CNS · Texas
Collaborative Practice Agreement for Clinical Nurse Specialists in Texas
Not unconditionally. Texas does not name a specific instrument.
Whether a Texas CNS needs a Prescriptive Authority Agreement turns entirely on whether they hold prescriptive authority at all — many TX CNSs practice consultative/specialist roles without it. Obtaining prescriptive authority requires CNS-specific coursework (22 Tex. Admin. Code § 222.2: ≥45 clock hours each in advanced pharmacotherapeutics, pathophysiology, and health assessment) that NP/CNM/CRNA programs are presumed to already satisfy.
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
CNS who holds prescriptive authority: No proximity requirement
Same as `np` — no codified mileage/radius or continuous-availability standard.
Supervision ratio
CNS who holds prescriptive authority: Up to 7 at a time (combined across provider types)
Same combined APRN+PA cap as `np` (§ 157.0512(c)), applicable only once a CNS holds prescriptive authority and a PAA is in place.
Chart review
Not codified — left to the agreement
Meeting cadence
CNS who holds prescriptive authority: Monthly, in person or via telehealth
Same cadence and no-fixed-percentage chart-review rule as `np` (§ 157.0512(e)(9)).
Prescriptive authority
CNS who holds prescriptive authority: Separate prescribing terms required · controlled substances permitted
Requires the dedicated ≥45-clock-hour coursework in advanced pharmacotherapeutics, pathophysiology, and health assessment/diagnosis-management within the CNS's specialty (22 Tex. Admin. Code § 222.2) — a hurdle NP/CNM/CRNA programs are presumed to already clear, but many CNS programs don't.
CNS who does not hold prescriptive authority: Covered by the practice agreement · no controlled-substance authority
Practices without a Prescriptive Authority Agreement; no independent or delegated authority to prescribe controlled substances.
Written agreement
Not required
Conditional, not unconditional — shown as 'Not required' for the default/non-prescribing branch, which many Texas CNSs fall into. A CNS who obtains prescriptive authority (after the dedicated coursework required by 22 Tex. Admin. Code § 222.2) DOES need a Prescriptive Authority Agreement, same as any other APRN (see Prescriptive Authority below).
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same as the general `np` entry — CNSs are an APRN category not listed in § 301.012, so no statutory ownership pathway into a medical PA/PLLC exists. This applies regardless of the prescribing/non-prescribing branch above — it governs entity ownership, not clinical agreement status.
Legal sources for these rules (3)
- 22 Tex. Admin. Code § 222.2 — Prescriptive Authority coursework prerequisites
- Tex. Occ. Code §§ 157.0511, 157.0512
- 22 Tex. Admin. Code § 221.2 — Advanced Practice Registered Nurse (Clinical Nurse Specialist role definition)
What a collaborating physician costs here
Typical monthly cost in Texas
$500 – $600
Estimate for one Clinical Nurse Specialist. This state's rules add a restrictive-tier premium.
About Texas's rules
Texas has no independent-practice pathway for any APRN type (NP/PMHNP/CRNA/CNM/CNS) at any experience level — a 2025 rural 10-year/20,000-hour bill (S.B. 3055) died in committee, as did 2023's full-practice-authority S.B. 1700. No chart-review percentage is codified (the physician and provider set the number themselves) — the commonly-cited 10%/20% figures reflect a pre-2013 rule since repealed. PA is the only non-physician profession with a statutory joint-ownership pathway into a medical entity.
Other clinicians in Texas: see the state overview.