ALCOAST 222/26 - JUL 2026 ADVANCED PRACTICE PROVIDER POLICY UPDATE

R 162029Z JUL 26  MID120041392035U
FM COMDT COGARD WASHINGTON DC
TO ALCOAST
BT
UNCLAS
ALCOAST 222/26
SSIC 6000
SUBJ: ADVANCED PRACTICE PROVIDER POLICY UPDATE
A. Coast Guard Medical Manual, COMDTINST 6000.1F
B. Coast Guard Officer Specialty Management System Manual,
COMDTINST 5300.3A
1. This ALCOAST updates policy contained in REF (A) and establishes
the utilization and scope of practice of Advanced Practice
Providers (APPs), to include Physician Associates (PAs), and Nurse
Practitioners (NPs). This policy applies to active duty and reserve
Coast Guard personnel, other Uniformed Services personnel detailed
to the Coast Guard, Coast Guard Auxiliary, and contracted providers.
2. REF (A) is actively being rewritten. Until it is published
in CY 2026, REF (A) is changed to read as follows:
    a. Section B.5.(d) of Chapter 1, "Supervise any assigned PAs and
NPs," is removed from REF (A) in its entirety and is replaced with a
new section B.5.(d), which states:

"Supervise assigned Medical Officers (MOs). To ensure the competence
and skill of those providing health care and services to every
category of CG health services beneficiaries, all health care
personnel are provided supervision of their clinical performance,
as appropriate. Supervisory activities are performed in the context
of the relationship that exists between supervisor
(senior staff member) and employee (subordinate staff member).
The assessment and ongoing validation of the employee's ability to
perform various privileged tasks or patient care activities, as
applicable, substantiates the competency of both privileged and
non-privileged health care personnel. A Clinical Appraisal Report
will be completed for all MOs at the beginning of the privilege
renewal process. The Credentialing Verification Office (CVO) will
ensure this is completed prior to Level 1 privileging reviews."

    b. Section B.10. of Chapter 1, "Duties of Medical Officers (MO),"
is removed from REF (A) in its entirety and is replaced with a new
section B.10. which states:

"Duties of Medical Officers (MOs). The principal mission of MOs
is to support the operational missions of
the CG. MOs include physicians and physician associates who are
members of the CG or PHS detailed to the CG, and NPs who are PHS
officers detailed to the CG. MOs are required to have appropriate
certification and/or licensure while assigned to the CG. All
non-DoW MOs must have an active, unrestricted state license to
practice medicine. PAs and NPs are collectively termed Advanced
Practice Providers (APPs), and must be nationally certified by
their respective organizational bodies.
Civilian medical practitioners (under contract) assigned to military
medical treatment facility are considered MOs to the limits defined
by the language of their contract and/or job description. Civilian
medical practitioners who have a contract with the CG to see
patients in their private offices are not considered MOs for the
purpose of this Manual. All MOs, except those serving as volunteers,
pursuant to a gratuitous services agreement or those in the CG
Auxiliary, must have a federal Drug Enforcement Administration (DEA)
registration number. A fee exempt Federal DEA registration meets the
requirement, and may be obtained by contacting CG-CMO-1, CG Pharmacy
Force Manager. Providers will collaborate with other providers as
often as needed when additional medical advice is necessary or
required by the jurisdiction that issued their credentials. APPs
will inform their respective supervisors of any specific state
license requirements. Health care personnel employed by the federal
government will abide by the practice requirements imposed by their
state of licensure when practicable. However, compliance with state
requirements must not interfere with the individual's performance of
assigned duties/responsibilities in the specified discipline within
the federal sector. CG-CMO will determine if and when other
privileging requirements need to be implemented."

    c. In accordance with REF (B), Section B.17. of Chapter 1,
"Physician Assistants (PAs) and Nurse Practitioners (NPs)" is
removed from REF (A) in its entirety and is replaced with a new
section B.17. which states:

"Physician Associates (PAs) and Nurse Practitioners (NPs).
       (1) PAs and NPs are collectively referred to as APPs.
       (2) All APPs detailed to the Coast Guard must be nationally
certified.
       (3) Physician Associates (PAs) who are not certified by the
National Commission on Certification of Physician Assistants (NCCPA)
and recent graduates who have not taken or passed the NCCPA
examinations may practice in CG facilities under the supervision of
Senior Advanced Practice Providers."

3. REF (A) will be updated per internal controls requirements.
4. POC: LCDR Bridget Metcalf, Physician Associate (PA)
Force Manager, COMDT (CG-CMO-1), (202) 475-5183,
Bridget.A.Metcalf@uscg.mil.
5. RADM Charles E. Fosse, Deputy Commandant for Personnel Readiness
and Chief Human Capital Officer (CG-DCP), sends.
6. Internet release is authorized.