As one of the fastest-growing professions, physician associates (PAs) are becoming the backbone of patient care. From small practices to large health systems, PAs manage everything from wellness visits and chronic conditions to urgent care needs. In rural areas, PAs often serve as the only available provider for miles. Yet, even as PAs expand access to care, outdated supervision laws and scope restrictions still limit how fully they can practice.
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This administration’s One Big Beautiful Bill Act, legislation title HR1, is starting to change that conversation. Because the bill’s budget cuts are expected to affect rural healthcare disproportionately, the bill includes the Rural Health Transformation Program. RHTP ties grant funding to how states structure their healthcare workforce. For the first time, states are financially motivated to examine whether their regulations actually help — or hinder — patient access.
“For the first time, states are asking how to achieve optimal PA practice because now it’s tied to funding. That’s a powerful shift,” says Chantell Taylor, an attorney and policy lead at the American Academy of Physician Associates (AAPA).
HR1’s Rural Health Transformation Program: Impact on PA Practice and Scope
HR1’s Rural Health Transformation Program awards points to states that demonstrate “optimal practice environments.” In the case of PAs and NPs, this means fewer unnecessary barriers to care delivery. While it’s too early to know the bill’s full impact, the potential is significant. As states compete for federal funding, they may begin modernizing supervision and licensure laws that have long constrained PA practice. “States are going to face budget cuts and are having to think about how to continue serving patient populations with fewer resources. PAs fit a nicely into that niche,” says Taylor.
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The AAPA has always focused on educating healthcare stakeholders, providers and legislators about the critical role PAs play. “We’re focused on removing barriers that prevent PAs from practicing to the top of their scope,” says Taylor.
Those barriers often stem from outdated perceptions of how physician supervision works in real-world settings.
How Outdated PA Supervision Laws Restrict Care and How HR1 is Changing Them
Few issues for PAs are as misunderstood as “physician supervision,” says Taylor. “While it sounds like a physician is directly engaged with every patient interaction, in reality, it’s often a transactional requirement of signing off on charts without ever seeing the patient.”
This administrative requirement comes with a financial cost for PAs. In states that still require formal supervision agreements, PAs or their employers must pay physicians to review charts and sign documents, which is time and money that could otherwise go toward patient care.
In Iowa, for example, when that state removed its physician supervision requirement, one PA was able to use those funds to hire additional providers, open her own practice and dramatically expand patient access in her community,” says Taylor.
In this case, legislative reform directly translated into more care for underserved patients.
How HR1 Improves Rural Healthcare Access Through Expanded PA Practice
With hospitals and clinics facing tighter budgets under HR1, affordable access to care is an urgent issue, especially in rural areas. PAs already fill that gap and are positioned to prove even more necessary.
“Nearly one in four PAs practice in federally designated shortage areas, and more than a third of those focus on primary care,” says Taylor.
The PA workforce, as well as nurse practitioners, is critical to the future of healthcare in the United States. States that submit proposals with concrete, affordable ways to meet healthcare demand are more likely to receive funding. This means the program’s funding formula favors states that allow PAs to work at the top of their training, encouraging local legislators to review outdated supervision, ratio and ownership restrictions.
“We’re now hearing from states asking how to achieve optimal practice for PAs, not just to improve care, but to qualify for federal funding under HR1,” says Taylor.
States from Maine to Arizona are reevaluating their regulations, with several exploring bills that would make it easier for PAs to open clinics, work without redundant oversight and join licensure compacts that allow more flexibility across state lines.
For PAs in these regions, that could mean expanded opportunities and new professional responsibilities as their scope grows.
HR1 and PA Practice: Balancing Quality, Access, and Risk in Rural Healthcare
A key question behind any expansion of practice is whether patient safety or risk exposure changes. Taylor says the evidence is clear. “There’s no indication that patient safety is compromised when PAs practice at the top of their license. In fact, access improves and costs decline.”
That data matters not only to policymakers but also to insurers and healthcare organizations. When barriers are removed, practices can hire more PAs without adding unnecessary supervision costs, expanding workforce capacity and improving financial stability.
When it comes to risk management, modernized laws can reduce liability exposure by allowing PAs to document and practice within well-defined, consistent parameters. For PAs, that means staying current on state law, maintaining clear patient documentation and ensuring malpractice coverage reflects their evolving role.
“When PAs are trusted to do what they’re trained to do, both providers and patients benefit,” says Taylor
The Future of Rural Health and PA Scope of Practice Under HR1
HR1 isn’t an overnight fix, and it remains unclear how the legislation will change healthcare, temporarily and even permanently. The multi-year program will affect each state over time. What is clear is that the RHTP is already changing the conversation around APPs’ role in filling healthcare gaps and practice modernization.
“This is just the beginning. We’re seeing new attention on PA practice, and as states modernize their laws, it’s good for patients and for providers,” says Taylor.
With time, modernization could ease burnout and strengthen workforce retention. When PAs are empowered to practice fully, they report higher job satisfaction. More providers in the labor force reduce the care burden for all providers and create a sustainable cycle of improved access and better care.
How Physician Associates Can Prepare for HR1 and Expanded Practice Opportunities
As the policy landscape quickly evolves, here’s how practicing PAs can stay informed and protected:
- Stay informed: Track your state’s progress toward “optimal practice” through AAPA and your state chapter.
- Engage locally: Join advocacy efforts that educate policymakers about the PA role in rural and primary care.
- Update agreements: If your responsibilities expand, revisit collaboration or delegation agreements.
- Review your coverage: Ensure your malpractice policy aligns with your actual scope of practice.
- Lead education efforts – Help patients and peers understand how modern PA practice increases access and safety.
Protecting Your PA Practice: Malpractice Coverage and Risk Management Under HR1
As laws evolve, your scope of practice and your professional risk can shift, too. Having a partner who understands those changes is essential.
Frequently Asked Questions
- How does HR1 impact Physician Associate (PA) practice? HR1’s Rural Health Transformation Program financially incentivizes states to modernize outdated PA supervision and licensure laws. States that support full PA scope of practice and reduce unnecessary oversight are more likely to qualify for federal funding, which can expand PA autonomy and rural access to care.
- Why are outdated PA supervision laws being reconsidered under HR1? HR1 forces states to evaluate whether their supervision rules limit patient access—especially in rural areas facing budget cuts. Many states are discovering that removing rigid supervision and chart-signing requirements improves care delivery, reduces costs, and enables PAs to practice at the top of their training.
- Will HR1 improve healthcare access in rural communities? Yes. Since nearly one in four PAs already practice in shortage areas, HR1 encourages states to expand PA scope to meet growing rural healthcare demands. By reducing barriers to practice and allowing PAs to operate more independently, states can increase provider availability and strengthen rural health systems.
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