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Federal Trade Commission staff submitted written comments supporting a U.S. Department of Veterans Affairs’ (VA) proposed rule that would permit the VA to grant “full practice authority” to the four main categories of Advanced Practice Registered Nurses (APRNs) – Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists, Certified Nurse Midwives and Certified Registered Nurse Anesthetists – provided certain background requirements are met, including verification of credentials and demonstration of necessary knowledge and skills.

As defined by the proposed rule, “full practice authority” means that APRNs employed by the VA would be able to provide certain services “without the clinical oversight of a physician, regardless of State or local law restrictions.” For example, APRNs generally would be able to evaluate VA patients, order diagnostic tests for them, and manage their treatments without physician involvement or approval as long as they do so within the limits of their professional education and training. In its announcement of the proposed rule, the VA recognizes that CNPs – the main category of primary care APRNs – already have full practice authority under the laws of over 20 states and the District of Columbia.

Staff of the FTC’s Office of Policy Planning and its Bureaus of Competition and Economics, responding to the VA’s request for public comments, stated that removing the remaining state law based supervision restrictions for APRNs working within the Veterans Health Administration system could benefit VA patients nationwide “by improving access to care, containing costs, and expanding innovation in health care delivery.”

The comment adds that, “To the extent that the VA’s actions would spur additional competition among health care providers and generate additional data in support of safe APRN practice, we believe those benefits could spill over into the private health care market as well.”

The Commission vote to issue the staff comments was 3-0. (FTC File No. V160013; the staff contact is Daniel J. Gilman, Office of Policy Planning, 202-326-3136.)

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Contact Information


Frank Dorman
Office of Public Affairs