The NCSL Blog


By Sydne Enlund

Scope of Practice website logoOur website tracking scope of practice legislation,,  tracked a total of 139 bills during the 2017 legislative session. Thirty-seven bills were enacted into law from 24 states, including 13 bills related to oral health providers, 12 bills related to nurse practitioners and 15 bills related to physician assistants. There are currently three bills awaiting a governor’s signature.

Oral Health Provider Legislation

A bill enacted in June in Wisconsin allows dental hygienists to practice in certain settings, such as hospitals, nursing homes and daycare centers, without direct supervision by a dentist. Washington now allows dental therapists to perform certain services on tribal lands. A bill enacted in May in Montana allows dental hygienists to prescribe fluoride and topical oral anesthetic agents under general supervision of a dentist. Hawaii now allows dental hygienists to perform certain procedures under general supervision of a dentist instead of direct supervision. Dental hygienists in Georgia may practice without the direct supervision of a dentist if they are providing screenings in certain settings, such as schools, federally qualified health centers, senior centers, and hospitals to name a few. The dental hygienist must have two years of experience in dental hygiene before practicing in these settings.

Nurse Practitioner Legislation

Nurse practitioners in South Dakota may now practice independently from a physician after the completion of 1,040 physician-supervised practice hours, typically called a transition-to-practice agreement. A few states updated their laws to allow nurse practitioners to have expanded signage authority. For example, Arkansas now allows nurse practitioners to certify handicap placards and disabled parking permits, sports physicals for student athletes and death certificates, among other documents. Nurse practitioners in Nevada may now sign any document where a physician is required to sign in lieu of that physician signature.

Physician Assistant Legislation

New Mexico now allows collaborative practice relationships between physician assistants and licensed physicians in primary care settings. Collaboration is defined as the “process by which a licensed physician and a physician assistant jointly contribute to the health care and medical treatment of patients” and requires each of the parties to deliver only the services they are licensed and authorized to provide. A collaborating physician does not need to be physically present when a PA is providing services. In West Virginia, physician assistants now practice in collaboration with a physician. Previously, physician assistants practiced under supervision of a physician. The bill also gave signage authority to physician assistants for death certificates and do-not-resuscitate forms, among others.

For more information on other enacted legislation, please visit the legislative database page.

Sydne Enlund is a research analyst in the NCSL Health Program.

Email Sydne

Posted in: Health
Actions: E-mail | Permalink |

Subscribe to the NCSL Blog

Click on the RSS feed at left to add the NCSL Blog to your favorite RSS reader. 

About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.