Pennsylvania candidates line up behind nurse practitioner independence before federal rural funding scores are set
Eighty-one of the 82 Pennsylvania legislative candidates who responded to a pre-election survey backed letting nurse practitioners practice without a contract with a physician. The answer set arrives just as the state waits for the next round of federal rural health awards, a formula in which scope of practice carries real weight and can affect how much money flows back to underserved communities.
The timing gives the survey more than campaign-season symbolism. It places nurse practitioner independence inside a broader debate over access, staffing, and state competitiveness for federal dollars tied to rural health infrastructure.
The survey came from the political action committee of the Pennsylvania Coalition of Nurse Practitioners, which sent six questions to all 382 major-party candidates for the General Assembly and followed up with reminders in August and September. Responses were later posted publicly, and the coalition announced the results at its annual conference in Erie. The lone dissent among respondents came from James Edwards, a Republican challenging Rep. Dan Goughnour in Allegheny County.
Pennsylvania law still requires certified registered nurse practitioners to work under a written collaborative agreement with a physician. NPs who prescribe also need a prescriptive authority collaborative agreement that names the collaborating physician and at least one substitute physician. In practical terms, the current model ties advanced practice nursing to physician oversight even after years of training and clinical work, and it keeps NP autonomy dependent on formal agreements rather than licensure alone.
The legislative push centers on three years and 3,600 hours
Two bills now on the state docket would change that structure. Senate Bill 25, sponsored by state Sen. Camera Bartolotta, and House Bill 739, sponsored by Rep. Nancy Guenst, would lift the collaborative agreement requirement for NPs who complete three years and 3,600 hours of collaboration with a physician.
Both proposals have already moved into committee without hearing. SB 25 went to the Senate Consumer Protection and Professional Licensure Committee on Jan. 22, 2025, and HB 739 went to the House Professional Licensure Committee on Feb. 26, 2025. Bartolotta has introduced the measure every year since 2017, and a prior version cleared the Senate 44-6 in June 2019 without becoming law.
The long legislative trail matters because it shows how persistent this fight has been. Pennsylvania has repeatedly approached the same policy question from slightly different angles: whether a structured transition period should be enough to allow independent NP practice, or whether physician collaboration should remain a standing requirement. Governor Josh Shapiro has already signaled support for full practice authority for NPs who have worked under a physician for three years in his 2025-26 budget proposal.
One political detail stands out against that backdrop. The PAC gave money to two candidates this cycle: Senate President Pro Tempore Kim Ward and Rep. Peter Schweyer. Ward has presided over a Senate in which no full practice authority bill has passed since she took over leadership, and a spokesperson previously said she continued to do her due diligence on the matter.
Rural health dollars are now part of the scope-of-practice argument
The rural funding case has become the most forceful public argument for the policy change. At the Erie event, coalition member Tammy Huey, a nurse practitioner who practiced in rural Venango County, said states with full practice authority receive $497 in federal rural health funding per rural resident on average, compared with $67 in Pennsylvania. Those figures were presented without a named source, but they were echoed in a July blog post on Judge.com that attributed similar numbers to unnamed Rural Health Transformation Program estimates.
The underlying program is real and immediate. The Rural Health Transformation Program is a $50 billion fund created by the 2025 budget reconciliation law, paying states $10 billion a year from fiscal 2026 through 2030. Half of each year’s money is divided equally among states. The rest is allocated by Centers for Medicare & Medicaid Services formula, and scope of practice carries a 1.75% weight within that formula.
Even a small percentage factor can matter when states are clustered near one another in the scoring pack. For NPs, CMS assigns 0 points for restricted practice, 50 for reduced practice and 100 for full practice. Pennsylvania’s February 2026 rural health plan lists the state at 50 points for NPs, 0 for physician assistants, 0 for pharmacists and 50 for dental hygienists. The plan commits the state to policy change on a physician assistant licensure compact but does not include a scope-of-practice commitment.
Pennsylvania received $193 million in the program’s first year, equal to $78 per rural resident and well below the national average of $157. KFF’s analysis showed that per-resident awards were generally smallest in states with the largest rural populations, because half of each year’s money is divided evenly regardless of need. Texas, with the most rural residents and the largest total award, still received just $66 per rural resident.
Safety concerns remain the physician counterargument
The Pennsylvania Medical Society continues to argue against loosening supervision requirements. On its scope of practice page, the society says expanding practice authority for non-physician providers can lead to safety concerns, increased costs and more unnecessary testing. The public argument is familiar across state houses, but in Pennsylvania it now intersects with a funding formula that rewards states for policy signals as well as service capacity.
The tension is not abstract. Rural communities face persistent physician shortages, long travel distances and thinner specialty coverage, so any policy that changes the supply of primary care clinicians can alter access patterns quickly. Expanded NP autonomy can speed appointment availability and reduce the administrative friction of collaborative agreements. Opponents, meanwhile, worry about fragmented care and the loss of physician-led oversight in complex cases.
CMS is due to announce fiscal 2027 allocations by Oct. 31, so the political stakes are immediate. Pennsylvania lawmakers, candidates and health systems are now operating under a federal clock, and the state’s own policy choices will be judged against that next allocation cycle. What remains unresolved is whether the current legislative momentum around NP independence will translate into enacted law before the next scoring round, or whether Pennsylvania will again enter the federal process with an unchanged scope-of-practice status quo.