February 20, 2020

State Legislatures Consider Expanded Scope of Practice Provisions

Legislatures in nine states are weighing the merits of proposed legislation that would expand the scope of practice for advanced practice registered nurses, certified nurse midwives, physician assistants (PAs) and physical therapists. A bill in Ohio would go further by permitting PAs to perform fluoroscopy.

Alabama

Alabama’s Sen. Jim McClendon introduced S 114. It would allow patients to select a certified registered nurse practitioner or a certified nurse midwife as their health care provider within the scope of practice of the collaboration agreement between the physician and nurse or nurse midwife. The bill would also prohibit the Joint Committee of the Board of Medical Examiners and Board of Nursing for Advanced Practice Nurses from establishing a ratio of physicians to certified nurse practitioners or certified nurse midwives.

Hawaii

In Hawaii, HB 39 would create a new category of professional licensure called “assistant physicians.” This position would be filled by recent medical school graduates who have passed certain medical exams but have not been placed into a residency program. The assistant physician would work in a collaborative practice with a physician to provide primary care in medically underserved urban or rural areas. The bill was referred to the House Consumer Protection and Commerce Committee.

Illinois

In Illinois, HB 4692 and its companion bill, S 2758, would amend the Medical Practice Act and Physician Assistant Practice Act of 1987. The bills would allow a physician to collaborate with a physician assistant under the Physician Assistant Practice Act of 1987. The bills would encourage physicians to collaborate with physician assistants rather than delegating certain health tasks to provide medical care and grant physician assistants authority to practice medicine rather than perform specific procedures.
The House bill was referred to the House Rules Committee, while the Senate version was referred to the Senate Committees on Licensed Activities and Assignments.

Ohio

In Ohio, HB 492 was read in the House for a second reading and referred to the House Health Committee. It would remove the physician supervision requirement for physician assistants and replace it with a collaboration requirement. It would also permit PAs to perform fluoroscopic procedures for imaging guidance during diagnostic and therapeutic procedures, if the PA has completed a fluoroscopy course that includes:

  • 40 hours of training in the following topics: radiation physics, radiation biology, radiation safety, radiation management and any other topics the state medical board (the board) considers appropriate; and
  • 40 hours of clinical practice in performing fluoroscopic procedures, completed in collaboration with a physician; and
  • Any other requirements the board considers necessary to receive its approval.

Oregon

In Oregon, HB 4081 passed the House Health Care Committee. It would remove the requirement that a physician assistant practice under a supervising physician. The bill would require physician assistants to enter into collaboration agreements with physicians, podiatric physicians or qualified physician assistants. It defines a ‘qualified physician assistant’ as a physician assistant with at least 10,000 hours of clinical experience.

Rhode Island

In Rhode Island, HB 7234 would expand the scope of practice for physical therapists to include ordering diagnostic imaging and studies. The bill was scheduled but later postponed for a hearing before the House Health, Education and Welfare Committee. A companion bill, HB 7438 would define “diagnostic imaging” as X-ray imaging, but would not include CT scans, ultrasounds, bone scans, MRIs or PET scans. That bill was referred to the House Health, Education and Welfare Committee.

South Dakota

In South Dakota, S 50 passed both chambers. It would permit certified registered nurse anesthetists to order and interpret diagnostic procedures.\

Vermont

In Vermont, S 128 passed the Senate chamber and was referred to the House Health Care Committee. The bill would remove the requirement that a physician assistant practice under a supervising physician. It would replace the supervision with a practice agreement, which would include an agreement between the physician assistant and the practice-identified physician that the PA’s scope would be limited to medical care within the PA’s education, training and experience.

West Virginia

In West Virginia, HB 4734 was amended on the House floor. It would expand the scope of practice of advanced practice registered nurses to include ordering and interpreting diagnostic procedures.