Which Trump-era executive orders affected nurse practitioner and CRNA scope-of-practice?

1. Trump’s 2019 executive order: an explicit federal nudge on APRN scope

President Trump’s October 2019 executive order instructed federal agencies — notably HHS — to review regulatory policies affecting advanced practice registered nurses (APRNs) and physician assistants and to develop recommendations intended to allow patients to “spend more time with their providers,” including potentially removing unnecessary restrictions on APRN scope of practice; advocacy groups interpreted Section 5 of that EO as directly affecting APRNs and PAs ^{[1] [6]}. The order set a one-year timetable for HHS to develop recommendations and included items such as examining Medicare reimbursement policy and facility Conditions of Participation that could limit APRN practice ^{[1] [6]}.

2. CMS rule changes that implemented parts of the EO and affected CRNAs’ billing/recognition

CMS subsequently issued rule changes that the agency and stakeholders framed as implementing the EO’s regulatory-burden reduction goals. One notable change recognized that Medicare Part B payment to CRNAs for certain evaluation-and-management services should be based on services “as defined by a state’s scope of practice,” and the final rule’s preamble explicitly linked the policy to Trump’s EO on reducing Medicare regulatory burden ^[2]. The American Association of Nurse Anesthetists praised the November 2019 final rule for recognizing CRNAs’ ability to perform pre-anesthetic assessments in ambulatory surgical centers ^[2].

3. Temporary waivers and supervision requirements: confusion, not wholesale federal takeover

Reporting and industry analysis show the Trump administration also issued waivers concerning supervision requirements that affected CRNAs—allowing, in some instances, practice “to the fullest extent allowed by the state”—but commentators cautioned these waivers did not necessarily supersede state scope-of-practice laws and did not change Medicare’s separate medical-direction billing rules ^[7]. That analysis stresses the practical limits: federal waivers or CMS rule language may remove a specific federal facility condition but do not automatically erase state licensure or supervision statutes ^[7].

4. The 2025 Department of Education reclassification: lending impact, not direct clinical scope

A separate and more recent policy change tied to President Trump’s One Big Beautiful Bill Act involved the Department of Education’s redefinition of which degree programs count as “professional degrees” for higher federal Grad PLUS loan limits; several outlets reported nursing (and related programs, including nurse practitioners and physician assistants) were excluded from the professional-degree list, reducing allowable graduate-borrowing caps and raising concerns among nursing organizations about workforce impacts ^{[3] [8] [4]}. Snopes explains the administration’s reinterpretation relied on Classification of Instructional Programs (CIP) coding; Snopes and other outlets covered the reporting and social-media spread of the change ^[5]. This is a financing and education-policy action that affects NP and CRNA students’ ability to borrow; the sources do not describe it as a clinical scope-of-practice order ^{[3] [4] [5]}.

5. Competing perspectives and where sources disagree or limit conclusions

Advocates for APRN autonomy and some state policymakers praised the 2019 EO and CMS moves as helpful steps to reduce federal regulatory barriers and improve access to care ^{[6] [2]}. By contrast, analysis and advisories flagged that federal actions often leave state-law supervision and scope rules in place and that waivers can be limited by state regulations or by other Medicare billing rules ^[7]. On the 2025 DOE reclassification, nursing organizations warned the loan changes would undermine workforce pipelines; fact-checking reporting noted the policy relies on technical CIP-code interpretation, and available reporting shows debate about whether the change was a drafting/interpretation issue versus an intentional policy to exclude nursing ^{[5] [3]}.

6. What the provided sources do not say (limits of current reporting)

Available sources do not mention a single Trump “executive order” that directly and unilaterally expanded NP or CRNA clinical scope of practice across all states; instead, the record shows federal executive actions that prompted reviews, waivers, or administrative rule changes and a separate Department of Education borrowing-classification change affecting nursing students ^{[1] [7] [2] [3]}. Available sources do not provide full text showing each agency’s final implementation steps in every state; state-level scope-of-practice law changes are not covered in these excerpts ^[7].

Bottom line: the Trump administration used executive orders, CMS rulemaking and waivers to press for fewer federal-level barriers and to recognize certain CRNA services in Medicare ^{[1] [2] [7]}, while a Department of Education reclassification in 2025 affected NP and CRNA students’ federal loan eligibility—an education-finance change rather than a direct expansion or contraction of clinical scope under state licensing law ^{[3] [4] [5]}.