Alabama

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

Alabama credentials three levels of addiction counselors. Individuals with master’s degrees may qualify for the Qualified Substance Abuse Professional (QSAP) I if they hold a license in a health discipline or have a combination of education, experience and certification. Those individuals with a master’s degree in psychology, counseling, social work or psychiatric nursing (or with a master’s in another behavioral health field and sufficient coursework to establish equivalency), may work as a QSAP II under the supervision of a QSAP I.

Individuals with bachelor’s degrees may qualify for the QSAP II or III with a bachelor’s degree in psychology, social work, community rehabilitation, pastoral care or family therapy. Other behavioral health degrees may be accepted if they include relevant clinical coursework. Ala. Admin. Code §580-9-44

Licensed professional counselors in Alabama may provide individual counseling, family counseling, marital counseling, group therapy, school counseling, play therapy, rehabilitation counseling, art therapy, human growth and development counseling, couples counseling, chemical abuse or dependency counseling, career counseling, and vocational disability counseling. A licensed professional counselor or associate licensed counselor may diagnose and develop treatment plans but shall not attempt to diagnose, prescribe for, treat, or advise a client with reference to problems or complaints falling outside the boundaries of counseling services. Ala. Code §34-8A-2-5a

Peer support specialists are certified by the Alabama Department of Mental Health (ADMH) as Certified Recovery Support Specialists. Peer support specialists assist those who are in recovery and are authorized to provide the services as outlined in the ADMH Substance Abuse Services Billing Manual. Ala. Admin. Code r. 580-9-44-.02

Physician relationship required for practice and prescriptive authority.

Certified registered nurse midwives are subject to practice agreements with a physician. Collaboration requires professional oversight and direction as required by the rules and regulations of the State Board of Medical Examiners and the Board of Nursing. The agreement must include practice sites, prescriptions orders and quality assurance. This collaboration does not require direct, on-site supervision of the activities of a certified registered nurse practitioner by the collaborating physician. Ala. Admin. Code §610-x-5.09, Ala. Code §34-21-81

In order to prescribe legend drugs, the drug type, dosage, quantity prescribed and number of refills must be authorized in the approved protocol signed by the collaborating physician and is on the list of medicines recommended by the joint committee and adopted by the State Board of Medical Examiners and the Board of Nursing. Upon receiving a Qualified Alabama Controlled Substances Registration Certificate (QACSC), an NP may prescribe Schedules III-V controlled substances. Ala. Code §34-21-86, Ala. Code §20-2-253

Physician relationship required for practice and prescriptive authority.

Certified registered nurse practitioners are subject to practice agreements with a physician. Collaboration requires professional oversight and direction as required by the rules and regulations of the State Board of Medical Examiners and the Board of Nursing. The agreement must include practice sites, prescriptions orders and quality assurance. This collaboration does not require direct, on-site supervision of the activities of a certified registered nurse practitioner by the collaborating physician. Ala. Admin. Code §610-x-5.09, Ala. Code §34-21-81

In order to prescribe legend drugs, the drug type, dosage, quantity prescribed and number of refills must be authorized in the approved protocol signed by the collaborating physician and is on the list of medicines recommended by the joint committee and adopted by the State Board of Medical Examiners and the Board of Nursing. Upon receiving a Qualified Alabama Controlled Substances Registration Certificate (QACSC), an NP may prescribe Schedules III-V controlled substances. Ala. Code §34-21-86, Ala. Code §20-2-253

Alabama does not have laws or regulations around POLST. Please see the Advance Directives Law for more information.

NPs are not explicitly recognized in state policy as primary care providers.

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Ala. Code §34-22-20

Optometrists may only administer an epinephrine autoinjector for treatment of anaphylaxis. Ala. Code §34-22-1(4)

Optometrists may prescribe Schedule III-V controlled substances. Ala. Code §34-22-1(4)

Alabama does not allow dental hygienists to practice with direct access.

Statute does not identify dental therapists as an oral health provider.

Alabama does not explicitly allow for the practice of teledentistry.

Alabama has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act does allow pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Alabama does not allow pharmacists to modify prescriptions.

Alabama does not allow pharmacists to prescribe hormonal contraceptives.

Alabama does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

The PA shall provide medical services within the education, training and experience of the PA that are delegated by the supervising physician. Supervision requires that there shall be at all times a direct, continuing and close supervisory relationship between the assistant to the physician and the physician to whom that assistant is registered but does not require direct onsite supervision at all times. ALA. ADMIN. CODE r. 540-X-7-.25(2)-(8); ALA. ADMIN. CODE r. 540-X-7-.01(10)

Subject to any limitations stated in protocols and medical regimens adopted by the board and subject to any limitations by the supervising physician in the approved formulary, a PA may prescribe any drug, substance or compound which is listed in Schedules III through V of the Alabama Uniformed Controlled Substance Act upon being granted a Qualified Alabama Controlled Substances Certificate (QACSC) and upon submission of an approved QACSC formulary. ALA. ADMIN. CODE r. 540-X-7-.28

Statute limits the number of PAs a physician may supervise.

The cumulative work time for all physician assistants being supervised by an individual primary supervising physician shall not exceed 360 hours per week (nine full-time equivalent positions) per week. The physician shall not supervise or collaborate with any combination of assistants to physicians, certified registered nurse practitioners, and/or certified nurse midwives exceeding 360 hours per week (nine full-time equivalent positions). ALA. ADMIN. CODE r. 540-X-7-.26(2), (4)-(7)

Chart co-signatures are required by statute to practice or prescribe as a PA.

Countersignature by supervising physician must be pursuant to established policy and/or applicable legal regulations and accreditation standards. ALA. ADMIN. CODE r. 540-X-7-.23(10)(a)(2)

Alabama does not explicitly allow adaptable proximity.

Physician supervision requires that there shall be at all times a direct, continuing and close supervisory relationship between the assistant to the physician and the physician to whom that assistant is registered but does not require direct onsite supervision at all times. ALA. ADMIN. CODE r. 540-X-7-.01(10)

The State Medical Board determines a PA’s scope of practice. The PA can provide medical services delegated by the supervisory physician within the education, training and experience of the PA. Ala. Admin. Code §540-X-7-.25