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What executive orders or federal rules under Trump specifically targeted nurse scope-of-practice or certification?
Executive summary
President Trump issued a high-profile Executive Order on October 3, 2019, titled “Protecting and Improving Medicare for Our Nation’s Seniors,” whose Section 5 directed HHS to propose regulatory changes that could reduce supervision and licensure barriers and change Medicare reimbursement so clinicians are paid for work rather than occupation — measures advocates said would expand APRN (nurse practitioner, PA, CRNA, etc.) scope-of-practice and pay parity [1] [2] [3]. Separate HHS reports and regulatory actions under the Trump administration and CMS implemented or signaled changes (including recognition of some CRNA billing and COVID-era waivers), but most concrete scope-of-practice changes occurred via proposed/agency rulemaking and state waivers rather than a single, immediate federal revocation of state licensure laws [4] [1] [5].
1. The 2019 executive order: a federal push to loosen supervision and reimbursement rules
President Trump’s October 3, 2019 Executive Order instructed the HHS secretary to propose reforms within a year aimed at eliminating “supervision requirements” and other licensure restrictions that limit clinicians from “practicing at the top of their profession,” and to examine paying clinicians for services provided rather than their occupation — language many nursing organizations praised and physician groups opposed because of its potential to expand APRN authority [1] [3] [6].
2. What the order does — and what it cannot do by itself
Multiple analyses note that the EO itself set policy goals and directed agency rulemaking and study; like most executive orders it does not instantly change state licensing law or Medicare statute but rather triggers a regulatory process that may yield proposals and final rules subject to public comment and legal limits [1] [7]. Advocacy groups framed this as federal leverage to encourage states and agencies to ease scope limits [8] [9].
3. Federal rulemaking and CMS actions that followed (examples and limits)
CMS and HHS used regulatory authority to consider or enact measures reflecting the EO’s intent. For example, CMS rules and preambles later recognized Medicare Part B payment to Certified Registered Nurse Anesthetists (CRNAs) for certain evaluation-and-management services as defined by state scope-of-practice, citing implementation of the EO’s burden‑reduction goals [4]. But those actions often relied on existing statute, tied payment changes to state law, or were incremental — not blanket federal overruling of state APRN licensing regimes [4] [1].
4. HHS reports and policy recommendations that pushed scope reform
Prior to and alongside the EO, HHS (with Treasury and Labor/FTC cooperation) issued reports urging states to consider loosening scope-of-practice statutes and highlighting potential consumer benefits — documents that the AANP and other nursing groups publicly commended and that the administration used as rationales for regulatory guidance [10] [9] [11]. These recommendations served as policy ammunition but required states or subsequent federal rulemaking to effect actual practice changes [9].
5. State-level waivers during COVID and the interplay with federal authority
During the COVID-19 emergency many governors and federal agencies issued temporary waivers that relaxed collaborative or supervisory requirements for APRNs; scholarly reviews document widespread state executive orders and waivers that directly altered APRN practice during the pandemic — actions distinct from the 2019 EO but illustrating that much of the practical expansion of NP authority happened at the state level or via emergency waivers, not by a single federal scope-of-practice edict [12] [5].
6. Opposition, uncertainty and where change was most concrete
Physician organizations and some specialty groups objected to Section 5’s vagueness and potential risks; professional societies urged careful rulemaking, and several watchdogs warned that the EO lacked statutory authority to override state licensure [6] [13] [14]. The most tangible federal effects tied to Trump-era policy were CMS regulatory adjustments (e.g., CRNA Medicare billing recognition) and administrative guidance nudging states — not a universal federal re-certification or wholesale federal scope-of-practice takeover [4] [1].
7. Bottom line and reporting gaps
Available sources show the October 2019 Executive Order and related HHS reports explicitly targeted supervision, licensure burdens, and reimbursement rules that affect APRN scope and certification and led to agency rulemaking and CMS policy moves [1] [9] [4]. Available sources do not mention a single, standalone federal rule that instantaneously abolished state NP supervision laws nationwide; instead, federal steps under Trump relied on regulatory proposals, payment policy changes, and encouragement for state reforms [1] [4] [12].