Prescriber Scope of Practice for Narcolepsy in Florida

If you’re a psychiatrist or PMHNP considering treating narcolepsy patients via telehealth — or you’re already doing it and want to make sure you’re compliant — you’re navigating one of the most complex intersections of telemedicine law: controlled substance prescribing across state lines.

Narcolepsy treatment often requires Schedule II stimulants (methylphenidate, amphetamines) or other controlled medications (modafinil, sodium oxybate). Under normal circumstances, federal law requires an in-person exam before you can prescribe any controlled substance via telemedicine. But we’re not in normal circumstances.

Here’s what you need to know about the current rules, where they’re headed, and how to stay compliant while serving patients who desperately need access to specialized care.

The Current Reality: Federal Telehealth Flexibilities Extended Through 2026

Bottom line first: As of early 2026, you can prescribe narcolepsy medications — including Schedule II stimulants — via telehealth without an initial in-person visit, thanks to ongoing federal waivers.

The Ryan Haight Online Pharmacy Consumer Protection Act (2008) normally requires at least one in-person medical evaluation before prescribing controlled substances via telemedicine. This law was designed to crack down on rogue online pharmacies, but it created significant barriers for legitimate telehealth providers.

When COVID hit in March 2020, the DEA waived this requirement to prevent care disruptions. That waiver has been extended multiple times — most recently through December 31, 2026 — while the DEA works on permanent telemedicine rules. This gives providers a stable two-year runway to operate under current flexibilities.

What this means for your practice:

• You can evaluate a new narcolepsy patient via video telehealth
• You can prescribe Schedule II–V controlled substances without an in-person visit
• You must still meet all other requirements: state licensure in the patient’s location, DEA registration, standard of care documentation, PDMP checks

The catch: This is temporary policy. The DEA is actively developing permanent regulations that will likely impose some limitations — possibly requiring an in-person visit after an initial 30-day telehealth prescription, or restricting certain drug classes entirely from telehealth initiation.

The DEA received over 38,000 public comments on its 2023 proposed rules (which would have severely restricted telehealth prescribing), leading them to pause and reconsider. Two narrow final rules were published in January 2025 — one expanding telehealth for buprenorphine in opioid treatment, another for VA continuity of care — but the broader telehealth framework remains in flux.

Provider takeaway: Build your narcolepsy telehealth practice now while the rules allow it, but have a plan for how you’ll adapt when permanent regulations drop. That might mean establishing partnerships with local clinics for hybrid care, or focusing on states where you can maintain compliant operations under tighter federal rules.

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State-Specific Rules: Where Telehealth Narcolepsy Prescribing Gets Complicated

Federal law sets the floor, but state laws add layers that can make or break your ability to treat narcolepsy remotely. Some states defer entirely to federal rules; others impose additional restrictions that effectively prohibit telehealth prescribing of stimulants for narcolepsy — even though it’s federally allowed.

Florida: The Outlier That Blocks Narcolepsy Stimulants via Telehealth

Florida Statute §456.47 explicitly prohibits prescribing Schedule II controlled substances via telehealth except in four situations:

1. Treating a psychiatric disorder (ADHD, depression, etc.)
2. Inpatient hospital care
3. Hospice care
4. Nursing home residents

Here’s the problem: Narcolepsy is not a psychiatric disorder — it’s a neurological sleep disorder. Even though the DEA currently allows telehealth prescribing of stimulants, Florida state law does not permit it for narcolepsy specifically.

What this means in practice:

• You cannot prescribe Adderall, Ritalin, or other Schedule II stimulants to a Florida narcolepsy patient via telehealth alone
• You can prescribe modafinil or armodafinil (Schedule IV wakefulness agents) via telehealth
• You need at least one in-person visit to start a Florida patient on Schedule II stimulants, then you can manage them remotely

Workaround: Some providers partner with local Florida clinics or sleep centers to provide the initial in-person evaluation and diagnostic testing (polysomnogram, MSLT), then take over telehealth management once the patient is established on medication. Others focus on non-Schedule II options for Florida patients.

