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Topic Descriptions

Addiction Counselors

Addiction counselors work with people with substance use disorders. Legislation includes changes to certification or licensure processes, supervision requirements and scope of practice for addiction counselors.

Certified Nurse Midwives – Practice and Prescriptive Authority

Practice authority can be defined as a certified nurse midwives’ (CNM) authority to practice with or without physician oversight. Prescriptive authority refers to a CNM’s authority to prescribe medications. 

Community Health Workers

Community health workers are frontline public health workers who are trusted members of and/or have a deep understanding of the community served. Legislation includes changes to certification or licensure processes, Medicaid and private insurance reimbursement, and scope of practice for community health workers.

Community Paramedics

Community paramedics provide care for patients at home or in other non-urgent settings outside of a hospital under the supervision of a physician or advanced practice provider. Legislation includes the creation or changes to community paramedicine programs, certification or licensure processes, Medicaid and private insurance reimbursement, and scope of practice for community paramedics.

Dental Hygienist – Direct Access

Direct access refers to the ability of a dental hygienist to initiate treatment based on an assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist and maintain a provider-patient relationship.

Dental Hygienist – Prescriptive Authority

Prescriptive authority refers to a dental hygienist’s authority to prescribe medications such as fluoride, antimicrobial solutions and anesthetics, among others.

Dental Therapists

Dental therapists provide specified dental services at dental offices or other approved practice sites, especially in rural and underserved areas. Legislation includes changes to licensure and certification requirements, Medicaid reimbursement, prescriptive authority and scope of practice for dental therapists.

Licensed Professional Counselors

Licensed professional counselors—also referred to as licensed mental health counselors—are mental health service providers who have a relevant master’s or doctoral degree. Legislation includes changes to authority or ability to diagnose a patient’s mental illness without having to refer patients to other licensed professionals.

Nurse Practitioner – Practice Authority

Practice authority can be defined as a nurse practitioner’s (NP) ability to practice with or without physician oversight.

Nurse Practitioner – Prescriptive Authority

Prescriptive authority refers to a nurse practitioner’s authority to prescribe medications.

Nurse Practitioner – Primary Care Provider

Some states explicitly identify a nurse practitioner as a primary care provider, allowing NPs to pursue certification in adult-gerontology or pediatric primary care as a defined population focus.

Optometrist – Authority to Perform Ophthalmic Procedures

Authority to perform ophthalmic procedures includes optometrists’ ability to perform common ophthalmic procedures within their scope of practice, including contact lens fitting, annual eye exams and foreign body removal. Some states grant optometrists the authority to use surgical and laser privileges.

Optometrist – Injectable Authority

Injectable authority refers to optometrists’ ability to administer injections including for the treatment of anaphylaxis, other medications or vaccinations.

Optometrist – Prescription of Controlled Substances

Prescription of controlled substances refers to optometrists’ ability to prescribe certain classifications of controlled substances.

Physician Assistant – Adaptable Proximity Requirements

Proximity requirements for physician assistants (PAs) refer to requirements that specify whether a physician must be continuously (or at regular intervals) near a PA who is providing medical services.

Physician Assistant – Chart Co-Signature Requirements

Chart review and co-signatures may be required by state statute, a practice facility, or by a supervising physician in for a physician assistant to practice or prescribe. 

Physician Assistant – Number of PAs Supervised

States have the option to regulate the number of physician assistants that a physician or other qualified health care professional are authorized to supervise. Some states may choose to include other mid-level providers, such as advanced practice registered nurses, within their number limit.

Physician Assistant – SOP Determination

Scope of practice determination refers to whether a physician assistant’s scope of practice is determined at the practice level, by a state medical board or state law.

Physician Assistant – Prescriptive Authority

Prescriptive authority refers to a physician assistant’s authority to prescribe medications.

Physician Assistant – Supervision Requirements

Supervision requirements refer to whether a physician assistant is required to practice under the supervision of or in collaboration with a physician either at the practice level, by the state medical board or in state law.

Peer Support Specialists

Peer support specialists use their lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to provide behavioral health services, education, recovery support and connection to other services. Legislation includes changes to licensure and certification requirements, and Medicaid and private insurance reimbursement of peer support specialists.

Pharmacist – Administration of COVID-19 Vaccine

Pharmacists are authorized to administer vaccines in all 50 states, but the type of vaccine and the age of a patient varies by state. Some states authorized pharmacists to administer the COVID-19 vaccine after the public health emergency ends.

Pharmacist – Prescription Adaptation

Prescription adaptation refers to a pharmacist’s authority to modify medication regimens from the original prescriber to improve a patient’s health outcome, either independently or in collaboration with the original prescriber.

Pharmacist – Prescription of Hormonal Contraceptives

Prescription of hormonal contraceptives refers to a pharmacist’s authority to prescribe contraceptives without having a collaborative practice agreement in place.

Pharmacist – Prescription of Tobacco Cessation Aids

Prescription of tobacco cessation aids refers to a pharmacist’s authority to prescribe tobacco, smoking or nicotine cessation aids without having a collaborative practice agreement in place.

Prior Authorization Requirements for Buprenorphine-containing Products

Some states prohibit or limit the use of prior authorization for buprenorphine-containing products and some states leave it up to the discretion of Medicaid and private insurance companies. 

Teledentistry

Teledentistry uses technology to provide and support dental care services remotely, including face-to-face consultations via video conference, sharing images and records among providers, and monitoring patients. Some states reimburse for teledentistry services through Medicaid and/or commercial insurance providers.

Other Dental Bills

Legislation allowing dental therapists and dental hygienists to perform other tasks or procedures that are not captured in the specific categories above.

Other Advanced Practice Registered Nurse Bills

Legislation allowing nurse practitioners and/or certified nurse midwives to perform other tasks or procedures that are not captured in the specific categories above.

Other Physician Assistant Bills

Legislation allowing physician assistants to perform other tasks or procedures that are not captured in the specific categories above.

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Related Resources

State Public Health Legislation Database

This database covers topics related to public health including infectious disease prevention and treatment, public health reporting and workforce and vaccines. It includes all introduced legislation from 2021 to the present and is updated at least twice per month as legislation is identified by NCSL staff.
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EMS Legislative Database

NCSL's new database that brings you up-to-date, real-time information about bills related to Emergency Medical Services.
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