ACP recognizes that issues related to licensure and scope of practice are becoming more predominant at both the state and federal levels. Chapters are being approached by other organizations with requests to join “scope of practice” state-based campaigns or otherwise comment on or support specific scope of practice bills at the state level.
ACP has developed this comprehensive issue brief as a resource for chapters dealing with scope of practice issues in their states. The issue brief is intended to give a broad overview of ACP policy on licensure and scope of practice that should empower chapters to join in efforts at the state level to influence state bills and laws that are not consistent with ACP policy on scope of practice, without having to get permission from ACP. This resource includes important questions that you should apply when considering scope of practice bills at the state level.
The College has extensive policy on licensure and scope of practice across many disciplines, as outlined below, and is included in numerous position papers as developed by ACP over the years. Links to all of those resources and position papers can be found at the end of this issue brief. ACP continues to partner with the American Medical Association, the American Academy of Family Physicians, and others on scope of practice issues, including opposing regulations to expand APN scope of practice in the VA system and to extend the Public Health Emergency expansions of scope of practice as so granted by the U.S. Department of Health and Human Services.
The federal government has significantly, expanded the role of non-physician health care professionals since the start of the COVID-19 pandemic.
On March 24, 2020, Health and Human Services (HHS) sent a letter to state governors with guidance on various actions they could take to address the COVID-19 public health emergency. The guidance included a request for states, territories, and the District of Columbia to take immediate action to “waive restrictions on licensure, scope of practice, certification, and recertification/relicensure consistent with the changes announced for federal programs.”
On August 8, 2022, CMS released a factsheet outlining its approach to re-establishing certain health and safety standards and other financial and program requirements once the COVID-19 public health emergency ends. April 21, 2020, the U.S. Veterans Health Administration (VHA) issued a directive allowing non-physician healthcare professionals in 32 specialties to operate “within the full scope of their license, registration, or certification” and encourages all VA medical facilities to allow CRNAs to practice without physician oversight during the national health emergency.
Legislations was also introduced in the 117th Congress to expand the scope of practice for nurse practitioners and pharmacists. The “Improving Care and Access to Nurses Act,” or the “I CAN Act,” (H.R. 8812) that would allow Medicare and Medicaid hospital inpatients to be under the care of a nurse practitioner without physician supervision. ACP expressed our concerns to Rep. Allard about the legislation. The “Equitable Community Access to Pharmacist Services Act” (H.R. 7213), would expand Medicare coverage to permanently include select services provided by a pharmacist in limited but significant ways (see joint opposition letter to legislators).
Many states have adopted or considered policies to modify their scope of practice laws for advanced practice registered nurse, physician assistance and other non-physician providers to increase access to care. So far, state legislators across the country have introduced over 150 bills that seek to expand scope of practice for nurse practitioners. The National Conference of State Legislators has an interactive map that provide information about the scope of practice laws in the 50 states, District of Columbia and territories.
Applying ACP Policy to State Scope of Practice Legislation
Chapters should consider the following questions when evaluating scope of practice legislation:
- Does it support or undermine physician-led clinical care teams?
- Does it recognize differences in the training and skills of physicians compared to other clinicians?
- Does it provide transparency on professional qualifications including use of the term “doctor”?
- Does it allow non-physician clinicians to practice at the full level of their training and skills within a dynamic clinical care team?
- Does it allow them to practice beyond their training and skills?
- Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position
- ACP New Vision Paper, Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms
- Understanding and Addressing Disparities and Discrimination Affecting the Health and Health Care of Persons and Populations at Highest Risk
- ACP letter to CMS Administrator Verma regarding scope of practice
- Joint letter to CMS regarding scope of practice requirements
- ACP Letter to the National Academy of Medicine Commenting on their National Plan for Health Workforce Well-being
- Position Statement on Pharmacist Scope of Practice
- Sign-On Letter Opposing Department of Veterans Affairs Interim Final Rule
- Team-Based Care Toolkit | Patient and Interprofessional Education
- Biden administration recently released guidance to allow "providers" licensed in one state to vaccinate people in other states
- ACP Scope of Practice Requirements During COVID-19 Toolkit
- Sec. Azar letter to state governors
- HHS Guidance to States: Lifting Restrictions to Extend the Capacity of the Health Care Workforce during the COVID-19 National Emergency
- CMS: Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19
- National Conference of State Legislators: 50-States Scope of Practice Landscape https://scopeofpracticepolicy.org/
- CMS Pandemic Plan