New York: Aligned with Federal Rules (For Now)

New York finalized regulations in May 2025 that require an in-person exam before prescribing controlled substances via telehealth unless:

• The patient was recently examined in person by another provider who referred them
• You’re covering for another practitioner’s established patient
• You’re complying with applicable federal law

That last exception is key. Because the DEA currently allows telehealth prescribing under the COVID waivers, New York permits it too. When the DEA’s permanent rules take effect, New York’s requirements will automatically adjust to match federal law.

Translation: You can treat New York narcolepsy patients via telehealth today. When federal rules change, be ready to comply with whatever in-person exam requirements the DEA imposes — and New York will enforce those same requirements at the state level.

New York also requires:

• Checking the I-STOP prescription monitoring program before every controlled substance prescription
• Electronic prescribing (no paper scripts)
• Thorough documentation of the clinical rationale for telehealth prescribing

Texas: Video Required, But Otherwise Permissive

Texas allows telehealth establishment of a physician-patient relationship via live two-way video (audio-only phone calls don’t meet the standard for prescribing controlled substances). Texas law bans telehealth prescribing for chronic pain management, but narcolepsy isn’t classified as chronic pain, so that restriction doesn’t apply.

Key points for Texas:

• Must use video conferencing for initial and follow-up visits when prescribing stimulants
• Must check the Texas Prescription Monitoring Program (PMP) before prescribing
• Follow standard prescribing practices — thorough documentation, appropriate diagnosis, ongoing monitoring

Texas defers to federal law on controlled substance telehealth rules, so you’re operating under the DEA waiver. When that changes, expect Texas to align with whatever federal requirements emerge.

California, Pennsylvania, Illinois: Generally Permissive

These states don’t impose additional telehealth restrictions beyond federal law for controlled substances:

California: No state-imposed in-person requirement. Telehealth exams are equivalent to in-person if they meet the standard of care. You must check the CURES prescription monitoring database before prescribing Schedule II–IV medications (initially and at least every 4 months for ongoing therapy). E-prescribing required.

Pennsylvania: No specific prohibition on telehealth controlled substance prescribing. The state allows telehealth for establishing patient relationships and defers to federal controlled substance rules. Pennsylvania recently authorized telehealth initiation of buprenorphine for opioid treatment (with 14-day in-person follow-up), signaling openness to telehealth for controlled meds when appropriate.

Illinois: Recognizes telehealth exams as valid for establishing care. Requires checking the Illinois PMP before prescribing controlled substances and mandates e-prescribing. Illinois has been a telehealth-friendly state and made many COVID expansions permanent in 2021.

Psychiatrist vs PMHNP Scope: Who Can Prescribe What, and Where?

Psychiatrists: Full Authority Everywhere (With State Licensure)

If you’re a psychiatrist (MD/DO), you have unrestricted prescriptive authority for narcolepsy medications in all 50 states, assuming you:

• Hold an active medical license in the state where the patient is located
• Have a DEA registration with Schedule II authority
• Meet any state-specific administrative requirements (e.g., state controlled substance registration)

Narcolepsy isn’t formally within the ‘specialty’ of psychiatry (it’s typically managed by sleep medicine or neurology), but there’s no law preventing psychiatrists from diagnosing and treating it. You should be familiar with the diagnostic workup (polysomnography, MSLT) and coordinate those tests even if you’re managing the patient remotely.

Practical note: Some states’ regulations list approved indications for prescribing stimulants. Florida, for example, explicitly lists narcolepsy as a legitimate use for Schedule II stimulants (alongside ADHD, treatment-resistant depression, etc.). This protects providers from unprofessional conduct claims for prescribing stimulants — narcolepsy is recognized as appropriate.

PMHNPs: State-Dependent Authority (Know Your Restrictions)

Nurse practitioner scope of practice for narcolepsy varies dramatically by state, particularly around Schedule II prescribing:

Full Practice States (Independent NP Authority):

• California: NPs can achieve full practice authority after 4,600+ hours of supervised practice (AB 890, implemented 2023). With proper training and DEA registration, independent NPs can prescribe Schedule II–V medications, including stimulants for narcolepsy.

• New York: Experienced NPs (3,600+ hours) can practice independently without a collaborative agreement (law made permanent in 2022). Full prescriptive authority for Schedule II–V controlled substances with state certification and DEA registration.

• Illinois: NPs with 4,000+ hours of collaboration and 250 hours of additional training can obtain Full Practice Authority. Can prescribe Schedule II–V independently (though there’s a ‘consultation relationship’ requirement for benzodiazepines and opioids — stimulants likely exempt).

