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NP Insurance Requirements by State

NP practice authority, collaborative agreement rules, and malpractice insurance mandates vary dramatically from state to state. Find your state's specific requirements — and understand how your practice authority level affects your insurance exposure.

Understanding the Three Tiers of NP Practice Authority

Full Practice Authority (FPA)

NPs can evaluate, diagnose, and treat patients without physician collaboration or supervision. You are the sole responsible party for clinical decisions. 27 states + DC + 2 U.S. territories as of 2025.

Insurance implication: Individual coverage is more critical than ever — no physician shares liability.

Reduced Practice

NPs may practice independently in some settings but require a collaborative practice agreement with a physician for specific functions. The CPA creates shared liability.

Insurance implication: Your CPA must be current, location-specific, and your insurer must be notified of scope changes.

Restricted Practice

NPs must work under physician supervision for all patient care. The physician’s license and policy may provide some coverage, but you still need individual protection.

Insurance implication: Confirm your individual policy covers supervised practice in your state and specialty.

Source: AANP State Practice Environment Map — updated regularly as states change legislation.

State Insurance Quick Reference

State Practice Authority Insurance Mandate Notable Rules
California Reduced Outpatient surgery only $250K non-economic cap (MICRA)
Texas Restricted No state mandate Strong tort reform; CPA required
Florida Reduced Yes — $100K/$300K min Strict financial responsibility law; "going bare" requires patient notice
New York Reduced No state mandate Hospitals require coverage; no cap on damages
Washington Full No state mandate Full FPA; NPs fully liable for clinical decisions
Michigan Full No state mandate Joined FPA states in 2023

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Coverage that works in your state — not a one-size-fits-all policy.

PL Brand Placeholder writes NP policies across all 50 states, with expertise in state-specific practice authority, collaborative agreement requirements, and coverage mandates.

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