Toolkit: Policy and Advocacy on Scope of Practice

Published: 7/25/2025

Physician-led health care teams enable health care professionals to deliver care commensurate with their training and strengths. 

ACTION:

ACP members can access members-only actionable materials.

Background:

Federal and state legislators are increasingly introducing legislation to expand the scope of practice of non-physician health care professionals. For example, twenty-seven states and the District of Columbia have adopted the “full practice model,” which allows all nurse practitioners (NPs) to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances.

ACP’s policy paper, “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care” highlights the importance and benefits of team-based care, affirming that teams should be led by physicians, underscoring the need for payment models to promote team-based care, and recommending interprofessional training to foster collaboration and cooperation among health care professionals. These principles represent a call for policymakers to ensure that all patients – including those residing in rural and other medically-underserved areas – have access to a personal physician with leadership of a highly-skilled health care team trained to deliver whole-person comprehensive, and longitudinal care. 

As a member of the Scope of Practice Partnership (SOPP), ACP partners with the American Medical Association, the American Academy of Family Physicians, and others on scope of practice issues, including supporting physician-led health care teams. 

Federal Activities

Legislation has been introduced in Congress to expand the scope of practice for pharmacists and nurse practitioners. The “Equitable Community Access to Pharmacist Services (ECAPS) Act would allow pharmacists to independently perform Evaluation and Management services for influenza, COVID-19, respiratory syncytial virus (RSV), or streptococcal pharyngitis (strep throat) for patients on Medicare. ACP sent a letter to the bill sponsors opposing this legislation. The “Improving Care and Access to Nurses Act,” or the “ICAN Act,” 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 the sponsor about the legislation.  ACP has also raised concerns about The Chiropractic Medicare Coverage Modernization Act that would amend the definition of physician to extend Medicare coverage for services furnished by chiropractors beyond the manual manipulation of the spine. 

State Activities:

Many states have considered or have already adopted policies to modify their scope of practice laws for advanced practice registered nurses (such as nurse practitioners), physician assistants, and other non-physician health care professionals. Twenty-seven states and DC have adopted the “full practice model,” which allows all nurse practitioners (NPs) to evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances.

In 2025, ACP tracked approximately 250 state-level scope of practice legislations in 44 states and advised state chapters on responding to policy proposals. To see what bills ACP have been tracking related to scope of practice click here.  For more information about state laws on scope of practice, the National Conference of State Legislatures has an interactive map with information about scope of practice laws in all 50 states, the District of Columbia, and U.S. territories.

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