Reduced/Restricted Practice States (Physician Collaboration Required):

• Texas: NPs cannot prescribe Schedule II controlled substances in outpatient settings except in hospitals or hospice facilities. For outpatient narcolepsy patients, the supervising physician must write Schedule II prescriptions. NPs can prescribe Schedule III–V (like modafinil) under delegation.

• Florida: NPs can prescribe Schedule II medications, but limited to 7-day supplies unless the NP is a certified ‘psychiatric nurse’ treating a mental health disorder. Since narcolepsy isn’t psychiatric, the 7-day limit applies — making long-term stimulant management impractical for NPs. Physician involvement needed for ongoing therapy.

• Pennsylvania: NPs must have a collaborative agreement with a physician. Can prescribe Schedule II controlled substances with physician approval, but limited to 30-day supplies (with physician consultation required for continuation beyond that). Schedule III–IV limited to 90-day supplies.

Business impact: If you’re building a telehealth platform focused on narcolepsy:

• In Texas and Florida, you need psychiatrists or physicians on staff to prescribe Schedule II stimulants
• In New York, California, and Illinois, experienced PMHNPs can handle the full scope of care independently
• In Pennsylvania, PMHNPs can manage patients but need physician oversight baked into the practice model

This isn’t just regulatory compliance — it’s a provider recruitment and cost structure issue. Independent PMHNPs are often easier to recruit and more cost-effective than psychiatrists, but only if your target states allow them to practice independently.

The Diagnostic Challenge: Narcolepsy Requires More Than a Video Call

Even when telehealth prescribing is legally permitted, diagnosing narcolepsy creates practical challenges because it typically requires:

1. Overnight polysomnography (sleep study) to rule out other sleep disorders
2. Multiple Sleep Latency Test (MSLT) the following day to measure daytime sleepiness and REM sleep onset

These tests must be performed in a sleep lab — you can’t do them via telehealth.

How telepsychiatrists handle this:

• Establish referral relationships with sleep centers in patients’ geographic areas
• Coordinate testing remotely (order the studies, receive and interpret results)
• Manage medication once diagnosis is confirmed
• Some providers accept patients who’ve already been diagnosed by a sleep specialist but need ongoing medication management

Legal consideration: Prescribing stimulants for ‘suspected narcolepsy’ without confirmatory testing could expose you to scrutiny. The standard of care requires objective sleep study evidence before committing someone to long-term Schedule II therapy (especially given the abuse potential and the fact that excessive daytime sleepiness can stem from many conditions).

Documentation is critical: When you prescribe controlled substances via telehealth, document your clinical reasoning thoroughly. Show that you:

• Took a comprehensive sleep history
• Ruled out alternative explanations (sleep apnea, insufficient sleep, medication side effects)
• Reviewed objective sleep study results confirming narcolepsy
• Assessed for contraindications and abuse risk
• Established a monitoring plan

This protects you if state medical boards or DEA auditors review your prescribing patterns.

Prescription Monitoring Programs: The Non-Negotiable Compliance Step

Every state now operates a Prescription Drug Monitoring Program (PDMP) that tracks controlled substance prescriptions. Most states legally require prescribers to check the PDMP before prescribing controlled medications.

State-specific PDMP requirements:

• California (CURES): Must check before the first Schedule II–IV prescription and at least every 4 months for ongoing therapy
• New York (I-STOP): Must check before every controlled substance prescription
• Texas, Florida, Illinois, Pennsylvania: Check required before prescribing (specifics vary, but generally every prescription or at least initially and periodically)

What you’re looking for:

• Other controlled substance prescriptions that could interact or indicate diversion risk
• Multiple prescribers (potential ‘doctor shopping’)
• Patterns suggesting misuse (early refills, escalating doses, combining substances)

PDMP integration into your EHR or telehealth platform saves time and ensures compliance. Some platforms auto-populate PDMP data during the prescribing workflow.

Failure to check the PDMP can result in medical board discipline, even if your prescribing was otherwise appropriate. State boards take this seriously — it’s a top enforcement action across the country.

