January 17, 2024

Scope of Practice Legislation Continues to Be Introduced at the State Level

States continue to introduce legislation ranging from scope of practice to licensure.

Scope of Practice


Senate Bill (SB) 24-018 would enjoin the state of Colorado into the physician assistant (PA) licensure compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.


Senate Study Bill 1142 would repeal the requirement that a PA practice under the supervision of a licensed physician.


SB 167 would require PAs to have a collaboration agreement, rather than a delegation agreement, with a physician.


House Docket 4731 would direct some insurance plans in the Commonwealth of Massachusetts to not make a distinction, for the purposes of participation, coverage and payment, between physicians and advanced practice registered nurses (APRNs).

New York

Assembly Bill (AB) 7725 would allow PAs to serve as primary care practitioners for Medicaid-managed care plans.

SB 6873 would enjoin the state of New York into the interstate nurse licensure compact and the advanced practice registered nurse compact. These compacts would allow individuals who meet certain eligibility requirements to practice in other compact states.

SB 5520 & AB 5012 would allow a PA to perform medical services with the supervision of a physician, once the PA has practiced for more than 3,600 hours. If passed, this bill would expire two years after implementation.

AB 4150 would allow a chiropractor to order and perform X-ray and diagnostic imaging studies but would not allow chiropractors to use ionizing radiation sources for radiotherapy.

Rhode Island

House Bill (HB) 7083 would enjoin the state of Rhode Island into the PA licensure compact.


SB 1727 would enjoin the state of Tennessee into the PA licensure compact.


HB 572 would enjoin the state of Vermont into the PA licensure compact.


HB 983 and HB 971 would lower from five years to two years the amount of full-time clinical experience required before an APRN may practice without a practice agreement.


HB 1417 would enjoin the state of Washington into the nurse licensure compact. This compact allows nurses who meet its eligibility requirements to practice in other compact states.

HB 1917 would enjoin the state of Washington into the PA licensure compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.

SB 5633 would require a PA to enter into a collaboration, rather than a practice agreement with a physician or group of physicians.


AB 154 would allow an APRN to practice without physician supervision if the APRN has completed 3,840 clinical hours.

AB 954 and SB 900 would allow the Wisconsin Medical Examining Board and the Physician Assistant Affiliated Credentialing Board to issue provisional licenses to certain internationally trained physicians and PAs.

Out-of-Network / Surprise / Balance Billing


HB 30 and SB 217 would conform provisions of Maryland state health insurance law with existing federal requirements, including: updating effective dates for federal regulations, clarifying federal consumer protection regulations resulting from changes to the federal No Surprises Act, altering the material errors that trigger special enrollment periods, and authorizing the Maryland Health Benefits Exchange to adopt an expanded open enrollment period under certain circumstances.


SB 1762 would require insurers to notify beneficiaries that nonparticipating providers may bill members for any amount up to the billed charge after the plan has paid its portion. This bill also states that a provider may not charge or collect from a Medicare beneficiary, insured or enrollee any amount over the Medicare-approved amount for any Medicare-covered item or service provided.



SB 1674 would direct the Bureau of TennCare (Tennessee’s Medicaid program) to modify their rules to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests utilizing established CPT® codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient's provider and the same standard of care is met.



SB 351 and HB 978 would move the profession and licensure of APRNs and licensed certified midwives (CNM) from being licensed jointly by the Board of Medicine and the Board of Nursing to being licensed by the Board of Nursing only.

The American College of Radiology® (ACR®) has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology and healthcare-related legislation. To stay current on state legislative developments relevant to radiology, view the ACR policy map.

For more information about state legislative activities, contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.