Scope of Practice

In response to the COVID-19 public health emergency, states have taken measures to alleviate the occupational licensure policy burdens that impede state response efforts and which are counterintuitive to social distancing practices. The following information presents a collection of policy actions states have implemented to expand the scope of practice of practitioners.

Given the increased healthcare workforce demands imposed by COVID-19, many states have expanded the authority of practitioners to augment the availability of services. These modifications to a scope of practice allow licensed practitioners to perform services not typically included in the state’s practice act.

Click to view each state’s actions

Alabama

• • • 5th Supplement to State of Emergency – This supplement expands scope of practice for certified registered nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, physician assistants, anesthesia assistants, and physicians practicing outside of a licensed health care facility.

Alaska

• • • Senate Bill 241 – Allows the Commissioner of the Department of Commerce, Community, and Economic Development may take actions regulating the scope and duration of any license, permit, or certificate issued under the applicable section of the legislation.
    • Health Mandate 15 – Allows unlicensed assistive personnel to be included in service delivery for routine health care services, non-urgent/non-emergent elective surgeries and procedures, and urgent/emergent elective surgeries and procedures. Licensing boards can determine if individual health care provider types can safely perform the services.

Arkansas

• • • EO 20-18 – Authorization and request to all emergency responders to provide services in support of this state and their administrators.

California

• • • EO N-25-20 – The Director of the Emergency Medical Services Authority has the authority to implement additions to local optional scopes of practice without first consulting with a committee of local EMS medical directors.
    • EO N-55-20 – Welfare and Institutions Codes are suspended to the extent they would restrict DHCS from granting Short Term Residential Treatment Programs, Special Treatment Programs, Psychiatric Health Facilities, Mental Health Rehabilitation Centers, Community Treatment Facilities, Community Residential Treatment Systems/Social Rehabilitation Programs and Psychiatric Health Facilities flexibility related to staffing requirements, and to the extent they would restrict DHCS from suspending on-site program reviews.

Colorado

• • • EO D 2020 038 – Ordering the Temporary Suspension of Certain Statutes and Rules to Expand the Healthcare Workforce for Hospitals and Other Inpatient Treatment Facilities Due to the Presence of COVID-19.  Executive Director of DORA, through the Director of the Division of Professions and Occupations (DPO), to promulgate and issue temporary emergency rules to permit the licensed professionals listed below to cross train, supervise, and delegate responsibilities concerning the temporary care and treatment of patients to the professionals listed in Section II.B. I temporarily suspend the following statutory and regulatory scope of practice limitations to permit the licensed professionals listed in Section II.A., above, to cross train, supervise, and delegate responsibilities concerning the temporary care and treatment of patients to the professionals listed below:
    • EO D 2020 063 – Extending EO D 2020 038
    • EO D 2020 097 – Extending EO D 2020 038 and EO D 2020 063
    • EO D 2020 131 – Extending EO D 2020 038, EO D 2020 063, and EO D 2020 097

Delaware

• • • HB 348/1 – Continues suspension of the Delaware Board of Medical Licensure and Discipline Regulation 19 limiting the scope of telemedicine, including with respect to prescribing opioids.

 Idaho

• • • EO 2020-19 – Home health agencies can accept written orders for service from any licensed physician, nurse practitioner, clinical nurse specialist, or physician assistant; creates temporary licensure for EMO students; waives the rule prohibiting the waiver of educational requirements for EMS licensure; creates temporary license for physician assistant students

Indiana

• • • EO 2020-33 – Home health agencies can accept written orders for service from any licensed physician, nurse practitioner.

Iowa

• • • Senate File 2357 – Expands the scope of practice for physician assistants and registered nurses

Kansas

• • • EO 20-26 – Suspends any and all provisions relating to supervision, delegation and related issues by healthcare providers that are licensed, registered or certified and ancillary workers.
    • EO 20-28 – Extends EO 20-26; All entities or individuals referenced in K.S.A. 48-915, are authorized to making triage decisions and rendering assistance, testing, care or advice in the care of patients reasonably suspected or confirmed to be infected with COVID-19 and shall be deemed immune from suit pursuant to K.S.A. 48-915.

Maine

• • • Executive Order 16 – Suspends supervision or collaborative practice requirements for otherwise qualified physician assistants and advanced practice registered nurses; All physicians, physician assistants and nurses licensed shall be allowed to perform health care services through telehealth

Maryland

• • • EO 20-05-19-01 – Authorizing COVID-19 Testing by any Licensed Pharmacists.

Massachusetts

• • • Department of Public Health Order – Expands the scope of practice for APRNs to those specific functions designated to physicians only.
    • Order, Commissioner of Public Health, Expanded Practice – Expands the scope of practice for APRNs to those specific functions designated to physicians only.
    • Order, Commissioner of Public Health, Expanded Practice – RN who hold authorization from the Board of Registration in nursing may engage in prescriptive practice.
    • Order, Commissioner of Public Health, Expanded Practice – registered nurses authorized by the Board of Registration in Nursing (BORN) pursuant to M.G.L. c. 112, §. 80B, who hold certification in the field of psychiatric mental health from a BORN recognized certifying organization or its equivalent approved and designated by BORN. Specifically, such advanced practice registered nurses shall have the same authority as qualified physicians to provide services pursuant to M.G.L. c. 123, §§. 4, 11, 12 and 21.