E-Prescribing: Mandatory for Controlled Substances in Most States

Electronic prescribing of controlled substances (EPCS) is now required in:

• New York (all controlled substances)
• Illinois (all controlled substances, since Jan 2023)
• California (mandate phased in)
• Many other states have mandates or are phasing them in

What this means:

• You can’t phone or fax in a prescription for Adderall or modafinil
• You need an EPCS-certified platform with two-factor authentication and other DEA security requirements
• Your telehealth EHR must integrate with pharmacies via EPCS networks

If you’re joining a platform like Klarity Health, this is handled for you. If you’re building your own telehealth practice, you need to contract with an EPCS-enabled prescribing system (common vendors: Surescripts, DrFirst, Practice Fusion with EPCS).

What Happens When the DEA Waiver Ends? Preparing for Permanent Rules

The DEA has signaled that permanent telehealth rules are coming, likely sometime in 2025–2026. Based on public feedback and the agency’s comments, expect some version of these scenarios:

Likely outcome:

• 30-day initial supply via telehealth for Schedule II medications (stimulants), with an in-person exam required before continuation
• Ongoing telehealth allowed after the initial in-person visit, possibly with periodic in-person check-ins (every 6–12 months)
• Carve-outs for certain conditions (like the buprenorphine exception for opioid use disorder) — though narcolepsy hasn’t been mentioned as a candidate for special treatment

What this means for your practice:You’ll need a plan for the in-person component. Options:

1. Hybrid model: Partner with local clinics or urgent care centers where patients can get an initial in-person exam, then shift to telehealth for ongoing care
2. Geographic focus: Concentrate your practice in areas where you can realistically see patients in person (or have a local partner), then expand via telehealth
3. Medication adjustment: For some patients, you might use Schedule III–IV alternatives (modafinil, armodafinil, sodium oxybate) that may face fewer telehealth restrictions

Don’t panic, but don’t wait: The DEA has extended the current rules through 2026, giving you time to plan. Use that time to:

• Build relationships with sleep centers and primary care clinics for referrals and in-person exams
• Document your patient outcomes to demonstrate that telehealth narcolepsy care is safe and effective
• Engage with professional associations (APA, AANP) that are lobbying for reasonable telehealth rules

The Economics: Why Telehealth Platforms Make Sense for Narcolepsy Care

Treating narcolepsy via traditional practice models has always been challenging:

• Low patient volume (narcolepsy affects only ~0.02% of the population — about 1 in 2,000 people)
• Concentrated in urban areas where sleep specialists practice, leaving rural patients underserved
• High diagnostic costs for sleep studies that patients often can’t access locally

Telehealth solves several of these problems, but patient acquisition is expensive if you’re marketing solo.

Reality check on DIY marketing:

• SEO for mental health and sleep disorder keywords takes 6–12 months of consistent investment before generating meaningful traffic
• Google Ads for psychiatric keywords cost $15–40+ per click, and most clicks don’t convert to booked appointments
• Realistic cost per booked patient through PPC advertising: $200–400+
• Directory listings (Psychology Today, Zocdoc) charge monthly fees PLUS you compete with hundreds of other providers on the same page

Total monthly marketing spend for a solo provider trying to build a narcolepsy-focused telehealth practice: $3,000–5,000 in ads, SEO services, and directory fees — with no guarantee of results.

Why Klarity’s model makes economic sense:Instead of gambling thousands on marketing channels that may or may not work, Klarity uses a pay-per-appointment model:

• No upfront marketing spend or monthly subscription fees
• You pay a standard listing fee only when a qualified patient books with you
• Patients are pre-matched to your specialty and availability
• Built-in telehealth infrastructure (no separate platform costs)
• Both insurance and cash-pay patient flow

The value proposition: Guaranteed ROI. Every dollar you spend goes toward an actual patient appointment, not testing ad copy or waiting for SEO to kick in.

For narcolepsy specifically — a niche specialty with limited patient volume in any single geographic area — a platform that aggregates demand across multiple states makes far more sense than trying to build a local patient base from scratch.

