March 12, 2020

Nine States Consider Expanded Scope of Practice

Several state legislatures advanced legislation that would expand the scope of practice for advanced practice registered nurses (APRNs), certified nurse midwives, physician assistants (PAs) and physical therapists. Bills in California and Oregon would change the physician supervision requirement to a collaborative agreement with PAs and certified nurse midwives.


In Alabama, S 114 passed the Senate and is scheduled for a hearing before the House Health Committee. 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 Advance Practice Nurses from establishing a ratio of physicians to certified nurse practitioners or certified nurse midwives. If passed, the bill would prohibit physicians from collaborating with more than nine certified registered nurse practitioners, certified nurse midwives or physician assistants.


In California, S 1237 was referred to the Senate Committee on Business, Professions and Economic Development. It would remove the supervision physician requirement for certified nurse midwives and would allow them to order, obtain and administer diagnostic tests.


In Florida, HB 607 is scheduled for a hearing before the Senate Appropriations Committee. The bill would define "autonomous physician assistant" as a physician assistant who can practice primary care without physician supervision. It would also revise the definition of “health care provider” to include an autonomous physician assistant and “practitioner” to include advanced practice registered nurses registered to engage in autonomous practice.


In Georgia, HB 1092 would grant APRNs the authority to order radiographic imaging tests. The bill would also increase the ratio of physicians-to-APRNs from one-to-four to one-to-six. The bill passed the House Committee on Regulated Industries.


In Missouri, HB 2583 would allow advanced practice registered nurses to order and interpret diagnostic procedures. The bill would also allow licensed APRNs to practice outside of a collaborative practice arrangement if the APRN has practiced advanced practice nursing for at least six months.


In Oregon, HB 4081 passed the House chamber. It would remove the requirement that a physician assistant provide clinical services under the guidance of a supervising physician. The bill would require PAs 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 is scheduled for a hearing before the House Health, Education and Welfare Committee. The bill would expand the scope of practice for physical therapists to include ordering diagnostic imaging and studies.

South Dakota

South Dakota’s Gov., Kristi Noem, signed S 50 into law. It will permit certified registered nurse anesthetists to order and interpret diagnostic procedures.

West Virginia

In West Virginia, HB 4734 was referred to the Senate Health and Human Resources Committee. It would expand the scope of practice of APRNs to include ordering and interpreting diagnostic procedures.