The short version. A weight-management practice delivering care through CRNPs across two Alabama locations
needed collaboration that actually satisfied Rule 540-X-8-.08. Alabama does not measure that in
signatures. It measures it in hours on site, meetings on a schedule, and visits to every remote
practice site — which is exactly where a two-location operator gets caught.
What this is. A real MDside engagement, described without naming the client. No client name, location, ownership or commercial terms appear here, and nothing below identifies the practice. It is not a client case study and it is not a testimonial: the client has not endorsed us and is not quoted. The regulatory points are cited at the foot of the page.
Why two locations changes the arithmetic
Most collaboration arrangements are written as though the practice has one address. Alabama does not assume that. Its rule contemplates remote practice sites and imposes a separate obligation to visit them, which means a second location is not a second copy of the first arrangement — it is an additional, independently verifiable duty.
The operator’s exposure here is asymmetric. If the collaboration fails at one site, it is the physician’s licence in front of the Board, and the practice loses the ability to deliver care at both.
What Alabama actually requires
- Ten percent presence. Under Alabama Board of Medical Examiners Administrative Code Rule 540-X-8-.08, the collaborating physician must be present for not less than ten percent of the CRNP’s scheduled hours in an approved practice site while that CRNP is inside the two-year or 4,000-hour window.
- Quarterly meetings after that window. Not annual, not on request.
- Visits to remote practice sites no less than twice annually — the provision that a single-site agreement silently fails once a second location opens.
- Certain settings are excluded from the minimum presence hours, which matters when calculating whether the ten percent has genuinely been met.
None of this is satisfied by a physician who is reachable by phone. It is satisfied by a physician whose calendar has the practice in it.
How the coverage was structured
- A collaborating physician licensed in Alabama with genuine availability for on-site hours at both locations, rather than one who could cover the arrangement only on paper.
- A written schedule tracking the presence percentage against each CRNP’s actual hours, so the ten percent is a measured figure and not an assumption.
- Site-visit scheduling for both locations against the twice-annual minimum, documented at the time rather than reconstructed later.
- Protocols written for weight management specifically — GLP-1 prescribing decisions, what triggers escalation, what the CRNP may not do without the physician.
The documentation is the deliverable. An arrangement that met the requirements but could not prove it two years later is, from a Board’s point of view, the same as one that did not.
What we would tell an operator opening a second site
- Re-read the collaboration agreement before the second location opens, not after.
- Confirm your physician can actually deliver the on-site hours at both, and price that time honestly — a director who cannot attend is the failure mode Alabama’s rule exists to catch.
- Track presence hours contemporaneously. Reconstruction is not evidence.
- Treat the twice-annual site visit as a scheduled obligation with a record, not a courtesy call.
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Frequently asked questions
Does the ten percent apply forever?
No. It applies while the CRNP is inside the two-year or 4,000-hour window. After that the obligation shifts to quarterly meetings and the remote-site visits, which continue.
Do both locations need their own site visits?
The rule requires visits to remote practice sites no less than twice annually. A second location is a second site for that purpose.
Can one physician collaborate across multiple practices?
Alabama places limits on collaborative arrangements, and the practical constraint arrives sooner than the legal one: a physician who has committed ten percent of several CRNPs’ scheduled hours has committed real time. Check both.
Sources. Alabama Board of Medical Examiners Administrative Code Rule 540-X-8-.08 (collaborating physician presence, quarterly meetings, and visits to remote practice sites). Engagement details are generalised and no client is identified.
General information, not legal advice. This page describes a real engagement without identifying the client. Confirm your own position with healthcare counsel licensed where you operate.