Key Takeaways for Psychiatrists and PMHNPs

Federal Law (2026):

• Telehealth prescribing of narcolepsy medications (including Schedule II stimulants) is currently allowed through December 31, 2026, under DEA COVID waivers
• Permanent rules are coming — expect some in-person exam requirements to return, but likely with more flexibility than the original Ryan Haight Act
• Prepare for regulatory changes by building hybrid care models or geographic partnerships

State Law Considerations:

• Florida: Cannot prescribe Schedule II stimulants for narcolepsy via telehealth (state law restriction); can prescribe Schedule IV alternatives
• New York: Currently permits telehealth controlled substance prescribing under federal waiver; will adapt to federal rules when they change
• Texas: Allows telehealth prescribing with video; NPs cannot prescribe Schedule II in outpatient settings
• California, Illinois, Pennsylvania: Generally permissive; defer to federal rules

Provider Type Matters:

• Psychiatrists have full authority in all states (with appropriate licensure and DEA registration)
• PMHNPs have independent authority in CA, NY, IL (after meeting experience requirements)
• PMHNPs face Schedule II restrictions in TX (can’t prescribe outpatient), FL (7-day limit), PA (30-day limit with physician oversight)

Operational Requirements:

• Check state PDMP before prescribing controlled substances
• Use EPCS-certified e-prescribing systems
• Coordinate sleep studies even when managing patients remotely
• Document thoroughly — telehealth controlled substance prescribing faces higher scrutiny

Economic Reality:

• DIY patient acquisition for niche specialties costs $200–500+ per patient when you factor in all marketing expenses
• Platforms that handle patient acquisition eliminate marketing risk and provide predictable ROI
• For low-volume specialties like narcolepsy, aggregated demand across multiple states makes far more economic sense than local marketing

Frequently Asked Questions

Can I prescribe Adderall or Ritalin for narcolepsy via telehealth in 2026?

Yes, under current federal law (DEA waiver through Dec 31, 2026), you can prescribe Schedule II stimulants via telehealth without an in-person exam, as long as you meet all other requirements (state licensure, DEA registration, standard of care). Exception: Florida state law prohibits this for narcolepsy specifically (only allows it for psychiatric conditions).

What happens if the DEA waiver expires?

When permanent DEA rules take effect (likely 2025–2026), you’ll probably need at least one in-person medical evaluation before prescribing controlled substances via telehealth. The exact requirements aren’t finalized yet. Plan for a hybrid model where you can arrange in-person exams (either by seeing patients yourself or partnering with local providers).

Can PMHNPs treat narcolepsy independently?

Depends entirely on the state. In New York, California, and Illinois, experienced PMHNPs can practice independently and prescribe Schedule II stimulants for narcolepsy. In Texas, NPs cannot prescribe Schedule II in outpatient settings at all. In Florida, NPs are limited to 7-day Schedule II supplies unless treating a psychiatric condition (narcolepsy doesn’t qualify). In Pennsylvania, NPs can prescribe Schedule II with physician collaboration, limited to 30-day supplies.

Do I need to see the patient in person for a sleep study before treating narcolepsy?

The sleep study itself (polysomnography and MSLT) must be performed in a sleep lab — you can’t do it via telehealth. But you can order the study remotely, receive and interpret the results, and manage the patient’s medication via telehealth after diagnosis is confirmed. Many telepsychiatrists partner with local sleep centers for testing.

What’s the standard of care for diagnosing narcolepsy via telehealth?

You need: (1) comprehensive sleep and medical history, (2) objective sleep study results confirming narcolepsy (polysomnogram showing no sleep apnea, MSLT showing short sleep latency and REM onset), (3) ruling out alternative causes of excessive daytime sleepiness, (4) assessment of contraindications and risk factors. Document everything thoroughly — telehealth controlled substance prescribing is scrutinized closely.

Can I treat patients in multiple states via telehealth?

Yes, but you must be licensed in each state where your patients are located. You can’t practice across state lines on a single license. Many providers use the Interstate Medical Licensure Compact (IMLC) to expedite multi-state licensing — Illinois, Texas, and Pennsylvania participate; New York, California, and Florida do not.

What are the most important compliance steps for telehealth narcolepsy prescribing?

(1) Check your state’s PDMP before every prescription (or as frequently as required by state law), (2) Use EPCS-certified e-prescribing, (3) Document the complete diagnostic workup including sleep study results, (4) Ensure you’re licensed in the patient’s state and have DEA registration with Schedule II authority, (5) Keep up with changing federal and state regulations.

