Telehealth Narcolepsy Prescribing: What Psychiatric NPs Can Do in North Carolina

You’re a psychiatrist or PMHNP managing ADHD, depression, anxiety — but now you have a patient with narcolepsy. They’re falling asleep at work, struggling to stay awake while driving, and desperately need medication management. Can you prescribe stimulants via telehealth? What about state restrictions? And how does your scope as an NP differ from an MD here?

If you’ve asked yourself any of these questions, you’re not alone. Narcolepsy isn’t a condition most mental health providers see daily — it affects roughly 1 in 2,000 Americans — but when these patients find you, they need specialized care that many primary care docs and even some neurologists aren’t equipped to provide via telehealth.

Here’s the reality: narcolepsy prescribing via telehealth is absolutely possible for both psychiatrists and PMHNPs — but the rules vary wildly by state, your provider type, and the specific medications involved. Let’s break down exactly what you can do, where you can do it, and how to stay compliant while helping these underserved patients.

Why Narcolepsy Patients Turn to Telehealth Psychiatry

Narcolepsy is a neurological sleep disorder, not a psychiatric condition — but here’s why it often lands in your lap: the primary treatments are controlled stimulants and wakefulness-promoting agents, the same medications you prescribe for ADHD. Many narcolepsy patients struggle to access sleep specialists (who are concentrated in major cities), face months-long wait times, or live in rural areas with zero local options.

When they discover you can prescribe modafinil, Adderall, or Ritalin via telehealth, you become their lifeline.

The challenge? Narcolepsy management is more complex than routine ADHD care. You’re dealing with:

• Higher stimulant doses (often 40-60mg+ of amphetamines daily)
• Polypharmacy (combining wake-promoting agents with nighttime sedatives for cataplexy)
• Schedule II controlled substances with strict prescribing rules
• REMS programs for medications like sodium oxybate (Xyrem/Xywav)
• Prior authorizations that require sleep study documentation
• State telehealth restrictions that may limit Schedule II prescribing

And if you’re a PMHNP? Your prescribing authority for these meds depends entirely on which state you’re licensed in.

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Federal Telehealth Rules: The Current Landscape (2025-2026)

Let’s start with the good news: As of early 2026, psychiatrists and PMHNPs can still prescribe Schedule II-V controlled substances via telehealth without an initial in-person exam, thanks to pandemic-era DEA flexibilities extended through at least the end of 2025.

This means you can:

• Conduct initial evaluations entirely via video
• Prescribe Adderall, Ritalin, modafinil, or other narcolepsy meds remotely
• Manage medication titration and follow-ups virtually

But this flexibility has an expiration date. The DEA and HHS extended these rules through December 2025, with ongoing discussions about permanent implementation. After this extension expires, providers may need to:

• Conduct at least one in-person exam within a specific timeframe
• Register for a special DEA telemedicine certification
• Comply with stricter state-level telehealth requirements

What this means for your practice: Stay alert to DEA updates. If you’re building a narcolepsy telehealth practice in 2026, have a backup plan for potential in-person requirements — whether that’s partnering with local clinics or requiring patients to see a PCP for an initial physical exam before you take over medication management.

Psychiatrist Scope: What MDs and DOs Can Do

If you’re a board-certified psychiatrist (MD or DO), you have full prescriptive authority for narcolepsy in every state, subject only to your DEA registration and state medical board requirements. This includes:

• All Schedule II stimulants (amphetamine, methylphenidate, dextroamphetamine)
• Schedule IV wake-promoting agents (modafinil, armodafinil)
• Newer narcolepsy medications (pitolisant, solriamfetol)
• Sodium oxybate (Schedule III, requires REMS enrollment)
• Off-label adjuncts (antidepressants for cataplexy, nighttime sedatives)

Your Telehealth Workflow as a Psychiatrist

Initial Evaluation (30-45 minutes):

1. Verify the narcolepsy diagnosis — most patients will need documentation of a sleep study (polysomnography with MSLT showing reduced sleep latency)
2. Review comorbid conditions (depression, anxiety, ADHD are common)
3. Obtain baseline vitals remotely (many patients have home BP monitors)
4. Check your state’s PDMP before prescribing controlled substances (legally required in most states)
5. E-prescribe via EPCS-compliant system (paper scripts aren’t feasible for telehealth)

