Pennsylvania candidates line up behind nurse practitioner independence as rural funding stakes rise
Eighty-one of the 82 Pennsylvania legislative candidates who responded to a pre-election survey backed allowing nurse practitioners to practice without a physician contract. The result arrives with unusual timing: two weeks before CMS is set to announce the next round of rural health awards, a formula that gives scope-of-practice rules a measurable, if limited, role in how states are scored.
One dissenting response stands out in a field that was otherwise nearly unanimous. James Edwards, the Republican challenging Rep. Dan Goughnour in Allegheny County, opposed the change; every other responding candidate supported it.
The Pennsylvania Coalition of Nurse Practitioners PAC sent its six-question survey to all 382 major-party candidates for the General Assembly and followed up with reminders in August and September. The PAC posted each candidate’s answers and rolled out the results at the coalition’s annual conference in Erie. Lorraine Bock, DNP, chair of the PCNP PAC, framed the ballot box as part of the access debate, arguing that voters can influence whether the state expands nurse practitioner autonomy.
The battle over collaborative agreements in Pennsylvania
Pennsylvania law still requires certified registered nurse practitioners to work under a written collaborative agreement with a physician. For prescribers, the rules go further: a prescriptive authority collaborative agreement must name the collaborating physician and at least one substitute physician. The coalition characterizes that arrangement as a two-physician contract.
SB 25, sponsored by Sen. Camera Bartolotta, and HB 739, sponsored by Rep. Nancy Guenst, would remove that requirement for NPs who complete three years and 3,600 hours of collaboration with a physician. Both bills moved into committee in early 2025 and had not received hearings as of June. Bartolotta has introduced the proposal every year since 2017, and a prior version cleared the Senate 44-6 in 2019 without becoming law.
The policy fight is no longer just about professional turf. It now sits inside a broader federal financing argument, where state practice rules can affect rural health scoring even if they do not determine the bulk of a state’s award.
Rural health dollars now intersect with scope-of-practice rules
At the Erie conference, Tammy Huey, CRNP, pointed to a striking funding gap: states with full practice authority receive an average of $497 in federal rural health funding per rural resident, compared with $67 in Pennsylvania. Those figures were attributed in the coalition’s materials to an unnamed analysis, and the same numbers appeared earlier in a July post by a Penn Medicine nurse practitioner that referred only to “some RHT Program estimates.”
The funding in question comes from the Rural Health Transformation Program, a $50 billion pool created by the 2025 budget reconciliation law. The program pays states $10 billion a year from fiscal 2026 through 2030. Half of each year’s money is split evenly across states, while CMS distributes the rest through a formula that includes a 1.75% weight for scope of practice. For nurse practitioners, the scoring scale assigns 0 points to restricted practice, 50 to reduced practice and 100 to full practice.
In Pennsylvania’s February 2026 rural health plan, the state receives 50 points for NPs, 0 for physician assistants, 0 for pharmacists and 50 for dental hygienists. The plan commits the state to work on a physician assistant licensure compact, but it does not promise a scope-of-practice change. Pennsylvania also received $78 per rural resident in the program’s first year, below the national average of $157.
A single formula line can carry real political weight. In a program where half the money is divided equally, the per-resident awards favor policy alignment as much as geographic need.
Physicians argue the access story is incomplete
The Pennsylvania Medical Society has taken the opposite view, warning that expanding practice authority for non-physician providers can increase safety concerns, spending and unnecessary testing. Its scope-of-practice materials cite research showing $43 higher monthly spending per member for patients whose primary care comes from non-physician clinicians, and it points to American Medical Association mapping that it says shows nurse practitioners tend to practice in the same locations as physicians regardless of state scope laws.
That argument gets at the central tension in the debate. Proponents describe full practice authority as a tool for access, especially in rural communities where recruiting and retaining clinicians remains difficult. Opponents see a system that could shift costs without reliably moving care into the counties that need it most. The same policy can look like relief in one setting and redundancy in another.
The medical society’s resistance has been durable. In a 2019 op-ed, then-PAMED President Danae Powers, MD, said the group would support limits on what physicians may charge for collaborative agreements but would not accept eliminating them.
Pennsylvania’s vote could echo beyond the statehouse
The coalition says 27 states allow nurse practitioners to practice without physician collaboration, though a June count by the Capital-Star put the number at 28. The difference may sound small, but in a policy fight defined by state-by-state momentum, one additional jurisdiction can alter how advocates tell the story of inevitability.
National practice trends add another layer. Nurse practitioners registered 5,097 new practices from Jan. 1 through Sept. 26, 2026, nearly six times as many as during the same period in 2019, based on a Medical Boulevard analysis of federal National Provider Identifier registry data. Full-practice states produced the most new NP practices per resident, while Florida and Texas led in absolute registrations despite restricting NP practice. The analysis tracked registrations, not confirmed openings, so the data speak to intent and administrative activity rather than completed clinical expansion.
For Pennsylvania lawmakers, the immediate question is whether that growth should be encouraged through state law or constrained by physician supervision. For CMS, the question is narrower but still consequential: how much should scope rules shape rural transformation dollars when the formula is recalculated?
All 203 state House seats and 25 Senate seats are on the Nov. 3 ballot, and the two-year session ends before year’s close. Bills that fail to pass must be reintroduced in the next session, leaving only a handful of voting days on the calendar. The next CMS allocation announcement, due by Oct. 31, lands first; the legislative deadline follows close behind.