South Dakota’s Path to Independence: A Case Study in PA Autonomy and Rural Healthcare Reform

South Dakota State Capitol located in Pierre, South Dakota

Introduction: Independence, Innovation, and Access

Across the United States, Physician Associates (PAs) are stepping forward to meet unprecedented healthcare challenges from provider shortages and administrative bottlenecks to rural hospital closures and underserved communities. Despite their extensive training and national certification, many PAs still operate under decades-old laws requiring ongoing physician supervision, limiting access to care, particularly in rural regions.

In 2025, South Dakota became a national leader by passing House Bill 1071, which removed the requirement for experienced PAs to maintain collaborative agreements with physicians. This reform was built upon earlier legislation in 2017 that granted full practice authority to nurse practitioners (NPs). South Dakota’s journey reflects a broader trend: a reevaluation of healthcare workforce policies to prioritize access, flexibility, and evidence-based governance.

This blog explores South Dakota’s path to provider independence from outdated policies and legislative resistance to a sweeping victory that modernized its healthcare framework.

Part I: The Landscape Before Reform

Outdated Laws in a Modern Workforce

Prior to reform, South Dakota followed the conventional model: PAs and NPs needed physician collaboration agreements, even in areas facing severe provider shortages. While intended to protect patients, these laws became misaligned with:

• The advanced training and national certification of PAs

• The clinical independence already practiced in many healthcare settings

• The urgent access needs of rural communities

These restrictions created barriers to care and administrative burdens, driving many qualified PAs out of state.

The Rural Healthcare Crisis in South Dakota

South Dakota’s deeply rural makeup, with nearly half of its counties designated as Health Professional Shortage Areas (HPSAs), only intensified the issue. By the mid-2010s:

• Over 60% of PA graduates were leaving the state

• Clinics struggled to comply with supervision laws due to physician shortages

• Telehealth remained constrained by outdated licensing rules

These conditions laid the foundation for a serious push toward policy reform.

Part II: NP Reform Paves the Way (SB 61, 2017)

A Breakthrough for Nurse Practitioners

In 2017, Senate Bill 61 granted NPs and nurse midwives the ability to practice independently after completing 1,040 supervised hours. Key provisions included:

• Removal of permanent collaborative agreements for eligible APRNs

• An emphasis on rural primary care access

• Strong bipartisan support in both legislative chambers

Framing the Policy: Patient Access First

Reform advocates succeeded by shifting the narrative: the issue wasn't provider rights, but patient access. Lawmakers saw a healthcare system straining under unnecessary restrictions, not a profession asking for special privileges.

Proven Results

Following passage:

• South Dakota became the 22nd state to offer some form of full practice authority to NPs

• No rise in adverse events or patient complaints occurred

• Rural access to care improved

  
  

This legislative victory became a strategic blueprint for the PA community.

Part III: The Long Road for PA Reform

Early Bills and Legislative Setbacks

After the NP reform, attention turned to PAs. Between 2019 and 2023, several bills were introduced. Senate Bill 175 (2023) was among the most ambitious, proposing independence for PAs with 2,080 hours of experience.

Despite support from advocacy groups, the bill failed primarily due to:

• Concerns over radiologic procedures and scope boundaries

• Strong opposition from the South Dakota Radiological Society

• Lack of support from the state medical board

Strategic Adjustments by Advocates

The defeat prompted introspection. The South Dakota Academy of PAs (SDAPA) recalibrated its strategy, emphasizing:

• The workforce crisis in rural health

• Retention of in-state PA graduates

• Data from NP reform shows safe practice

  
  

They also intensified legislative outreach and partnered more closely with rural clinics and health systems.

Part IV: HB 1071 and the Breakthrough for PA Independence

A Landmark Law

In March 2025, Governor Larry Rhoden signed House Bill 1071 into law. The bill allows PAs to practice independently after completing 6,000 supervised hours (~3 years full-time). Key elements:

• No ongoing requirement for a collaborative agreement

• A streamlined affidavit process to verify experience

• Continued commitment to certification and education standards

Broad Support and Legislative Success

Unlike previous efforts, HB 1071 enjoyed:

• Broad bipartisan legislative support

• Neutral or positive feedback from medical associations

• No organized opposition from the state Board of Medicine

The law’s passage reflected a growing consensus that PAs were already functioning independently in practice and should be recognized accordingly.