Follow-Up Visits (15-20 minutes monthly):

• Update symptom scales (Epworth Sleepiness Scale)
• Review medication adherence and side effects
• Monitor blood pressure and weight (stimulants can increase both)
• Adjust doses or switch medications as needed
• Screen for misuse (though narcolepsy patients rarely abuse their meds — they need them to function)

Documentation Requirements:

• Maintain records as if in-person
• Document PDMP checks with each controlled substance prescription
• Use diagnosis codes G47.411 (narcolepsy with cataplexy) or G47.419 (without cataplexy)
• Note rationale for dose changes or polypharmacy

State-Specific Restrictions for Psychiatrists

While you have prescriptive authority everywhere, state telehealth laws can restrict how you prescribe. The big outlier:

Florida — Even as an MD, you technically cannot prescribe Schedule II stimulants via telehealth for narcolepsy because Florida law limits telemedicine controlled substance prescribing to psychiatric disorders, inpatient settings, hospice care, or chronic pain management. Since narcolepsy is neurological, not psychiatric, strict interpretation means you’d need an in-person visit or use Schedule IV alternatives (modafinil).

Workarounds in Florida:

• Start with modafinil or armodafinil (Schedule IV, allowed via telehealth)
• If the patient also has ADHD, you might prescribe stimulants under the psychiatric disorder exception
• Coordinate an initial in-person exam with a local provider before prescribing Schedule II long-term

Other states like Texas, California, Illinois, New York, and Pennsylvania allow psychiatrists to prescribe narcolepsy meds via telehealth with no additional restrictions beyond federal requirements and PDMP checks.

PMHNP Scope: Where You Can (and Can’t) Prescribe Narcolepsy Meds

This is where state laws diverge dramatically. As a PMHNP, your ability to independently manage narcolepsy depends on your state’s scope-of-practice regulations, your experience level, and whether you have a collaborative agreement with a physician.

Full Practice Authority States (Independent NP Practice)

California — After completing 4,600 hours (roughly 3 years) in a group practice setting as a ‘103 NP,’ you can apply for ‘104 NP’ status starting in 2026, granting full independent practice authority. Until then, you need physician-supervised standardized procedures. California NPs can prescribe Schedule II-V controlled substances once they meet requirements.

New York — After accumulating 3,600 clinical hours (about 2 years), PMHNPs can practice and prescribe completely independently with no collaborative agreement required. This includes all narcolepsy medications. New York requires all prescribers to check the I-STOP PDMP before every controlled substance prescription.

Illinois — After 4,000 hours + 250 hours of pharmacology CE, you can obtain Full Practice Authority certification. Illinois FPA-certified PMHNPs can prescribe Schedule II-V independently, with two exceptions that don’t affect narcolepsy:

• Schedule II opioids require physician consultation (monthly documentation)
• Benzodiazepines beyond 120 days require physician consultation

Since narcolepsy meds are stimulants (not opioids) or Schedule IV wake-promoters (not benzos), you have full autonomy.

Restricted Practice States (Physician Collaboration Required)

Texas — This is the most restrictive state for PMHNPs treating narcolepsy. Texas law:

• Requires a Prescriptive Authority Agreement with a supervising physician
• Prohibits NP prescribing of Schedule II drugs except in hospital inpatient or hospice settings

What this means: You cannot prescribe Adderall or Ritalin for outpatient narcolepsy patients as a Texas NP. Your supervising physician would need to write those prescriptions. You can prescribe modafinil (Schedule IV) under your PAA, up to 90-day supplies with physician consultation for refills.

Florida — PMHNPs must practice under a collaborative agreement with a psychiatrist (the 2020 autonomous practice law excluded psychiatric NPs). Florida NPs can prescribe Schedule II, but with a 7-day supply limit unless you’re a state-certified ‘psychiatric nurse’ prescribing for psychiatric disorders.

For narcolepsy (a neurological condition), you’d be writing a new 7-day prescription every week — creating massive administrative burden. Most Florida PMHNPs rely on their collaborating psychiatrist to prescribe ongoing stimulant therapy or stick with modafinil.

Pennsylvania — Requires a collaborative agreement with a physician. Pennsylvania NPs can prescribe Schedule II for up to 30 days and Schedule III-IV for up to 90 days. Any quantities beyond that require physician involvement. This aligns well with standard monthly follow-ups for stimulant management, making PA more workable than Florida or Texas for NPs treating narcolepsy.

