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Did any executive orders under Trump expand scope of practice for advanced practice nurses (NPs, CRNAs)?
Executive summary
President Trump signed a 2019 executive order directing HHS to review Medicare rules that affect advanced practice nurses (APRN), nurse practitioners (NPs) and physician assistants (PAs) and gave the agency one year to propose regulatory changes aimed at tying Medicare reimbursement more to services performed than clinician title [1] [2]. Reporting and nursing organizations described the EO as potentially expanding APRN roles and reimbursement, but the order itself instructed reviews and proposals rather than directly changing state scope‑of‑practice laws or immediately granting independent practice to NPs or CRNAs [2] [3] [1].
1. What the 2019 executive order actually did: a mandate to study and propose — not an immediate scope change
The October 3, 2019 Executive Order on “Protecting and Improving Medicare for Our Nation’s Seniors” directed HHS to review Medicare policies that might limit non‑physician clinicians, and it gave HHS one year to propose a regulation intended to ensure services are “appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation,” including nurse practitioners and PAs [1]. Multiple nursing groups and state associations interpreted Section 5 as affecting APRNs and PAs and as potentially paving the way for greater practice autonomy and reimbursement parity, but the EO itself was a directive to study and propose changes — not a federal override of state scope‑of‑practice laws [2] [3] [4].
2. How advocates framed the EO: opportunity to advance APRN authority and pay parity
State and specialty nursing groups framed the EO as an opening to press for APRNs to “practice to the full extent of their education and training” and to correct pay disparities (for example, Medicare fee schedules that historically pay NPs at lower percentages versus physicians), seeing HHS’s tasking as supportive of legislative or regulatory moves that could expand APRN roles or billing practices [4] [3] [2]. Medscape reported HHS commentary suggesting that supervision requirements or “artificial limitations” sometimes prevent NPs and PAs from maximizing their value, indicating the administration’s intent to explore easing those limits [1].
3. Limits of federal executive action on scope of practice — states still control licensure
Available sources emphasize the EO’s focus on Medicare payment and federal regulations — not an immediate federal takeover of licensure or state scope laws. Nursing groups urged use of the EO’s recommendations to support state legislation, implying that actual changes to who may practice independently remain primarily governed by state boards and statutes [4] [3]. The EO asked for regulatory recommendations, and HHS needed to follow rulemaking processes; thus any practical expansion would depend on subsequent federal regs, CMS policy changes, or coordinated state action [1].
4. What concrete changes were reported or proposed? Billing, “incident‑to” rules, and reimbursement alignment
Coverage singled out Medicare billing mechanics: MedPAC had previously recommended eliminating “incident‑to” billing for APRNs and PAs and having them bill Medicare directly under their own NPI; the EO’s instruction dovetailed with that conversation by asking for payment rules that reflect the service not the occupation [1]. Reporting and advocacy pieces suggested potential shifts in Medicare Advantage and certificate‑of‑participation rules could affect how APRNs are utilized and reimbursed, but these were framed as potential regulatory or legislative outcomes rather than immediate executive fixes [2] [4].
5. Competing perspectives and caveats in the reporting
Proponents (nursing associations and some state advocacy groups) viewed the EO as a lever to expand APRN practice and correct pay disparities [4] [3]. HHS officials framed the move as a review to remove “artificial limitations” [1]. Critics or neutral observers noted it was unclear whether and when the EO’s items would take effect — the EO required proposals and rulemaking but did not itself change scope‑of‑practice statutes or definitively alter payment right away [1] [3].
6. Bottom line for the original question
Did any Trump executive orders expand scope of practice for advanced practice nurses? The 2019 EO initiated reviews and ordered HHS to propose Medicare regulatory changes targeting reimbursement and constraints that affect APRNs, which advocates interpreted as supportive of expanded roles — but the order did not directly and immediately expand legal scope‑of‑practice or override state licensing; it mandated study and possible regulatory proposals [1] [2] [3]. Available sources do not mention a Trump EO that unilaterally changed state scope‑of‑practice laws or instantly granted independent practice to NPs or CRNAs [1] [3].