Monica Barfield: Florida’s fumble on full practice authority for nurse practitioners

When the Centers for Medicare and Medicaid Services (CMS) announced its Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment to improve rural health care, it marked a pivotal shift in how states will be rewarded for removing barriers to care (Centers for Medicare & Medicaid Services [CMS], 2024^[1]).

The program’s Notice of Funding Opportunity (NOFO) opened on Sept. 15 and will close on Nov. 5, 2025, with awards announced by December 31. Part of each state’s technical score will depend on its scope-of-practice environment, specifically whether it allows nurse practitioners (NPs) to practice independently with full practice authority (FPA).

This metric recognizes what decades of research have proven: nurse practitioners provide high-quality, cost-effective, and accessible care across every setting. States that grant FPA empower NPs to evaluate, diagnose, order and interpret tests, and prescribe treatments without mandated physician oversight. Evidence shows these states experience better primary care access, especially in rural and underserved communities (Xue et al., 2021^[2]).

Florida, however, remains a reduced-practice state. Despite progress with HB 607 in 2020, allowing some autonomous primary care practice, psychiatric and many specialty NPs remain restricted by supervisory requirements. These outdated barriers do more than limit professional autonomy; they limit access for Floridians.

Studies consistently demonstrate that FPA states have stronger rural health outcomes. After states expanded NP practice authority, the number of NPs practicing in Health Professional Shortage Areas increased significantly (Xue et al., 2021^[3]). Patient outcomes remain equivalent or superior to those under physician-led care, with comparable control of blood pressure, hemoglobin A1c, and cholesterol levels.

Research also shows no increase in adverse outcomes when NPs practice independently (Grant & Ball, 2023^[4]).

The CMS RHTP uses these findings to justify rewarding states that modernize practice laws. The agency will allocate scoring points based on whether states have eliminated unnecessary physician oversight for NPs (CMS, 2024). In other words, states that empower NPs could capture millions in new federal dollars for rural infrastructure, care coordination, and workforce expansion.

If Florida does not act, it will forfeit this opportunity. The state already ranks among the lowest for primary care access, with more than seven million residents living in federally designated shortage areas (Health Resources and Services Administration [HRSA], 2023^[5]). By continuing restrictive practice laws, Florida effectively disqualifies itself from receiving higher funding scores under CMS’s criteria, sending tax dollars to states like Arizona, New Mexico, and Colorado that recognize full NP authority.

The evidence is clear: Full practice authority does not harm patients; it helps them. The Cato Institute’s 2023 analysis found no measurable increase in patient harm when NPs practiced independently (Grant & Ball, 2023^[6]). Similarly, states with FPA report shorter wait times, lower emergency-room utilization, and higher patient satisfaction (Yang et al., 2021).

Modernizing Florida’s nurse practitioner laws is not a partisan issue; it is a public health and fiscal necessity. Updating the Nurse Practice Act to grant full practice authority would immediately strengthen the state’s RHTP eligibility, improve provider distribution, and bring much-needed health care access to rural communities.

Florida has an opportunity to lead. If policymakers fail to act, they risk losing federal dollars that could transform rural care delivery and support the very communities that need it most.

The path forward is clear: empower nurse practitioners, expand access, and ensure that no Floridian is left behind in the nation’s push toward equitable rural health transformation.

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Monica Barfield, DNP, APRN, AGACNP-BC, FNP-BC, owns New Horizon Primary Care and serves as Region One director for the Florida Nurse Practitioner Network and secretary of the Florida Coalition for Advanced Practice Nurses.