The Health Resources and Services Administration predicts an increase in the demand for every health professional type by 2037. Although the National Center for Health Workforce Analysis projects that the primary care workforce supply is expected to increase, demand for health services is projected to outpace the supply of providers.
In response, states enacted several bills in 2024 addressing interstate licensure compacts, graduate medical education, allied health and scope of practice. States continue to explore scope of practice policy options to increase access to safe, quality health care services.
Every state determines its own scope of practice laws for health care professionals. Scope of practice refers to the types of services a health professional is allowed to provide within a state, along with supervision requirements, authority to administer vaccines and/or prescribe medications, and other roles and responsibilities.
In 2024, at least 34 states, Washington, D.C., and Puerto Rico enacted more than 120 bills regarding health professionals’ scope of practice, largely addressing practice and prescriptive authority.
Practice Authority
Many states modified the practice authority for various health professionals, including nurse midwives, advanced practice registered nurses, behavioral health workers, dentists, dental hygienists and assistants, physician assistants, and pharmacists and pharmacy technicians.
Ohio expanded the responsibilities of APRNs and physician assistants. APRNs can now sign documents related to psychiatric inpatient care, and physician assistants can handle admission, treatment or discharge documentation for hospital patients. In Maryland, physician assistants must have a collaboration agreement with a physician rather than a delegation agreement. A collaboration agreement is a formal written contract between the health care professional and a physician that defines their working relationship. In a delegation agreement, a physician delegates specific tasks or duties to another health care professional to practice.
Alaska allowed optometrists to delegate routine tasks to optometric technicians and assistants. Utah permitted podiatrists to perform surgical wound care on the limbs and torso under certain conditions. Connecticut authorized independent ankle surgeries by podiatrists. Hawaii and South Dakota allowed a licensed dental hygienist to perform preventive dental sealant services under supervision.
Vaccine Administration
Pharmacists are authorized to administer vaccines in all 50 states, although the specific types of vaccines and the age of patients eligible to receive them can vary. In 2023, at least 13 states allowed pharmacy technicians to administer vaccines under certain conditions, with vaccine types and age of eligible patients varying. Last year, many of the 38 enacted pharmacy workforce bills addressed vaccine administration. New Hampshire enabled pharmacists, pharmacy interns and technicians who meet specific criteria, to administer FDA-approved vaccines for influenza and COVID-19 to people 18 years or older. Hawaii authorized pharmacists and pharmacy interns and technicians to administer FDA-approved vaccines to people 3 years or older.
Medication Management
At least seven states enacted legislation addressing health professional prescriptive authority in 2024. Kentucky specified that certified medication aides can administer medications under the supervision of registered nurses in settings such as assisted living facilities. Delaware, Maryland and Florida authorized pharmacists to manage and dispense drugs for HIV pre-exposure prophylaxis, following specific guidelines.
Supporting Emerging Professions
To help fill in the health workforce shortage areas—especially in rural and underserved areas, according to the Rural Health Information Hub—states may use allied health professionals to extend the reach of existing health workers.
States may license or certify new health care occupations and define their scope of practice across primary care, behavioral health and other health care areas. For example, Louisiana created a psychological associate license for applicants who complete a master’s level degree in psychology. Illinois created a permanent certified medication aide program and allowed aides to administer medications under specific conditions.
Based on these 2024 legislative trends, scope of practice will likely remain a hot topic among states into the 2025 legislative sessions. For the latest policy trends, visit NCSL’s Scope of Practice Policy Resource Center.
For legislative tracking on health care workforce topics, visit NCSL’s Health Workforce Legislation Database. This resource is updated biweekly. For scope of practice bills dating to 2015 across the 50 states, territories and Washington, D.C., visit NCSL’s Scope of Practice Legislation Database.
Razan Badr is a policy analyst with NCSL’s Health Program.
This resource is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $747,800 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government.