State lawmakers facing chronic health care workforce shortages are exploring legislative solutions across a variety of health care professions.
Using non-physician health care practitioners is one strategy to increase access to care, especially in rural and underserved areas. A practitioners’ scope of practice may vary greatly across states. Scope of practice laws determine what services health care practitioners can legally provide, and in what settings. State professional regulatory boards, under the authority of their state legislature, outline what activities or procedures a provider with a specific level of education, licensure, training and/or competency is authorized to engage in.
Policy Website
State legislators consider a broad range of issues related to scope of practice, including supervision and prescriptive authority, among other requirements. NCSL maintains a national Scope of Practice Policy website covering more than 20 policy areas for nine types of health care practitioners.
Since January, NCSL has updated the website with new information on certain advanced practice registered nurses, physician assistants and provider authority for prescribing buprenorphine, which has been approved for use in treating opioid use disorder.
Advanced practice registered nurses, or APRNs, are professionals who have obtained at least a master’s degree in nursing and provide patient care in primary or specialty health care. Within the APRN category are specialty areas that include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists.
The APRN section of the website now includes information on certified nurse midwives, including their practice and prescriptive authority in all the states, territories and Washington, D.C. The site also features maps on nurse practitioner practice and prescriptive authority, their ability to sign provider orders for life-sustaining treatment forms and to serve as primary care providers.
Physician assistants, known as PAs and sometimes also referred to as physician associates, are licensed non-physician practitioners who practice medicine in every specialty and setting. The website now features information on these practitioners, along with policy maps on adaptable proximity requirements, requirements for chart co-signatures, and the number of PAs that a physician is allowed to supervise. It also includes policy maps on PA supervision requirements (practice and prescriptive authority), as well as scope of practice determination.
Practitioners’ authority to prescribe buprenorphine is shown in a new policy map featuring prior authorization requirements. Some states explicitly prohibit or limit the use of prior authorization for buprenorphine products, and some states leave it up to the discretion of their Medicaid program and other private insurers.
Visit scopeofpracticepolicy.org to learn more on these topics and what states are doing regarding scope of practice.
Sarah Jaromin is a policy associate in NCSL’s Health Program.
This resource and the SOP website are supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $813,543 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.