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COVID-19 Scope of Practice Expansions
Topic Collection
May 6, 2020

Topic Collection: COVID-19 Scope of Practice Expansions

Hospitals and health systems throughout the U.S. are faced with increases in patient volumes, leading to significant challenges in delivering vital services. Allowing clinicians to practice to the full scope of their licenses is critical to address staffing needs during the public health emergency. The resources in this collection provide information for specific cadres of healthcare professionals' Scope of Practice Expansions during the COVID-19 response, recommendations, and past expansions. Additional resources detail novel and innovative ways that healthcare professionals are being utilized to address the full breadth of services necessary to meet the needs of patients during the COVID-19 pandemic.

Please refer to CDC’s Coronavirus Disease 2019 webpage for the most up-to-date clinical guidance on COVID19 outbreak management.

If you are a decision-maker and have COVID-19 promising practices, plans, tools, or templates to share with your peers, please visit the ASPR TRACIE Information Exchange COVID-19 Information Sharing Page (registration required) and place your resources under the relevant topic area. Resources specific to decision-making on healthcare workforce can be placed under the COVID-19 Workforce Virtual Toolkit Topic.  

NOTE: inclusion of any reference in this document does not constitute an endorsement, acknowledgment, or suggestion that the reference is the only or best example for that topic. References are included as examples which were provided as suggestions at the time the document was developed.

All guidance posted is accessible to the public, and non-federal resources are noted with an asterisk (*). Linking to a non-federal website does not constitute an endorsement by the U.S. government, or any of its employees, of the information and/or products presented on that site.  

General


Centers for Medicare & Medicaid Services. (2020). COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.
CMS is empowered to take proactive steps to rapidly expand the Administration’s efforts against COVID-19 through both 1135 waivers as well as authority under section 1812(f) of the Social Security Act (the Act). As a result, the blanket waivers listed in this document are in effect through the end of the emergency declaration, with a retroactive effective date of March 1, 2020.
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Dentists


Association of State and Territorial Health Officials. (2020). ASTHO Legal Preparedness Series Scope of Practice Toolkit-FACT Sheet *.
This fact sheet highlights modified scopes of practice in select states due to COVID-19; Illinois, Massachusetts, and New York authorized licensed dentists to administer seasonal and H1N1 vaccine.
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Colorado Dental Association. (2020). CDA COVID-19 Letter to Gov. Pollis.
This letter, written to Colorado Governor Polis, details the multiple ways that dentists can be utilized during the pandemic. The CDA suggests that in a hospital setting dentists can assist medical staff with COVID-19 testing, advanced airway management, and anesthesia services among other services that can be found in the letter.
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Minnesota Department of Human Services. (2020). Minnesota Health Care Programs Immunization and Vaccination Program *.
The Minnesota Health Care Programs Immunization and Vaccination Program allows dentists to administer influenza vaccines to those age 19 and older.
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Oregon State Legislature. (2020). House Bill 2220 *.
House Bill 2200 signed into law the addition of vaccine prescription and administration for children and adults into a dentist’s scope of practice (in Oregon).
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U.S. Department of Health and Human Services. (2005). Commissioned Corps Personal Policy Memorandum (PPM) 05-014.
This letter explains that during a past public health emergency, and upon completion and certification of specified training and education, dental officers in the Commissioned Corps of the U.S. Public Health Service were authorized to administer vaccines as part of emergency response activities.
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Nurses


