The State of Full Practice Authority in the 2019 Legislative Session

Mar 18, 2019

*Note: This post is being continuously updated to reflect changes in national policy around the scope of practice. Last updated: April 15, 2019

The National Nurse-Led Care Consortium is tracking legislation across the country aimed at allowing nurse practitioners to practice independently of physician supervision, to the full scope of their education and training. Nationally, 22 states and DC already have full practice authority in place. Because this is a state issue, each bill requires a different level of rigor for transition to independent practice. NNCC will be monitoring these bills and any others introduced throughout each state’s legislative session.

Full Practice Authority Bills

Pennsylvania

Senate Bill 25 passed the Senate Committee on Consumer Protection and Professional Licensure on March 27. The bill, which passed the Senate in the previous legislative session, would require 3,600 hours of collaborative practice over three years. A companion bill, House Bill 100, was introduced in the House on April 9 and assigned to the House Professional Licensure Committee on April 15. Pennsylvania’s legislative session adjourns December 31, 2019.

Massachusetts

House Bill 1867 and Senate Bill 1330 were referred to the Joint Committee on Public Health on January 22, 2019. The bills would remove all prescribing restrictions for nurse practitioners, making Massachusetts a full practice authority state.

 

Barrier Reduction Bills

California

Assembly Bill 890 passed the Assembly Business and Professions Committee on April 9 and now moves to the Appropriations Committee. It would require a minimum of 4,600 hours or 3 years of collaborative practice with a physician for nurse practitioners to begin practicing independently. The bill contains settings restrictions for which NPs may transition to independent practice, and other statutes would likely need to be repealed in order for the bill to take full effect. California’s legislative session adjourns September 13, 2019.

Florida

House Bill 821 was reported out of the Health and Human Services Committee on April 10 and received its first reading in the House the same day. The bill would require 2,000 hours of supervised practice within five years in order for nurse practitioners to practice without physician supervision. The bill also adds requirements for malpractice insurance. Florida’s legislative session will adjourn May 3, 2019.

Indiana

Senate Bill 394 passed the Senate with a vote of 43-5 on February 12, 2019, and had its second reading on the House floor on April 4. It now awaits a vote on the House floor. The bill would require nurse practitioners to work under a practice agreement for the full time equivalent of at least three years before practicing independently. Additionally, their collaborating practitioner must review 5% of charts during the three-year period. NPs in hospital settings would be left vulnerable to further regulation at the discretion of their employer. The legislative session in Indiana will adjourn April 29, 2019.

North Carolina

House Bill 185 and Senate Bill 143 both sit in committee in their respective chambers. While the bills could significantly expand NP practice in North Carolina, more clarification is needed to describe the relationship between nurse practitioners and physicians after passage. North Carolina’s legislative session ends July 12, 2019.

Ohio

House Bill 177 was referred to the House Health Committee on April 2. The bill would remove the requirements for APRNs to maintain a collaborative agreement with a physician in order to practice. Other restrictions on practice would remain in place. Ohio’s legislative session will adjourn on December 31, 2019. 

Texas

House Bill 1792 sits in the House Committee on Public Health, and was left pending in subcommittee on April 4. The bill requires nurse practitioners to practice at least 2,080 hours under the delegation of a physician in order to practice without a practice agreement, but leaves prescribing restrictions for Schedule II drugs in place. Texas’s legislative session ends May 27, 2019.

Changelog

  • (April 15, 2019) Pennsylvania: HB 100 introduced in the House and assigned to the Professional Licensure Committee; California: Assembly Business and Professions Committee approved AB 890; Florida: HB 821 reported out of the Health and Human Services Committee and read in House; Ohio: Added to the list for HB 177, a barrier reduction bill.
  • (April 8, 2019) Massachusetts: More information added about bills.
  • (April 2, 2019) Massachusetts: Added to the list for HB 1867 and SB 1330, full practice authority bills; Florida: HB 821 reported out of subcommittee.
  • (March 27, 2019) Kansas: Removed from the full practice authority bill list after their bill was gutted; Pennsylvania: SB 25 approved by the Senate Committee on Consumer Protection and Professional Licensure.
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