Survey: Pennsylvania candidates back ending NP collaboration agreements

Eighty-one of the 82 Pennsylvania legislative candidates who responded to a pre-election survey from the state's nurse practitioner lobby said they support ending the requirement that nurse practitioners (NPs) practice under a contract with a physician, according to results released Oct. 15.

The political action committee (PAC) of the Pennsylvania Coalition of Nurse Practitioners (PCNP) sent its six-question survey to all 382 major-party candidates for the General Assembly.

One respondent, James Edwards, a Republican challenging Rep. Dan Goughnour (D-Allegheny County), said he did not support full practice authority, the Pennsylvania Capital-Star reported.

The PAC posted the responses ahead of the Nov. 3 election.

Tammy Huey, CRNP, a coalition member who practiced in rural Venango County, said in the PAC's announcement that “in many communities like mine, family practice physicians are retiring with no replacements lined up, and hospitals are closing because they cannot afford to stay open.”

What practices maintain today

Pennsylvania requires certified registered nurse practitioners (CRNPs) to practice under a written collaborative agreement with a physician.

CRNPs who prescribe also need a prescriptive authority collaborative agreement, submitted through the state's online licensing system, that names the collaborating physician and at least one substitute physician, each holding a current Pennsylvania license.

The collaborating physician reviews and approves the agreement in the system but cannot edit it, according to the Department of State's application guide.

When a prescriptive authority agreement is updated or terminated, the CRNP must notify the State Board of Nursing in writing and, when appropriate, file a change form with the amended agreement and pay a fee, under state regulations.

After a Philadelphia federally qualified health center hired a psychiatric NP, nearly six months passed before that NP saw a patient because of the state's collaboration requirement, CEO Emily Nichols said, the Capital-Star reported in June.

Amanda Laskoskie, DNP, then president of the coalition, described an NP-owned practice that pays its collaborating physician 2% to 3% of monthly revenue for each of the practice's four NPs, CBS News Pittsburgh reported.

In 2019, the Pennsylvania Medical Society (PAMED) said it would support limits on what physicians can charge for collaborative agreements, then-President Danae Powers, M.D., wrote in a Morning Call op-ed.

What the bills would change

Senate Bill 25 (SB 25), sponsored by state Sen. Camera Bartolotta (R-Washington County), and House Bill 739, sponsored by Rep. Nancy Guenst (D-Montgomery County), would let NPs practice without a collaborative agreement once they complete three years and 3,600 hours of collaboration with a physician.

The text of SB 25 would also create a new license title, “advanced practice registered nurse-certified nurse practitioner,” and would provide for the expiration of the State Board of Nursing's power to license CRNPs.

Both bills have sat in committee since early 2025 and had not received hearings as of June, according to the Capital-Star.

Gov. Josh Shapiro backed the three-year approach in his 2025-26 budget proposal.

PAMED opposes the change. Its scope of practice page says expanding practice authority for non-physician providers “can lead to safety concerns, increased costs and an increase in unnecessary testing.”

This cycle, the PAC gave money to two candidates, Senate President Pro Tempore Kim Ward (R-Westmoreland County) and Rep. Peter Schweyer (D-Lehigh County), according to state campaign finance reports cited by the Capital-Star.

No full practice authority bill had passed the Senate since Ward took over the chamber's leadership, WFMZ reported in 2024.

Competition for NPs

Most of Pennsylvania's neighbors, with the exception of Ohio, let NPs practice independent of a physician, the Capital-Star reported in June. The PAC says 27 states grant full practice authority.

NPs registered 5,097 new practices nationwide from Jan. 1 through Sept. 26, 2026, nearly six times as many as in the same period of 2019, according to a Medical Boulevard analysis of federal National Provider Identifier registry data.

Psychiatric and mental health NPs accounted for more than half of the new practices.

Full-practice states had the most new NP practices per resident, though growth since 2022 was strong under every type of state law. The analysis counts registrations, not confirmed openings.

The federal funding argument

Huey said at the coalition's Erie event that states with full practice authority receive $497 in federal rural health funding per rural resident on average, compared with $67 in Pennsylvania, citing an unnamed analysis.

The money comes from the Rural Health Transformation Program, which pays states $10 billion a year from fiscal 2026 through 2030. Half of each year's money is split equally among states.

The Centers for Medicare & Medicaid Services (CMS) allocates the rest by formula, and scope of practice carries a 1.75% weight in it, averaging state scores for NPs, physician assistants, pharmacists and dental hygienists.

Pennsylvania's reduced-practice status earns 50 of 100 possible points for NPs, according to the state's February 2026 plan.

Pennsylvania received $193 million in the program's first year, or $78 per rural resident against a national average of $157, WESA reported in June.

CMS is due to announce fiscal 2027 allocations by Oct. 31.

What's next

All 203 state House seats and 25 Senate seats are on the Nov. 3 ballot.

The two-year legislative session ends Nov. 30, and bills not enacted by then must be reintroduced in the next session. The House calendar lists five voting days before that deadline.