New York’s healthcare landscape faces a potential disruption for nurse practitioners (NPs), as their ability to practice independently, i.e., without a collaborative physician relationship, which is scheduled to sunset in July 2026. Unless the New York State Legislature takes action to extend or make permanent the current practice authority provisions, thousands of NPs may face significant operational and care-delivery challenges.
Background of Independent Practice in New York
In 2014, the Nurse Practitioner Modernization Act (NPMA) eliminated the written practice agreement requirement for NPs who had completed 3,600 hours of practice, but still required those NPs to maintain “collaborative relationships” with qualified physicians. NPs in such collaborative relationships were required to communicate with the physician for the purposes of exchanging information, as needed, to provide comprehensive patient care and to make referrals as necessary. Executive orders issued during the COVID-19 pandemic waived requirements for written practice agreements and collaborative relationships, allowing NPs to provide medical services appropriate to their education, training, and experience.
In 2022, the New York Legislature passed updates to the NPMA that allowed NPs with more than 3,600 hours of experience to have full practice authority and no longer required NPs to maintain written agreements or collaborative relationships with a physician as a condition of practice. The elimination of the collaborative relationship requirement was initially set to expire in April 2024. However, recognizing the ongoing importance of independent practice authority, the New York Legislature extended the elimination of the collaborative relationship requirement until July 2026.
Consequences of Legislative Inaction
If the New York State Legislature fails to act and allows NP independent practice flexibilities to expire in July 2026, the consequences would be immediate and far-reaching. All NPs with more than 3,600 hours of practice could be required to immediately establish collaborative relationships with qualified physicians in order to provide care. If the change is effective immediately upon sunset, with no transition period for NPs who have been practicing independently for years, patient care may be disrupted. NPs will need to work quickly to identify suitable collaborating physicians, and the collaborating physicians will need to prepare the required documentation describing the collaborative relationship, criteria for consultation, referral protocols, etc.
Potential for Another Extension
Given that the New York Legislature has already extended the sunset date once before, from April 2024 to July 2026, there is precedent for another extension. Additionally, New York has introduced a bill (S2360) that would make NP independent practice without collaboration or supervision permanent in New York. Frier Levitt is currently monitoring the status of this legislation, which was referred to the Higher Education Committee on January 7, 2026. It remains to be seen whether an extension of the NPMA or enactment of S2360 will allow nurse practitioners with the required hours to continue practicing independently in New York.
How Frier Levitt Can Help
The July 2026 sunset of NP independent practice authority represents a significant regulatory cliff for New York’s healthcare system. Whether through enactment of the current contemplated bill S2360 or another extension, nurse NPs in New York should engage legal counsel if they have any questions about the status of independent practice, current collaboration and supervisory requirements, and future planning regarding independent practice status in New York.