 Michigan

• • • Executive Order 2020-61 – Suspends provisions relating to scope of practice to the extent that expansion will help provide necessary medical services at a facility.
    • Executive Order 2020-104 – A licensee holding one of the following license types may establish and administer a COVID-19 testing service without an additional state license or permit at any site, with permission from the person with the right to occupy and exclude others from the property.

Nebraska

• • • EO 20-10 – Permits physicians to have any number of physician assistants under their supervision and without a written agreement with these physician assistants insofar as doctors determine necessary within their professional discretion.

Nevada

• • • Declaration of Emergency Directive 011 – All providers of medical services are authorized to practice outside the scope of their specialization, within the limits of their competency, to the extent necessary to augment and bolster Nevada’s healthcare system during the COVID-19 crisis

New Hampshire

• • • EO 47 – Emergency order allows pharmacists to administer Covid-19 tests, if properly trained, for the duration of the State of Emergency.

New Jersey

• • • DCA Administrative Order No. 2020-06 and DCA Waiver No. W-2020-10 – Administrative order authorizes pharmacists to order and administer tests.

New York

• • • EO 202 – Allows unlicensed non-nursing staff to perform basic nursing tasks incl. swabs/tests
    • EO 202.1 – Allows physicians and nurse practitioners to issue non-patient-specific regimens to those authorized by law or executive order to conduct swabs/tests
    • EO 202.10 – Allows physician assistants, specialist assistants, nurse practitioners, professional nurses and practical nurses to exceed the normal bounds of their practice; Allows pharmacy technicians to perform duties beyond the usual scope of their licenses.

North Dakota

• • • Executive Order 2020-09 – Permits licensed pharmacists to administer COVID-19 tests

Oklahoma

• • • EO 2020-13 – Executive order directs Board of Medical Licensure and Supervision, State Board of Osteopathic Examiners, and Board of Nursing to promulgate rules necessary to increase the number of professionals able to practice. Actions include reducing supervisory requirements or limitations placed on non-physicians.

Oregon

• • • OAR 847-035-0032 – Allows EMS personnel to assist with patient care as directed by supervising physician orders.

Pennsylvania

• • • PA Dept of State Waiver – Temporarily waives requirements for pharmacists. Clarifies that proof of prescription receipt is not required. Fully licensed pharmacy practitioners are authorized to carry out Covid-19 testing including ordering, testing, and communicating results.
    • PA Dept of State Waiver – Physicians previously were limited to supervising 4 physicians assistants, however this ratio requirement has been suspended. The requirement is suspended that temporary authorization to practice as a physician assistants be issued for up to 120 days upon board receipt of a complete written agreement. The requirement that the board must approve the use of a physician assistant at “satellite operations” is suspended.

Rhode Island

• • • Executive Order 20-33 – Allows medical personnel to exceed the scope of their licenses or provide care without a license (if testing for or treating COVID-19)

Tennessee

• • • EO 15 – Suspends certain restrictions on Nurse Practitioners and Physician Assistants issuing prescriptions
    • EO 36 – Allows all licensed medical professionals to practice telehealth

Texas

• • • Press Release: Gov. Abbott Waives Certain Pharmacy Regulations To Increase Workforce Capabilities – Allows pharmacy technicians to accept prescription orders over the phone and to transfer or receive a transfer of original prescription information on behalf of patients. Also allows pharmacy interns to assist pharmacists without the designation of preceptor.

Vermont

• • • SB 128 – Modifies terms of physician assistant practice agreements, including allowing physician assistants to provide care without a practice agreement during an emergency.

Washington

• • • Proclamation 20-32 – Waives requirements of physician assistants’ practice agreements that limit PA mobility.
    • Dept. of Health Emergency Rule 20-10-014 – Allows licensed practical nurse (LPN) students to practice as nursing technicians.
    • Dept. of Health Emergency Rule 20-12-075 – Includes physician assistants among the practitioners authorized to order home health services and to sign plans of care.

West Virginia

• • • EO 17-20 – Suspends statutory provisions restricting administration of anesthesia to certain personnel; governing prescriptive authority for advanced practice registered nurses, and requiring in-person examinations to refill a schedule II opioid prescription.

Wisconsin

• • • Emergency Order 21 – Nurse Aid Training Provisions: Allows nurses with less than 2 years of experience to serve as nurse aide instructors.

MODIFICATION OF LICENSING REQUIREMENTS

TEMPORARY LICENSURE

TELEHEALTH

SCOPE OF PRACTICE

INTERSTATE COMPACTS

All Actions

The executive orders, administrative orders and legislation included in this web resource represent a sample of the actions states have enacted in response to COVID-19. Therefore, this resource is not intended to be represented as an exhaustive list of state actions, but rather used to review the variances in strategies states have implemented through occupational licensing policy to effectuate response efforts. The descriptions of the policy actions have been summarized to include relevant detail but should be viewed in full for their entire context. CSG will continue to update the list of policy actions throughout the duration of the state public health emergency response and recovery efforts.