American Association of Nurse Anesthetists. (2020). Coronavirus Disease (COVID-19)*.
The Clinical Practice Resources and COVID-19 State Government Resources webpages linked to on this site are updated regularly with information for anesthesia professionals and include COVID-19 FAQs in a clinical setting, and an infographic titled “Anesthesia Care of the Patient with Coronavirus.” Additional resources include CRNA-specific Executive Orders for each state. For example, in Kentucky, the requirement for APRNs to have collaborative agreements with physicians as a prerequisite for the prescribing of legend drugs and controlled substances within the Commonwealth has been waived. Other states have waived the requirement to review patient charts and records. More examples of waived requirements can be found on AANA’s website.
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American Association of Nurse Anesthetists. (2020). Utilizing CRNAs Unique Skill Set During COVID-19 Crisis*.
This webpage describes certified registered nurse anesthetists' various areas of expertise such as airway management, ventilatory support, emergency preparedness, and resource management.
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American Association of Nurse Practitioners. (2020). 2020 State Policy Priorities*.
In this brief AANP advocates for nurse practitioners (NPs) to practice at the top of license and to have full practice. Only half of states currently allow NPs to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatment as well as prescribe medication (full practice). This is also recommended by the National Academy of Medicine and the National Council of State Boards of Nursing.
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American Association of Nurse Practitioners. (2020). Temporarily Suspended and Waived Practice Agreement Requirements*.
This webpage provides a regularly updated map and table with links to information regarding temporarily suspended and waived practice agreement requirements by states. Examples include waiving the requirement for nurse practitioners (NP) to have a joint protocol with a collaborating physician and the requirement that the NP practice within 75 miles of the collaborating physician. Examples of expanded prescriptive authorities include suspended rules requiring Advanced Practice Registered Nurses to obtain authorization from a collaborating physician in order to dispense narcotic drugs and suspended restrictions that prohibit Certified Registered Nurse Practitioners from prescribing drugs outside of the established formulary.
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American Association of Nurse Practitioners (AANP). (2020). Nurse Practitioner Prescriptive Privilege*.
In this position paper AANP describes why nurse practitioners should have unlimited prescriptive authority.
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In this news brief ACNM urges members of the Coronavirus Task Force to implement emergency measures to temporarily lift the restrictive state licensure requirements that limit access to full-scope midwifery-led care in the 24 states where midwives are prevented from practicing to the top of their scope.
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American College of Nurse-Midwives. (2020). COVID-19 Resources Page*.
This webpage includes resources to help ACNM members and consumers stay informed on the rapidly evolving COVID-19 response efforts. This page will be updated continuously. Resources in each section are sorted by date published; those without dates listed are either updated continuously or did not include a publication date.
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This executive order permits registered nurses to order the collection of throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19 for purposes of testing.
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Physician Assistants


This webpage contains state emergency actions related to physician assistant licensing and practice.
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In response to the COVID-19 pandemic, Wisconsin is now allowing physician assistants (PA) to limit their practice to the scope of their own experience, education, training, and capabilities as opposed to the scope of practice of the physician who is supervising them. Additionally, the state has waived the requirement to identify a supervising physician, the existing ratio of physicians or podiatrist to PA, and is now allowing them to delegate tasks to other healthcare providers.
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Pharmacists and Pharmacy Technicians


Among the recommended measures, pharmacy organizations urge the COVID-19 Task Force and appropriate agencies to authorize pharmacists to order, collect specimens, conduct, and interpret tests for various infectious diseases, including COVID-19, influenza, and strep. This act would include expanding state pharmacists’ authority to administer all FDA-approved vaccines, including the forthcoming novel vaccine for COVID-19.
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American Society of Health-System Pharmacists. (2020). Pharmacy Readiness for Coronavirus Disease 2019 (COVID-19)*.
This brief includes recommendations for state policymakers to ensure that pharmacists are able to effectively support the COVID-19 response. ASHP recommends allowing them to: administer immunizations for prevention of infectious diseases, order point-of-care testing, and initiate time-sensitive therapies.
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National Alliance of State Pharmacy Associations. (2020). COVID-19: Information from the States*.
This webpage contains state actions affecting pharmacy services, including provisions for allowing out- of-state pharmacists to practice.
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This executive order allows pharmacists and pharmacist technicians in New York to practice at alternative locations.
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The Office of the Assistant Secretary for Health issued guidance under the Public Readiness and Emergency Preparedness Act authorizing licensed pharmacists to order and administer COVID-19 tests authorized by the U.S. Food and Drug Administration.
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Emergency Medical Technicians


National Registry of Emergency Medical Technicians. (2020). COVID-19 National EMS Certification Information*.
This webpage describes the EMS Compact, which was enacted by legislation in 20 states, and protects the public and enhances the emergency medical services system in the United States. The EMS Compact facilitates the day-to-day movement of EMS personnel across state boundaries in the performance of their EMS duties as assigned by an appropriate authority. The EMS Compact also authorizes state EMS offices to afford immediate legal recognition to EMS personnel licensed in any other member state.
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Medical and Clinical Lab Technologists