Statements from Leaders

Kayla Frank, SDAPA’s legislative chair, said:

“It’s not about expanding what PAs do. It’s about recognizing the work we’re already doing and removing paperwork that slows us down.”

The AAPA praised South Dakota’s leadership:

“A modern law for a modern profession.”

Part V: Impact on Healthcare Access and the Workforce

Attracting and Retaining Talent

With collaboration requirements lifted, South Dakota is now more competitive in attracting PAs, both new graduates and seasoned professionals. This is a game-changer, especially considering:

• Historical outmigration of PA talent

• Clinics in rural and tribal communities are struggling to meet physician supervision mandates

Improving Access in Rural and Frontier Areas

HB 1071 empowers PAs to serve where they’re needed most, such as:

• Critical access hospitals

• Tribal health services

• Remote primary and urgent care facilities

The law’s flexibility removes barriers that previously forced some communities to go without regular care.

Maintaining Safety and Quality

Data from NP independence since 2017 already showed:

• No rise in malpractice or complaints

• Better patient access and continuity of care

• Increased satisfaction in rural areas

South Dakota expects similarly positive outcomes from PA independence, backed by robust education and licensure standards.

Conclusion: A Roadmap for Reform

South Dakota’s path to PA independence required persistence, adaptation, and collaboration. But the result is clear: a more flexible, efficient, and accessible healthcare system, especially in rural regions.

The success of HB 1071 is a model for other states considering similar reforms. It shows what’s possible when advocates build coalitions, center their message on patient access, and remain undeterred by setbacks.

South Dakota has proven that even in conservative, rural-dominated states, forward-thinking healthcare policy is not only achievable it’s essential.

Deadwood, South Dakota—where history and progress meet. As South Dakota advances healthcare legislation, communities like this reflect the state’s rich heritage and promising future.

References

1. South Dakota Legislature. (2025). House Bill 1071 – Modify Practice Criteria for Physician Assistants. Retrieved from https://sdlegislature.gov/Session/Bill/25490

2. South Dakota Legislature. (2017). Senate Bill 61 – Update Provisions for Nurse Practitioners and Nurse Midwives. Retrieved from https://sdlegislature.gov/Session/Bill/7790

3. American Academy of PAs (AAPA). (2025, March). South Dakota Governor Signs Legislation Removing Mandatory Practice Agreements for PAs. Retrieved from https://www.aapa.org/news-central/2025/03/south-dakota-governor-signs-legislation-removing-mandatory-practice-agreements/

4. American Association of Nurse Practitioners (AANP). (2017). Nurse Practitioners Salute South Dakota for New Health Care Law. Retrieved from https://www.aanp.org/news-feed/nurse-practitioners-salute-south-dakota-for-new-health-care-law

5. South Dakota Public Broadcasting (SDPB). (2017, February 13). Nurse Licensing Bill Goes To Governor. Retrieved from https://www.sdpb.org/health/2017-02-13/nurse-licensing-bill-goes-to-governor

6. AARP South Dakota. (2017). 2017 South Dakota Legislative Update – Week Three. Retrieved from https://states.aarp.org/south-dakota/2017-sd-legislative-update-week-three

7. LegiScan. (2025). South Dakota HB 1071 – 2025 Regular Session. Retrieved from https://legiscan.com/SD/bill/HB1071/2025

8. FastDemocracy. (2025). Bill Tracking for South Dakota HB 1071 (2025). Retrieved from https://fastdemocracy.com/bill-search/sd/2025/bills/SDB00006934/

9. American Medical Association (AMA). (2025, January 30). Letter Opposing South Dakota HB 1071. Retrieved from https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2Flfcmts.zip%2F2025-1-30-Letter-opposing-SD-HB-1071-Final.pdf

10. Campaign for Action. (2018). APRN Practice Report Shows Consumers Gaining Access to Care. Retrieved from https://campaignforaction.org/report-details-legislative-wins-consumers-2017/