Utah: Ownership and Oversight
Permissive: NP FPA (2023, no transition) + tiered PA independence at 10,000 hours. Utah eliminated the NP-physician contract entirely in 2023 with no transition period at all, and runs PAs through a three-tier hours system ending in genuine independence, with a separate hard track for mental health.
Who the statute actually covers
- NP full practice authority (SB 36, signed March 2023): the state-mandated physician contract was eliminated as a condition of licensure; no transition-to-practice hours; NPs evaluate, diagnose, prescribe (controlled substances with Utah CS license + DEA), and sign death certificates and DNRs under Board of Nursing authority alone. Utah has enacted the APRN Compact. PMH-APRN licensure has its own supervised-hour prerequisites on the front end.
- PA three-tier system (Utah Code § 58-70a-307 et seq.; SB 27/SB 28, 2021): under 4,000 hours (non-mental-health): collaboration per written practice-level policies; 4,000–10,000 hours: written collaboration agreement with a physician or a PA with 10,000+ hours in the same specialty; documents kept at the practice; 10,000+ hours: no collaboration agreement, full independence, unless the PA changes specialty (then 4,000 collaborative hours in the new specialty).
- Mental health PA track (SB 28): psychiatry CAQ, doctorate-level and post-graduate psychiatric coursework, supervised psychotherapy hours, and 10,000 clinical hours through psychiatrist supervision and collaboration phases before independent mental-health practice.
- Regulatory watch: Utah's Office of Professional Licensure Review (Jan. 2026 PA report) recommended cutting the PA threshold to 8,000 hours and flagged the state's ketamine and IV-hydration clinic landscape as under-developed, including whether advanced practitioners can operate such clinics independently. Expect movement.
1. Who can own what
| Entity / Path | Who may own | Key limits |
|---|---|---|
| Practice entities | Utah has no broadly enforced CPOM doctrine; professional entities available but ordinary structures and lay involvement are common, policed through DOPL rather than entity law. | Confirm structures with Utah counsel; permissive is not unregulated. |
| NP-owned practice | Fully independent from licensure; no physician relationship at any stage. | Cleanest NP-ownership state in this series alongside Arizona. |
| PA-owned practice | Feasible, tier-dependent: a 10,000-hour PA operates independently; sub-threshold PA owners still need collaboration documents in the building. | For IV-hydration or ketamine concepts, treat OPLR's warning as the compliance headline. |
| Lay / MSO | Low-friction; standard fee and referral rules apply. |
2. Collaborative and supervisory oversight
| Role | Agreement required | Oversight mechanics | Path to independence |
|---|---|---|---|
| PA | Tiered: under 4,000 hours, practice-level written policies; 4,000–10,000 hours, written collaboration agreement (physician or 10,000-hour same-specialty PA); 10,000+ hours, none. | No ratio at any tier; "collaboration" defined as mutual awareness of qualifications, consultation, and physician direction, with the PA responsible for the care provided. | Yes: 10,000 hours (potentially 8,000 if OPLR recommendation is enacted), resetting only on specialty change. Mental health PAs follow the separate SB 28 track. |
| NP | None. No agreement, protocol, transition period, ratio, or chart review at any career stage since SB 36 (2023). | Controlled-substance prescribing per Utah CS license and DEA registration; PMH-APRN licensure has front-end supervised-hour requirements. | Independent from licensure. |
3. Primary authorities
- SB 36 (2023); Utah Code § 58-31b (Nurse Practice Act); APRN Compact.
- Utah Code § 58-70a-307, § 58-70a-501.1; SB 27 and SB 28 (2021).
- Utah OPLR, 2025 Periodic Review: Physician Assistants (pub. Jan. 2026).
Practical read: Utah is the most founder-friendly state in the interior West, and the PA tier system is its signature: a 10,000-hour PA is genuinely independent, and even the middle tier can satisfy collaboration through a senior PA rather than a physician. The caution flag: Utah's own regulator says the IV-hydration and ketamine clinic rules are unsettled, so aggressive advanced-practice-owned models there should be built conservatively and re-checked against DOPL guidance each cycle.
General education, not legal advice.