What This Means for Your Practice

If you’re a PMHNP in New York, Illinois, or California (by 2026) with the required experience, you can build a narcolepsy telehealth practice virtually identical to a psychiatrist’s — full prescriptive authority, independent decision-making, and no mandatory physician oversight.

If you’re in Texas, Florida, or Pennsylvania, you’ll need a collaborative physician willing to:

• Sign off on or directly prescribe Schedule II medications (Texas)
• Review your practice regularly and maintain formal agreements
• Be available for consultation on complex cases

The business reality: Platforms hiring PMHNPs in restricted states must either provide collaborating physicians or limit your scope to Schedule IV alternatives and psychiatric comorbidities. That’s why state licensure strategy matters when choosing where to practice telehealth.

Medication Management: Clinical and Economic Realities

Managing narcolepsy medication requires more frequent touchpoints than routine psychiatric care — typically monthly visits during titration and every 3 months minimum for stable patients (aligning with insurance requirements and controlled substance prescription limits).

Common Medication Scenarios

Starting Treatment:

• First-line is often modafinil/armodafinil (200-250mg daily) — Schedule IV, easier insurance approval
• If insufficient, escalate to amphetamine stimulants (20-60mg daily in divided doses)
• For narcolepsy with cataplexy, add sodium oxybate (Xyrem/Xywav) — requires REMS enrollment

Medication Challenges:

• Prior authorizations — Insurers typically require sleep study documentation for any narcolepsy med
• Supply limits — Schedule II scripts need monthly refills (no refills allowed federally)
• The ongoing Adderall shortage (since mid-2022) — you’ll frequently need to switch patients between amphetamine formulations or pharmacies
• High costs — Newer agents like pitolisant or solriamfetol can cost $1,000+ monthly without insurance

Reimbursement: What You’ll Actually Get Paid

For Psychiatrists:

• Typical follow-up visit: 99213 ($80-$110) or 99214 ($110-$160) depending on complexity
• Initial evaluation: 99204/99205 ($180-$250)
• Monthly management generates roughly $1,000-$1,500 per patient annually

For PMHNPs:

• Medicare reimburses at 85% of physician fee schedule when you bill under your own NPI
• Private insurers increasingly pay NPs at parity with MDs, though mental health providers overall receive 22% less than other specialists in many markets

Telehealth parity laws in states like California, Illinois, and New York ensure you’re reimbursed the same as in-person visits. However, many psychiatrists have opted out of insurance panels due to low reimbursement and administrative burden — a viable strategy for narcolepsy care given patients’ desperation for access.

Cash-pay model: Monthly follow-ups at $150-$200 out-of-pocket can work well. Patients get immediate access and prescriptions, you avoid insurance bureaucracy, and the economics are straightforward.

Practical Compliance: PDMP, EPCS, and Documentation

Every state now requires Prescription Drug Monitoring Program (PDMP) checks before prescribing controlled substances. For narcolepsy:

• Check the database before initial prescription
• Re-check at regular intervals (varies by state — some require every prescription, others quarterly)
• Document your PDMP review in the patient chart

E-prescribing is mandatory for controlled substances in most states. You’ll need:

• DEA-compliant Electronic Prescribing for Controlled Substances (EPCS) software
• Two-factor authentication for every controlled substance prescription
• Integration with your EHR/telehealth platform

Red flags to monitor:

• Patient requesting early refills consistently
• Obtaining similar medications from multiple providers (PDMP will show this)
• Diversion behaviors (though rare in narcolepsy patients)

If you identify misuse, your obligation is to taper, refer, or discontinue — document your clinical reasoning thoroughly.

State-by-State Comparison: Where Can You Practice?

The Klarity Health Advantage: Why Treating Narcolepsy Makes Sense

Most psychiatrists and PMHNPs stumble into narcolepsy care by accident — a patient mentions their sleep study, or they’re already on stimulants and need management. But there’s a compelling business case for intentionally adding narcolepsy to your scope:

1. Massive unmet demand. Narcolepsy patients face months-long waits for sleep specialists and often can’t access local care. You’re filling a critical gap.

2. Long-term, stable patients. Unlike acute psychiatric crises, narcolepsy is a chronic condition requiring ongoing medication management. Patients stay in your panel for years, providing predictable revenue.

