’s classification.

How Medical Director Co. Supports Practices in Reduced Practice States

A compliant collaborative agreement takes more than a physician willing to sign. Medical Director Co. matches Florida NPs and med spa owners with a vetted physician collaborator based on specialty and scope, then has an attorney draft the agreement against the specific requirements of the 2025 Florida Statutes 464.012. If the collaborator relationship ends or the underlying statute changes, the agreement gets updated instead of left outdated. Pricing starts at a flat $799 per month with no setup fees.