The AMA has been busy this year, on Capitol Hill and in statehouses around the country.
On a range of vital issues, the AMA has worked with state medical societies across the nation to help enact legislation that improves care for patients and defeat bills that could put them in harm’s way.
Below is a snapshot of some of the notable legislative activity at the state level so far this year on scope of practice, physician well-being, prior authorization and making tech work for doctors.
Reining in scope of practice
The AMA is fighting scope creep, defending the practice of medicine against inappropriate scope of practice expansions that threaten patient safety. The AMA has worked with nearly every state medical association this year and it continues to update and create new advocacy tools and resources for physicians to combat improper expansions.
Compared with previous years, the sheer volume of scope of practice bills introduced in state legislatures is smaller. However, state legislation that proposes removing physician supervision or collaboration for physician assistants, letting pharmacists to diagnose and treat patients and allowing naturopaths to prescribe medications was on the rise in 2024. So far, the AMA has worked with state medical and specialty societies to defeat more than 80 bills to inappropriately expand nonphysicians’ scope of practice.
Here’s a snapshot of just some of the scope of practice bills have played out in state legislatures so far this year.
Physician assistants. Nine states defeated legislation that would have expanded the scope of practice of physician assistants: Alaska, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, South Carolina and West Virginia. In New York, a proposal that would have let physician assistants practice without physician supervision or collaboration was stripped from the Governor’s final budget.
Nurse practitioners and nurse anesthetists. About a dozen states have defeated nurse practitioner or advanced practice registered nurse (APRN) legislation this year. Oklahoma and Wisconsin’s governors vetoed legislation; Arizona, Hawaii, Maryland and New York defeated bills that proposed the APRN Compact, which unlike every other licensure compact preempts state scope of practice laws. .
Meanwhile,15 states defeated legislation that would have removed physician supervision or collaboration of nurse anesthetists.
Pharmacists. Eight states defeated “test and treat” legislation that would let pharmacists diagnose and prescribe medications over the pharmacy counter: Arizona, Mississippi, New York, Ohio, Oklahoma, South Carolina, Washington and West Virginia.
Psychologists. Psychologist prescribing bills were defeated in Arizona, Florida, Hawaii, New York, Oklahoma and Washington this year.
Naturopaths. At least 11 states defeated bills that would have allowed naturopaths to prescribe drugs, including controlled substances, and perform surgical procedures: Alaska, Colorado, Connecticut, Florida, Indiana, Kansas, Minnesota, Missouri, New Jersey, New York and Washington.
Optometrists. Lawmakers in 11 states defeated bills that would have allowed optometrists to perform surgery: California, Idaho, Kansas, Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire, Utah, Vermont and West Virginia.
Fixing prior authorization
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles. States have enacted 13 prior authorization reform bills this year, measures that aim to decrease the volume of prior authorization requirements, reduce patient care delays, improve transparency surrounding prior authorization rules and increase prior auth data reporting.
Here are some examples of bills that have been enacted.
- Vermont. The law limits prior authorization requirements on primary care physicians and helps ensure patients with chronic conditions don’t’ have to continuously seek repeat prior auth approvals.
- Minnesota. The law prevents prior authorization on some services, including cancer care, outpatient mental health care and preventive care. It also prevents denials based solely on a lack of prior authorization and prohibits repeat prior authorization for patients with chronic conditions. Health plans must now submit data showing rates of authorization and denials, among other things, to state regulators.
- Wyoming. A new law establishes a gold carding program for physicians, reduces the amount of time plans have to respond to a prior authorization request, extends the time that an approval is good for, establishes a grace period where insurers must honor prior authorizations for patients switching health plans, prevents retroactive denials after an approval and targets step therapy requirements.
- Colorado. The law, among other things, prevents retroactive denials of authorizations, extends the length of a prior authorization, reduces health plan’s response time, requires health plans to establish gold-carding programs and is one of the first state laws to mirror federal automation requirements for medical services.
Mississippi, Maine, Maryland, Oklahoma, Illinois, Virginia, the District of Columbia and New Jersey also enacted prior authorization reform laws this year.
Boosting physicians’ well-being
AMA advocacy to support medical students’ and physicians’ health and wellness has resulted in dozens of victories at the state legislative, regulatory and hospital and health system levels. AMA wins also have come via positive changes and communications from national policymaking and accreditation organizations.
As of this September, more than 1.1 million physicians and other licensed health professionals benefited from 34 licensure boards, including 29 medical boards, and more than 425 hospitals and health systems now having verified that their applications do not ask intrusive mental health questions or use stigmatizing language.
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
The AMA continues to work with several dozen additional state medical boards, hospitals and health systems to review language and make changes. This is an increase from only two years ago, when only 22 medical boards and a few dozen hospitals and health systems had reviewed their applications and made changes, if necessary, to ensure their licensing or credentialing applications didn’t contain intrusive mental health questions and stigmatizing language that prevents physicians from seeking care.
The AMA’s success in this work has been the result of partnerships with the Dr. Lorna Breen Heroes’ Foundation, Federation of State Medical Boards, Federation of State Physician Health Programs and other national organizations. These partnerships have also resulted in clarifications and statements from National Committee for Quality Assurance, Utilization Review Accreditation Commission, The Joint Commission and National Association of Medical Staff Services that aligned with AMA advocacy to remove stigmatizing questions about mental health and substance use disorders.
These efforts are detailed in an AMA issue brief explaining the broad nature of the AMA’s efforts to advocate for physicians’ well-being (PDF).
The AMA’s legislative and regulatory advocacy is part of the AMA’s broad efforts for reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
Making tech work for physicians
From AI implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden. That includes making sure that the effective telehealth modality of care is accessible to patients and sustainable for physician practices.
This year, states continued to evaluate and take action on telehealth, expanding:
- Telehealth coverage and payment. Connecticut, Georgia, Michigan, Nebraska, New York and Pennsylvania passed laws to this effect.
- The definition of telehealth to include audio-only. Connecticut and Florida passed laws to solidify this.
- Licensure flexibilities for out-of-state physicians. Alaska, California, South Carolina, Washington and the District of Columbia created limited exceptions to licensure for out-of-state physicians who provide care via telehealth to patients. The language in several of these states closely follow language in the AMA’s model bill. Colorado and Connecticut created a registration process for out-of-state physicians.
More than 100 bills related to augmented intelligence (AI) were introduced in state legislatures this year, many falling into one of three categories: regulating AI at the state level or creating a state entity to study, evaluate or review AI activities policies, transparency, and applications in health care—including using AI in clinical decision-making. To date, about 20 bills passed this year. Among those bills, most were aimed at regulating state activities or establishing AI task forces or committees.
From Medicare payment reform to reducing physician burnout, fixing prior authorization to defending against scope creep, the AMA is fighting for you, so you can stay focused on your patients. Hear more from our AMA members.