3. Straightforward medication management. Most visits are 15-20 minutes, medication-focused, and highly reimbursable. No extensive therapy, no crisis management — just clinical pharmacology.

4. Low patient acquisition cost on the right platform. Here’s where most providers waste money: trying to DIY your marketing.

The Real Economics of Patient Acquisition

Let’s be brutally honest about what it costs to acquire psychiatric patients through traditional channels:

DIY Marketing Costs:

• SEO: 6-12 months of consistent investment ($2,000-$5,000/month for agency or consultant) before meaningful traffic. Most solo providers don’t have the expertise or patience.
• Google Ads: Mental health keywords cost $15-$40+ per click. Realistic cost per booked patient is $200-$400+ after factoring in clicks that don’t convert, no-shows, and optimization time.
• Psychology Today listings: $30-$60/month subscription, but you’re competing with hundreds of providers on the same page in major metros. Conversion rates are low.
• Zocdoc: $35-$100+ per booking, plus monthly subscription fees. Adds up fast.

Total all-in cost per patient through DIY channels: $200-$500+ when you factor in agency fees, failed campaigns, ad spend testing, staff time to qualify leads, and months before ROI.

The Klarity Health model eliminates this gamble entirely:

• Pay-per-appointment — You only pay a standard listing fee when a qualified patient books with you
• No upfront marketing spend — Zero monthly subscriptions or ad budget required
• Pre-qualified patients — Already matched to your specialty, availability, and licensed states
• Built-in telehealth infrastructure — No separate platform costs, EHR integration, or tech overhead
• Both insurance and cash-pay patient flow, depending on your preferences

Here’s the math: Instead of spending $3,000-$5,000/month on marketing with uncertain results, you pay only when you see patients. That’s guaranteed ROI versus gambling on marketing channels you don’t have time to manage.

For narcolepsy specifically, patients are searching desperately for providers who understand their condition and can prescribe their medications. They’re motivated, they book quickly, and they stay long-term. On our platform, you get matched with these patients without spending months building an SEO presence or burning cash on PPC ads that may never convert.

The alternative: Spend 6-12 months and $30,000-$60,000 building your own patient pipeline through SEO and ads, hire a marketing agency, manage ad campaigns, handle unqualified leads, and hope it eventually works — or join a platform that delivers qualified patients tomorrow.

For most providers (especially those starting out or scaling), the choice is obvious.

How to Get Started: Joining a Narcolepsy-Ready Telehealth Platform

If you’re ready to add narcolepsy management to your practice, here’s what you need:

✓ State licensure in states where you want to practice (multi-state licensure is key for telehealth volume)

✓ DEA registration with EPCS capability

✓ Understanding of your state’s scope and collaborative requirements (use the table above)

✓ Familiarity with narcolepsy medications and titration protocols (if you prescribe ADHD meds, you’re 90% there)

✓ A platform that handles the heavy lifting: patient acquisition, scheduling, billing, PDMP integration, and compliance

That’s where Klarity Health comes in. We’ve built a telehealth platform specifically designed for psychiatrists and PMHNPs to deliver high-quality medication management — including for underserved conditions like narcolepsy. Our providers don’t waste time marketing or fighting with insurance; they focus on clinical care while we handle patient flow, tech infrastructure, and administrative support.

Whether you’re a psychiatrist with full prescriptive authority or a PMHNP navigating collaborative agreements, we match you with patients who need your expertise and ensure you’re practicing within your state’s legal scope.

Ready to explore how Klarity Health can streamline your narcolepsy practice? Visit our provider network page to learn more about joining a platform that values your clinical skills and eliminates the patient acquisition headache.

Frequently Asked Questions

Can psychiatrists prescribe narcolepsy medications via telehealth?

Yes. Psychiatrists (MD/DO) can prescribe all narcolepsy medications — including Schedule II stimulants like Adderall and Ritalin — via telehealth in every state, subject to federal DEA rules and state telehealth laws. As of 2026, the DEA’s pandemic-era flexibilities (extended through at least end of 2025) allow controlled substance prescribing without an initial in-person exam. Some states like Florida have additional telehealth restrictions on Schedule II prescribing for non-psychiatric conditions, which may require workarounds (using Schedule IV alternatives or coordinating an in-person visit).