Join Klarity Health’s Provider Network

If you’re a psychiatrist or PMHNP interested in treating narcolepsy and other sleep disorders via telehealth, Klarity Health offers the infrastructure and patient flow you need without the marketing gamble.

Why providers choose Klarity:

• Pre-qualified patients matched to your specialty
• Pay-per-appointment model (no upfront costs or monthly fees)
• Compliant telehealth platform with EPCS integration
• Both insurance and cash-pay patient options
• You control your schedule — work as much or as little as you want

We handle patient acquisition. You handle care.

Learn more about joining Klarity’s provider network and expanding your practice to serve underserved patient populations across multiple states.

Sources and References

1. HHS Press Release – ‘HHS & DEA Extend Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026’ (Jan 2, 2026) – U.S. Department of Health & Human Services official announcement confirming extension of COVID-era telehealth waivers through December 31, 2026. www.hhs.gov

2. DEA Press Release – ‘DEA and HHS Extend Telemedicine Flexibilities through 2025’ (Nov 15, 2024) – Drug Enforcement Administration announcement detailing ongoing rulemaking process and temporary extension of telehealth prescribing authority. www.dea.gov

3. 21 U.S.C. §829(e) Ryan Haight Act – Federal statute defining requirements for prescribing controlled substances via internet/telemedicine, including in-person medical evaluation mandate and exceptions. Legal Information Institute (Cornell University). www.law.cornell.edu

4. Florida Statutes §456.47 – Use of Telehealth to Provide Services – Official Florida state law restricting telehealth prescribing of Schedule II and III controlled substances (except for psychiatric disorders, inpatient care, hospice, or nursing homes). Updated through 2025. www.leg.state.fl.us

5. New York State Department of Health – Controlled Substances Prescribing via Telehealth Final Rule (Effective May 21, 2025) – Summary by Nixon Peabody LLP analyzing NY’s finalized regulations requiring in-person exam before controlled substance prescribing unless federal law exceptions apply. www.nixonpeabody.com

This content is for informational purposes and does not constitute legal or medical advice. Controlled substance prescribing laws change frequently; consult your state medical board and DEA regulations for current requirements.

Source:

• https://www.law.cornell.edu/definitions/uscode.php?defid=21-USC-1796173870-113781527&height=800&iframe=true&termoccur=999&term_src=title%3A21%3Achapter%3A13%3Asubchapter%3AI%3Apart%3AC%3Asection%3A831&width=840#:~:text=,that%20a%20prescription%20has%20been
• https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html#:~:text=announced%20a%20fourth%20temporary%20extension,while%20permanent%20rules%20are%20finalized
• https://www.dea.gov/documents/2024/2024-11/2024-11-15/dea-and-hhs-extend-telemedicine-flexibilities-through-2025#:~:text=promulgate%20a%20final%20set%20of,Medications%2C%E2%80%9D%20was%20submitted%20to%20the
• https://www.dea.gov/press-releases/2025/12/31/dea-extends-telemedicine-flexibilities-ensure-continued-access-care#:~:text=On%20January%2017%2C%202025%2C%20DEA,to%20as%20the%20%E2%80%9CTwo%20Final
• https://www.leg.state.fl.us/statutes/index.cfm?Appmode=DisplayStatute&URL=0400-0499%2F0456%2FSections%2F0456.47.html#:~:text=telehealth%20to%20provide%20health%20care,in%20Schedule%20II%20of%20s
• https://www.tmb.state.tx.us/page/facility-based-prescriptive-delegation#:~:text=at%20the%20hospital%E2%80%99s%20facility,from%20a%20qualified%20hospice%20provider
• https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2025/#:~:text=Texas%20regulations%20emphasize%20continuity%20of,Note
• https://www.nixonpeabody.com/insights/alerts/2025/06/18/new-york-state-finalizes-telemedicine-rule-for-controlled-substances#:~:text=match%20at%20L114%20The%20rule,and%20the%20US%20Department%20of
• https://www.nixonpeabody.com/insights/alerts/2025/06/18/new-york-state-finalizes-telemedicine-rule-for-controlled-substances#:~:text=In%20short%2C%20the%20exception%20permits,as%20a%20condition%20of%20state
• https://rxagent.co/blog/np-prescribing-authority#:~:text=Conversely%2C%20in%20Restricted%20Practice%20states,expand%20this%20scope%20%206