American Society for Clinical Pathology. (2020). COVID-19 Resources and Efforts*.
This webpage includes COVID-19 guidance and updates created specifically for laboratories.
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This resource provides an overview of the “Immediately in Effect Guidance for Clinical Laboratories, Commercial Manufacturers, and Food and Drug Administration Staff,” allowing for the acceleration of COVID-19 diagnostic tests developed by commercial manufacturers and laboratories.
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Behavioral Healthcare Providers


American Psychiatric Association (APA). (2020). APA Coronavirus Resources*.
APA is tracking guidance released by the U.S. Department of Health and Human Services and at the state level related to COVID-19 to assist psychiatrists with providing mental health and substance use services. Access APA Practice Guidance and state-by-state guidance for COVID-19 at https://www.psychiatry.org/psychiatrists/covid-19-coronavirus/practice-guidance-for-covid-19*.
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American Psychological Association Services, Inc. (2020). Latest Developments for Practicing Psychologists in Response to COVID-19*.
APA presents an information hub specifically for psychology practice resources in response to COVID-19. This webpage includes the latest advocacy updates, reimbursement and licensing/regulatory guidance, and other information to help navigate this public health emergency.
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American Psychological Association Services, Inc. (2020). What the COVID-19 Telehealth Waiver Means for Psychology Practitioners*.
Emergency legislation and guidelines are temporarily expanding psychologists’ ability to provide telehealth services to Medicare patients so they can receive treatment at home during the COVID-19 pandemic.
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Association of State and Provincial Psychology Boards. (2020). Temporary Interjurisdictional Telepsychology Practice & COVID-19.
This webpage provides updates regarding how changes at the Centers for Medicare & Medicaid Services (CMS) affect teletherapy and resources for social workers.
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National Association of Social Workers. (2020). Coronavirus (COVID-19).
The National Association of Social Workers (NASW) provides a range of resources that can be used to support clients, individuals in special populations, and self-care for behavioral health providers on this coronavirus-specific webpage.
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National Association of Social Workers. (2020). Telehealth Medicare Flexibilities for LCSWs *.
This webpage provides updates regarding how changes at the Centers for Medicare & Medicaid Services (CMS) affect teletherapy and resources for social workers.
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Home Health Aides


This webpage addresses how healthcare employers are confronting difficult questions regarding how to handle employment issues.
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Community Health Workers


Boyce, M.R, and Kath, R. (2019). Future Opportunities: Recommendations for Engaging Community Health Workers*. Frontiers in Public Health. 2: 35.
The authors of this article webpage provides information regarding the utilization of community health workers in the distribution of health information and social mobilization during outbreaks.
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Radiology Professionals


American College of Radiology (ACR). (2020). ACR COVID-19 Clinical Resources for Radiologists*.
The information on this webpage can help radiology professionals make more informed decisions during the COVID-19 pandemic. It includes radiology-specific materials for COVID-19 and will be regularly updated as reliable information becomes available.
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American Society of Radiologic Technologists. (2020). COVID-19 Resources for Radiologic Technologists and Students*.
The resources on this webpage include a free infection control course, compliance modules and resources related to hand hygiene and infection control, posters, and links to related information.
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Diagnostic Medical Sonographers


The Society of Diagnostic Medical Sonography (SDMS). (2020). Coronavirus Disease 2019 (COVID-19) Resources*.
SDMS has compiled a list of trusted resources with information on COVID-19 for sonographers to use. Sonographers should familiarize themselves with and carefully follow their facility's infection control policies and procedures to help protect their patients, family, and community.
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Surgeons


This webpage includes links to resources for “older surgeons and out-of-specialty surgeons” deployed to care for COVID-19 patients. Another webpage called “COVID-19 and Surgery” includes content developed or curated under the auspices of ACS Regents and Officers to bring surgeons trusted information, including best practices and guidance that specifically targets the concerns and challenges surgeons face. As the COVID-19 landscape is rapidly changing, this website is updated several times weekly and houses current and past editions of electronic newsletters. Access COVID-19 and Surgery at https://www.facs.org/covid-19*
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Cardiovascular Clinicians


The American College of Cardiology. (2020). COVID-19 Resources Hub*.
This webpage has compiled resources and support information on clinical guidance and practice geared towards cardiovascular clinicians treating COVID-19 patients.
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Addictions Counselors


This webpage explores opportunities for the utilization of telehealth delivery methods to increase access to Medicaid services.
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