Can PMHNPs prescribe stimulants for narcolepsy independently?

It depends entirely on your state. PMHNPs in full-practice states like New York, Illinois, and California (with required experience and certifications) can prescribe stimulants independently. In restricted states like Texas, NPs cannot prescribe Schedule II drugs in outpatient settings at all — you’d need your collaborating physician to write those prescriptions. In Florida, NPs can prescribe Schedule II but only for 7-day supplies (unless it’s a psychiatric medication), creating significant administrative burden. Check your state’s nurse practice act and scope-of-practice rules.

What’s the difference between narcolepsy prescribing and ADHD prescribing?

Clinically, narcolepsy patients often require higher stimulant doses and may use polypharmacy (combining wake-promoting agents with nighttime medications for cataplexy). Legally, there’s no difference in prescribing authority — the same controlled substance regulations apply. However, narcolepsy requires documentation of a sleep study diagnosis (polysomnography with MSLT), whereas ADHD is typically diagnosed clinically. Insurance prior authorizations for narcolepsy meds also require more extensive documentation than ADHD medications.

Do I need to be a sleep specialist to treat narcolepsy?

No. While sleep specialists (typically neurologists or pulmonologists with fellowship training) diagnose narcolepsy via polysomnography, psychiatrists and PMHNPs are fully capable of managing the medication component once the diagnosis is confirmed. Many narcolepsy patients receive their diagnosis from a sleep center but then need ongoing prescribing and titration — which you can provide via telehealth. Collaboration with sleep specialists is helpful for complex cases or when cataplexy management requires specialized input.

What are the PDMP requirements for narcolepsy prescribing?

Nearly all states require prescribers to check the state Prescription Drug Monitoring Program before prescribing controlled substances. For narcolepsy, you must query the PDMP at least before initial prescription and at intervals specified by state law (some states require checks with every controlled substance prescription; others quarterly or semi-annually). Document your PDMP review in the patient’s chart. PDMP checks help identify any concerning patterns like overlapping prescriptions from multiple providers or early refill requests.

How do I handle prior authorizations for narcolepsy medications?

Most narcolepsy medications — especially newer agents like Sunosi, Wakix, or sodium oxybate — require prior authorization from insurance. You’ll need to submit documentation including:

• Confirmed narcolepsy diagnosis (sleep study results)
• Previous medication trials (insurers often require stimulants or modafinil first)
• Clinical rationale for the specific medication requested

This paperwork can take 30-60 minutes per patient and is typically unpaid administrative work. Some platforms (like Klarity Health) have support staff who help with prior authorizations, reducing your burden. If prior auth is denied or delayed, starting with modafinil (often easier to approve) or cash-pay options can bridge the gap.

Sources and Citations

All regulatory and clinical information in this article has been verified against current federal and state sources as of early 2026:

1. Axios – ‘COVID-era telehealth prescribing extended again for Adderall’ (Nov 18, 2024) – Reports DEA/HHS extension of telehealth controlled substance flexibilities through end of 2025. www.axios.com

2. Texas Medical Board – FAQ on Schedule II delegation under physician supervision – Confirms Texas NPs/PAs can only prescribe Schedule II in hospital inpatient or hospice settings. www.tmb.state.tx.us

3. California Board of Registered Nursing – AB 890 Implementation (2024) – Details 103 NP and 104 NP pathways to independent practice, effective 2023-2026. www.rn.ca.gov

4. Florida Statutes – Section 464.012 (Nurse Practice Act, 2021 compilation) – Establishes 7-day Schedule II prescribing limit for APRNs with psychiatric nurse exception. www.flsenate.gov

5. Rivkin Radler LLP – ‘New Law Allows Experienced NPs to Practice Independently in NY’ (Apr 13, 2022) – Summarizes NY 2023 budget law eliminating collaborative agreement requirement after 3,600 hours. www.rivkinrounds.com

6. 49 Pa. Code §21.284 – Pennsylvania Code (prescribing limitations for NPs, current through Oct 2025) – Specifies 30-day Schedule II and 90-day Schedule III-IV limits for CRNPs. www.pacodeandbulletin.gov

7. 225 ILCS 65/65-43 – Illinois Nurse Practice Act (Full Practice Authority provisions, effective Jan 2018) – Details FPA certification requirements and consultation rules for Schedule II narcotics and benzodiazepines. www.ilga.gov

