States Continue to Enact Legislation to Address Health Care Workforce Shortages

Access to health care remains a challenge for many Americans, especially those living in rural and underserved communities. As state legislatures return to session in January, legislators will continue to look for ways to increase access to health care for these residents. Examining scope of practice of laws is likely to be among the top strategies used to address this need.

Scope of practice describes the procedures, action and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional licensure. In recent years, more and more states have enacted legislation that broadened the ability of non-physician practitioners to provide care for Americans.

More than 40 states introduced scope of practice legislation during the 2019 legislative sessions. NCSL’s Scope of Practice Policy website, a resource to help educate state policymakers about scope of practice issues, tracked a total of 177 bills.

Fifty-four bills from 30 states were enacted into law related to behavioral health providers, physician assistants, nurse practitioners and oral health providers.

Behavioral health providers. Behavioral health providers saw 17 bills address certification and licensure standards, supervisory and prescribing authority, and reimbursement requirements.

For example, Arkansas passed at least three bills relating to peer support specialist certification and practice and prescribing authority for nurse practitioners. Individuals with prior drug-related offenses may now work with individuals receiving substance abuse treatment as peer support specialists.

Twelve states enacted legislation addressing licensure and reciprocity for addiction counselors. For example, Minnesota, North Dakota and Washington established a reciprocity program for addiction counselors applying for certification in their states.

Physician Assistants. Sixteen bills nationwide addressed the relationship between a physician assistant and a physician, and authorized additional procedures that could be performed by the physician assistant.

California, for example, now allows physician assistants to work in collaboration with a physician instead of under delegation and allows for development of the practice agreement in collaboration with a physician. Missouri allows for collaboration between a physician assistant and a physician. The physician also no longer needs to practice at the same facility as the physician assistant.

Nurse Practitioners. Nurse practitioners saw six bills address prescribing ability and signage authority. In Arkansas, for instance, nurse practitioners may now prescribe Schedule II controlled substances if authorized in their practice agreement with the supervising physician and if the opioid prescription is for the duration of five days or less. Podiatrists may now have a collaborative practice agreement with a nurse practitioner.

Oral health providers. Supervision requirements, practice authority and licensing requirements were enacted in 13 bills for dental therapists and dental hygienists. Five states enacted legislation to allow for the practice of dental therapy, representing a growing trend of states looking to improve access to dental services for their rural, underserved and tribal constituents. In total, thirteen states now allow dental therapists to practice as a dental provider.

Other states are looking at ways to utilize dental hygienists outside of a dental office. Previously, dental hygienists in Maryland could only work in dental offices and long-term care facilities. These providers may now practice in settings beyond those facilities after 3,000 hours of clinical practice and if a written agreement with the supervising dentist is in place.

For more information on enacted legislation and for information 2020 scope of practice legislation, please visit Scope of Practice Policy’s legislative database page.