CNS · Indiana
Collaborative Practice Agreement for Clinical Nurse Specialists in Indiana
Yes, a written physician agreement is required. Indiana does not name a specific instrument.
CNS is a fully recognized APRN role in Indiana (IC 25-23-1-1(b)(3); 848 IAC 4-1-3, 4-3-1) and the title is statutorily protected. Unlike Texas and Virginia, where the agreement requirement turns on whether the CNS prescribes, Indiana's IC 25-23-1-19.4(c) reaches every APRN regardless of prescribing — so a consultative, non-prescribing Indiana CNS still needs a practice agreement. There is no independence pathway at any experience level.
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
Same as `np` — no codified proximity or reachability rule. 848 IAC 4-3-1 (competent practice of clinical nurse specialists) was not read in full in this pass; its sibling rules for NPs and nurse-midwives impose professional-judgment consultation standards rather than proximity rules, and no reason was found to expect the CNS rule to differ. Flag as an assumption if load-bearing.
Supervision ratio
Not codified — no cap on file
Chart review
CNS who holds prescriptive authority: 5% of charts · As needed (documentation of prescribing practices submitted to the collaborating practitioner within 7 days)
Same 848 IAC 5-1-1(a)(7) requirement as `np`. Conditioned here because a non-prescribing CNS — a common Indiana CNS role — is outside 848 IAC 5 entirely, though still inside IC 25-23-1-19.4(c)'s agreement requirement.
Meeting cadence
CNS who holds prescriptive authority: Every 6 months, in person or via telehealth
Same two-year prescriptive-authority renewal/agreement-refresh cycle as `np` (IC 25-23-1-19.5(c); 848 IAC 5-1-3).
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
OPEN ITEM, not resolved in this pass: IC 25-23-1-19.5 excludes only CRNAs, so CNS prescriptive authority appears available on the face of the statute. But 848 IAC 5-1-1(a)(5)'s alternative track for applicants holding only a baccalaureate degree requires national certification 'as a nurse practitioner or certified nurse-midwife' and does not name CNS — which may mean a baccalaureate-only CNS cannot qualify, or may simply reflect that CNS programs are graduate-level anyway. Coded controlledSubstancesAllowed=True on the statute's plain reading; verify against the Board of Nursing before relying on it for a specific CNS. Notably, no Texas-style dedicated-coursework prerequisite (22 Tex. Admin. Code § 222.2's 45-clock-hour requirement) exists in Indiana.
Written agreement
Required
Unconditional — and worth calling out because this is where Indiana diverges from the Texas and Virginia CNS entries in this dataset, both of which answer 'not required' for the non-prescribing branch. IC 25-23-1-19.4(c) applies to every advanced practice registered nurse other than a CRNA, with no prescribing condition. Unconditional. IC 25-23-1-19.4(c) requires an APRN to 'operate in collaboration with a licensed practitioner as evidenced by a practice agreement,' or alternatively under privileges granted by a hospital governing board — the agreement requirement attaches to APRN practice generally, not only to prescribing. Note the asymmetry in enforcement: the biennial random audit at IC 25-23-1-19.8(a) reaches only APRNs who hold prescriptive authority under IC 25-23-1-19.5, and only prescribers must file their agreement with the board (848 IAC 5-1-1(a)(7)). A non-prescribing APRN still needs an agreement under § 19.4(c) but has no filing or audit obligation attached to it.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same as the general `np` entry — a CNS is a registered nurse in a specialty role under IC 25-23-1-1(b)(3), so the same inferred IC 25-22.5-1-2(a)(22)(G) reading applies. CNS is not named in that list in its own right.
This analysis governs entity ownership only. It does not extend to any service outside the APRN's own scope — notably delegated medical-aesthetic procedures, which stay under the delegating physician's control via IC 25-22.5-1-2(a)(20) regardless of who owns the entity (see the `esthetician` entry).
Legal sources for these rules (4)
- IC 25-23-1-1(b)(3) — clinical nurse specialist as an APRN; IC 25-23-1-32 area — title protection for 'clinical nurse specialist' (Justia archived 2014 Indiana Code chapter PDF)secondary
- IC 25-23-1-19.4, 25-23-1-19.5 — same APRN framework as `np`, applying to CNS regardless of prescribing status (FindLaw mirror, current as of 1/1/2026)secondary
- 848 IAC 4-3-1 — Competent Practice of Clinical Nurse Specialists (Cornell LII Indiana Administrative Code mirror; NOT read in full in this pass — see the `proximity` note)secondary
- 848 IAC 5-1-1(a)(5) — baccalaureate-only alternative track naming NP and CNM certification but not CNS (Cornell LII mirror; basis for the open item above)secondary
What a collaborating physician costs here
Typical monthly cost in Indiana
$500 – $650
Estimate for one Clinical Nurse Specialist. This state's rules add a restrictive-tier premium.
About Indiana's rules
Indiana requires a career-long collaborative practice agreement for every APRN role except CRNAs (IC 25-23-1-19.4(c)); APRN prescribers additionally face a codified 5%-of-charts random-sampling review (848 IAC 5-1-1). CRNAs instead face a stricter rule — physician direction and immediate presence (IC 25-23-1-30). Widely repeated reports that Indiana enacted full practice authority in 2026 are unsupported: HB 1116, HB 1129 and SB 60 all failed. Indiana's corporate-practice doctrine is comparatively permissive.
Other clinicians in Indiana: see the state overview.