Recent state scope of practice legislative activity
The AMA continues its advocacy efforts in collaboration with state medical associations and national medical specialty societies to address ongoing scope of practice challenges across the country. This legislative session, most scope expansion bills have focused on nurse practitioners, physician assistants and pharmacists. As anticipated, these proposals seek to weaken collaboration or supervision requirements and increase independent practice privileges for these non-physicians. For example, many nurse practitioner and physician assistant bills would allow them to practice without physician oversight, while numerous pharmacist bills aim to permit pharmacists to diagnose and treat patients based on the results of a CLIA-waived test.
The following is a brief summary of activity to date based on just over a dozen state legislatures that have adjourned for the year.
Nurse practitioners: Efforts to expand nurse practitioner independence have faced significant pushback this year. Bills seeking to remove physician involvement for nurse practitioners have been defeated in Florida, Indiana, Mississippi, Tennessee, Virginia and West Virginia. Unfortunately, however, New Jersey passed legislation permitting nurse practitioners providing primary or behavioral health care to independently prescribe medications after completing 5,000 hours of practice.
Physician assistants: Bills to remove physician supervision or collaboration of physician assistants were defeated in Idaho, New Mexico, Tennessee, Wisconsin and West Virginia. In Oregon, a bill to allow physician assistants to certify workers' compensation claims failed, and Mississippi defeated a bill that would have allowed the board to determine physician assistant scope of practice. Of the bills that passed, it is a bit of a mixed bag. For example, Kentucky enacted legislation that was favorably amended to maintain physician supervision, but grants physician assistants Schedule II prescribing authority. Kansas Governor Laura Kelly signed legislation into law that retains physician supervision and collaboration of physician assistants but allows use of the title "physician associate." Separately, Governor Mills signed Maine LD 2800 into law, which removes the practice agreement requirement for physician assistants with over 4,000 clinical hours. Iowa passed a bill that permits use the term “physician associate.” Finally, in Virginia, HB 746 was signed into law, which grants physician assistants independent practice after three years of full-time clinical experience (defined as 1,800 hours/year) in their specialty.
Pharmacists: Many pharmacist bills have been introduced this year, including legislation that would allow pharmacists to diagnose and prescribe medications to patients based solely on the results of a CLIA-waived test. To date, Washington defeated this type of legislation, and Tennessee successfully stopped a test-and-treat bill.
Optometrists: Legislation authorizing optometrists to perform surgeries has been on the rise across the states. To date, surgery bills have been defeated in Maine, New Hampshire and New Mexico, with New Hampshire’s Governor Kelly Ayotte vetoing their bill and the legislature upholding her veto. Unfortunately, surgery bills have been signed into law in Kansas and Tennessee.
Other practitioner bills:
- Naturopaths: Licensing and prescribing bills were defeated in Florida, Kansas, Washington and West Virginia.
- Psychologists: Prescribing bills failed in Tennessee and Washington.
- Nurse anesthetists: Florida and Mississippi defeated efforts to remove physician involvement for nurse anesthetists, and West Virginia turned back a broad APRN bill including nurse anesthetists.
Looking ahead: With more than 40 state medical associations and national medical specialty societies engaged, the AMA’s Advocacy Resource Center and Scope of Practice Partnership remain vigilant in tracking and influencing scope of practice legislation. The victories and challenges highlight the ongoing need for dedicated advocacy to protect patient safety and uphold the highest standards of physician-led care.
Major medical liability reform bill passed in New Mexico
On March 6, New Mexico Governor Michelle Luhan Grisham signed HB 99, a major medical liability reform bill that will help reduce the cost of medical liability insurance and attract more physicians to New Mexico. The new law modernizes New Mexico’s medical liability framework to reduce the cost of medical liability insurance and attract more doctors to a state that has long been underserved.
HB 99’s reforms include caps on punitive damages and limiting damages for medical expenses to amounts paid to providers rather than on billed charges. HB 99 also stops frivolous claims for punitive damages by raising the evidentiary standard to prove punitive damages from a preponderance of evidence to “clear and convincing,” and requiring judicial review before punitive damage claims can proceed. The AMA help the New Mexico Medical Society achieve this success through funding under the AMA’s new State Advocacy Accelerator Grant Program.