8. KFF Health News (via MedicalXpress) – ‘Narcolepsy patients face dual nightmare of medication shortages and stigma’ (Jan 3, 2024) – Reports narcolepsy prevalence (~1 in 2,000), ongoing Adderall shortage impacts, and patient access challenges. medicalxpress.com

9. Axios San Antonio – ‘Texas churches respond to mental health access crisis’ (Aug 7, 2024) – Cites Mental Health America data ranking Texas last nationally for mental health access and workforce availability. www.axios.com

10. Axios Chicago – ‘Illinois bill could make mental health care more affordable’ (Mar 6, 2025) – Reports private insurers pay mental health providers 22% less than other physicians on average; discusses IL legislative efforts to address reimbursement gaps. www.axios.com

11. Clinical Advisor – ‘Is Medicare’s 85% reimbursement rule fair?’ (Feb 10, 2012) – Explains Medicare’s long-standing policy of reimbursing nurse practitioners at 85% of physician fee schedule rates. www.clinicaladvisor.com

12. National Law Review – ‘New Florida Law Allows Telemedicine Prescribing of Controlled Substances’ (Apr 7, 2022) – Analyzes Florida SB 312, which permits telehealth prescribing of Schedule III-V while maintaining Schedule II restrictions except for psychiatric treatment, inpatient, hospice, or chronic pain. natlawreview.com

13. New York State Education Department – Nurse Practitioner Practice Issues: Collaborative Practice with Physicians (Feb 2013, updated) – Official guidance on NY collaborative agreement requirements and practice protocols for NPs. www.op.nysed.gov

14. Psychiatric Services Journal (via Axios, Aug 2023) – Projects psychiatrist workforce shortage of up to 31,000 by 2024; notes over 160 million Americans live in mental health professional shortage areas. www.axios.com

All sources were accessed and verified as current as of February 2026. Federal and state regulatory citations reflect laws in effect at time of publication, though providers should always verify current requirements with their state boards and DEA regulations, particularly regarding telehealth controlled substance prescribing rules that may change after the December 2025 extension expires.

Source:

• https://www.axios.com/2024/11/18/covid-telehealth-prescribing-extended-adderall#:~:text=The%20Drug%20Enforcement%20Administration%20and,person%20doctor%27s%20visit%20for%20the
• https://natlawreview.com/article/new-florida-law-allows-telemedicine-prescribing-controlled-substances#:~:text=controlled%20substances%20via%20telemedicine%2C%20with,more%20on
• https://www.ilga.gov/legislation/ILCS/details?ActID=1312&ActName=Nurse+Practice+Act.&ChapAct=225+ILCS+65%2F&Chapter=&ChapterID=24&MajorTopic=&Print=True&SeqEnd=17850000&SeqStart=16500000#:~:text=,drugs%2C%20such%20as
• https://www.ilga.gov/legislation/ILCS/details?ActID=1312&ActName=Nurse+Practice+Act.&ChapAct=225+ILCS+65%2F&Chapter=&ChapterID=24&MajorTopic=&Print=True&SeqEnd=17850000&SeqStart=16500000#:~:text=,require%20a%20physician%20name%3B
• https://www.rivkinrounds.com/2022/04/new-law-allows-experienced-nps-to-practice-independently-in-ny/#:~:text=New%20York%E2%80%99s%202023%20state%20budget%2C,practice%20without%20a%20collaborative%20relationship
• https://www.rn.ca.gov/practice/ab890.shtml#:~:text=%2A%20103%20NP%20,focus%20of%20their%20National%20Certification
• https://www.rn.ca.gov/practice/ab890.shtml#:~:text=Please%20note%2C%20the%20law%20requires,certify%20104%20NPs%20until%202026
• https://www.tmb.state.tx.us/274-who-can-prescribe-schedule-ii-drugs-under-physician-delegation#:~:text=1.%20in%20a%20hospital%20facility,has%20elected%20to%20receive%20hospice
• https://www.flsenate.gov/Laws/Statutes/2021/Chapter464/All#:~:text=match%20at%20L1566%20limit%20the,455
• https://www.pacodeandbulletin.gov/Display/pacode?file=%2Fsecure%2Fpacode%2Fdata%2F049%2Fchapter21%2Fs21.284.html#:~:text=,may%20not%20delegate%20prescriptive%20authority