How to Become a Mid-Level Prescriber in South Carolina

There are several steps to becoming fully licensed and registered with the state of South Carolina to have legal prescriptive authority. We've outlined the steps to take to gain prescriptive authority as a new mid-level provider and how to move to a new practice as an existing provider.

Gaining Prescriptive Authority as a New Mid-level Graduate:


Congratulations! You have completed your nurse practitioner or physician assistant studies and are ready to register with the state and begin practicing. Among the many options, you might have decided to specialize in family practice, surgical services, or even psychiatric care. Fortunately, the process to register for prescriptive authority is consistent across most specialties with only a few exceptions. Below are the steps you'll need to follow to gain prescriptive authority:

  1. Sign a collaborative practice agreement: This requirement applies to both nurse practitioners and physician assistants in the State of South Carolina. A collaborative practice agreement must be obtained prior to applying for licensure in the state. A written collaborative practice agreement is an agreement between the mid-level provider and a physician that is licensed, certified, or practicing within a scope similar to that of the mid-level provider. This collaborative practice agreement outlines the scope of practice that the mid-level provider will be practicing within, such as what medical acts and prescriptive authority the physician agrees the mid-level provider is capable and independent to complete. Collaborative practice agreements are renewed yearly. At all times, in order to qualify for licensure in the State of South Carolina and in order to practice, a mid-level provider must maintain an active collaborative practice agreement with a physician. Different stipulations for these practice agreements apply to Advanced Practice Registered Nurses and physician assistants. Advanced Practice Register Nurses are able to practice with a physician collaborator and generally have more independence in practice autonomy whereas physician assistants must practice under physician supervision which is generally more restrictive.

  2. Advanced Practice Register Nurse (APRN) Collaborative Practice Agreement Requirements: At the time of this blog post writing, 28 states currently have full-practice authority guidelines for Advanced Practice Registered Nurses. As of March 2021, South Carolina is currently not a full-practice authority state for APRNs, which means that nurse practitioners must have a collaborative practice agreement signed with a physician prior to beginning to clinically practice. Although a collaborative practice agreement is required in South Carolina for APRNs, there are no chart review requirements, mileage radiuses between the location of the APRN and the physician, or other such stipulations to the collaborative practice agreement that are required. Examples for templates of Collaborative Practice Agreements are available on the South Carolina Board of Nursing and are available for reference here.

  3. Physician Assistant Collaborative Practice Agreement Requirements: At the time of this blog post, physician assistants are not able to practice in the State of South Carolina without a supervising physician. Supervision requirements for physician assistants in the State of South Carolina require the physician to specifically list out the delegated medical acts that he/she approved the physician assistant to carry out. Furthermore, there could be requirements for the supervising physician of a physician assistant to require that the physician assistant is physically located at the same site or a percentage of clinical charts are reviewed, depending on the stipulations set forth in the supervisory agreement. Supervisory forms for physician assistants can be found on the South Carolina Board of Medical Examiners website and are available for reference here and here.

  4. Register for your state medical license: Once a practice agreement is signed, a mid-level provider then must apply for a license in the State of South Carolina. Follow the links below to register for your nurse practitioner or physician assistant license. It typically takes 2-4 weeks to receive your license back after submission. There are specific requirements for licensure as an APRN or a PA that are detailed on the Board of Nursing or Board of Medical Examiners. Links to these licensing boards are available below:

  5. Advanced Practice Register Nurse - Board of Nursing

  6. Physician Assistant - Board of Medical Examiners

  7. Register for state prescriptive authority: The state prescriptive authority registration must be completed AFTER you receive your license number. You may fill out the state prescriptive authority application at the applicable board and may utilize the links above for convenience.

  8. Register for DHEC license - After licensure and prescriptive authority is granted from the applicable board, there is another state organization known as the South Carolina Department of Health and Environmental Control (DHEC) which requires registration prior to the prescription of controlled substances. State licensure to prescribe controlled substances must be obtained prior to federal or DEA licensure. A copy of a South Carolina licensure with prescriptive authority is required in order to apply. For the DHEC prescriptive authority application, a wet signature is required by a physician that is collaborating / supervising with the mid-level provider. DHEC will not accept a scanned or electronic signature at the time of this blog post's writing. Here is a link to the DHEC application.

  9. Register for DEA License - After securing DHEC licensure (state licensure for controlled substances) you are able to apply for the federal DEA controlled substance license. Here is a link to the page that reviews all required information. Select a business activity (note: there is a cost associated with this application) and click continue at the bottom to begin your submission. It is recommended you complete the DEA application in its entirety, at one time, to avoid delay in processing or additional charges. Once you have completed the above steps, and received back your licenses and certifications you are able to prescribe within South Carolina! It is now advisable to register for malpractice insurance at a 1 million / 3 million liability limit if you have not done so already. You will want malpractice insurance prior to seeing your first patient. If you will be accepting insurances you may now move forward with the credentialing process.

Moving to a new practice as an Existing Mid-level provider:


We're excited to hear you are changing practices. Here are the steps you will need to take to ensure all your licenses and registrations are updated:

  1. Update your State license practicing location with a Change-of-Practice form. It may be required to a physician to sign off on this change of practice form. a. APRN b. PA - login to the SC licensing website to change address

  2. Update your collaborative / supervisory practice agreement.

  3. Update your DHEC address.

  4. Update your DEA address -Login to the DEA website using your registration certificate. Fill out the change of address form to update your details.

  5. Update your NPPES Profile - Login to NPPES. Click the pencil under the "Actions" column. a. Updating Address - 1. Go to the "Address" tab on the left side of the screen. 2. You can then update your address. b. Updating Taxonomy - If you are changing your specialty of practice you will need to update your Taxonomy code to ensure that credentialing goes smoothly. To do this: 1. Go to the taxonomy page on the left side 2. Select your new, most accurate taxonomy from the "Choose Taxonomy" drop down. Note: If you are applying to iTrust Wellness Group please use 363A00000X if you are a PA and 363LP0808X if you are an APRN) 3. Click "Save" to add this to the table below 4. Select your new taxonomy code as your primary code using the checkboxes on the left of the table. 5. Click "Save" once more to update your profile c. Submit your Changes - Your profile is not updated until you resubmit your profile. Click "Next" at the bottom of your screen until you reach the submit screen. Review your profile and click "Submit" to have NPPES review your profile. They typically approve changes within a day

  6. Update your CAQH Profile 1. Hover over "Profile data" and select "Practice locations" 2. Add your new practice locations, and remove any former ones. 3. Proceed through the remainder of your profile by clicking "Save and Continue" at the bottom right, until you reach the "Review and Attest" Page. 4. Confirm your profile information and attest your profile. Your profile will typically update in 3-5 days.


Conclusion:

Becoming a new provider or changing practice locations can be confusing. If you have any additional questions, please contact the appropriate licensing board specific to APRNs or PAs. For convenience, the links to these boards will be available below:

- Advanced Practice Register Nurse - Board of Nursing

- Physician Assistant - Board of Medical Examiners



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