SOUTH CAROLINA Bill May Bring PAs and NPs Independence

Posted By Madilyn Moeller, Monday, February 27, 2023

Bill Name: Senate Bill 553 (S 553)

Primary Sponsor: Senator Tom Davis

Status: 2/21/2023 Referred to Committee on Medical Affairs

AmSpa’s Take: Allowing advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) to practice to the level of their education and skill, without the need to maintain cumbersome chart review and meeting requirements, frees up time and resources that can be better spent seeing patients, improving their skills and developing their practices. Independence also allows these practitioners to innovate in new practice areas through owning their own practices.

Outlook: This bill is in the first steps of the process but, based on the sponsor’s past record, it has a much higher likelihood of passing.

Analysis: Currently, South Carolina physician assistants (PAs) and nurse practitioners (NPs) practice under the supervision of a physician. This supervising physician delegates the medical tasks that the PA or NP may perform. The relationship is formalized using a written scope of practice guidelines (PA) or practice agreement (NP), which lays out what is authorized. Under S 553, NPs and PAs would no longer need a physician to oversee their practice once certain conditions are met.

Initially, PAs would still practice pursuant to written scope of practice guidelines with an overseeing physician. However, once the PA completed 6,000 hours of post graduate clinical experience, they would no longer need to maintain such an agreement. Instead, the PA would only need to collaborate, consult or refer to appropriate members of the health care team as indicated by a patient’s condition. Still, this does not create a supervisory duty or legal responsibility on behalf of the physician. PAs who change specialty would need to practice under written scope of practice guidelines for the first 1,000 hours as they transition.

Under S 553, NPs would no longer need to enter a practice agreement to perform medical acts. These acts now become part of the NP’s general scope of practice. Other advanced practice registered nurses would likewise be made independent under this bill; clinical nurse specialists and certified nurse midwives would both have full practice authority, as well.

The majority of states allow nurse practitioners to practice independently; more recently, many states have been giving more freedom and autonomy to physician assistants, as well. Most states have begun to provide reduced oversight or more flexibility, but still retain the physician oversight. S 553 would solidly go along with this trend in providing both independence for NPs and a path to independence for PAs. If you would like additional information, to read the language of the bill or to contact the sponsors or committee, you can find the information you need through this link.