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Washington Watch | Issues Update | Health & Safety

Washington Watch

American Journal of Nursing - October, 2003 - Volume 103, Issue 10

Recognizing APRNs
The ANA works to expand their scope of practice.

By Erin McKeon

The American Nurses Association (ANA) is actively working to support the right of advanced practice RNs (APRNs) to provide the broadest range of health care services possible. The ANA has long opposed barriers that constrain APRNs from performing the full range of services allowed under state practice acts. Crucial to this ongoing effort are recent legislative proposals.

The Medicaid Nursing Incentive Act The ANA worked with Rep. John Olver (D-MA) to support the June 2003 reintroduction of the Medicaid Nursing Incentive Act (H.R. 2295), which would reinstate the federal mandate for Medicaid coverage of services provided by nurse practitioners, clinical nurse specialists, and certified nurse midwives.

Prior to 1997 federal law required state Medicaid programs to cover health care services provided by some APRNs (pediatric nurse practitioners, family nurse practitioners, and certified nurse midwives). Some states also opted to cover the services of certified registered nurse anesthetists and clinical nurse specialists because these practitioners were willing to provide services needed in physician shortage areas.

The Balanced Budget Act of 1997 (P.L. 105-33) effectively removed this mandate. The far-reaching law encouraged states to move their Medicaid beneficiaries into managed care plans and granted these plans the option to recognize APRNs. In addition, the act provided only a vague reference to the types of providers who must be included in the managed care provider panels. Plans must show only that they provide access to “a sufficient number, mix, and geographic distributions of providers.”

The Medicaid Nursing Incentive Act addresses APRN coverage problems by:

• expanding fee-for-service Medicaid coverage to include services provided by all nurse practitioners and clinical nurse specialists.

• eliminating the state option to refuse to recognize pediatric nurse practitioners, family nurse practitioners, and certified nurse midwives as primary care case managers under managed care, which will restore the previous federal mandate to cover these services.

• requiring Medicaid-managed care plans to include nurse practitioners and clinical nurse specialists in their provider panels. This would enable Medicaid patients to receive specialized APRN services—such as pain management services provided by nurse anesthetists and mental health services provided by clinical nurse specialists—through their managed care plans.

"If enacted, the Medicaid Nursing Incentive Act will help ensure that Medicaid patients receive care in a timely and cost-efficient manner,” said ANA president Barbara Blakeney, MS, APRN,BC, ANP. “By properly utilizing the services of APRNs, this bill will increase access to health care and decrease preventable acute care admissions and emergency room visits.”

The ANA is now working to add House cosponsors to the Medicaid Nursing Incentive Act and to encourage the introduction of this bill in the U.S. Senate.

Rural Provider Equity Act

The ANA is actively supporting provisions in the Rural Provider Equity Act (H.R. 2333, S. 1185) that would expand the scope of Medicare services provided by APRNs. This bill would allow nurse practitioners and clinical nurse specialists to develop and sign plans of care for Medicare beneficiaries receiving home health and hospice services. The bill would also enable physician assistants (PAs) to perform these duties. It would grant APRNs and PAs the ability to certify that a beneficiary is homebound, and therefore eligible for the Medicare home health benefit. In addition, the bill would allow APRNs and PAs to fulfill Medicare requirements for health care supervision, emergency care, and patient record keeping in skilled nursing facilities.

The ANA is working to garner support for the Rural Pro­vider Equity Act and hopes to include the APRN provisions in the final Medicare modernization and prescription drug benefit legislation passed by this Congress and currently in conference.

“By addressing the role of APRNs in providing services under Medicare and Medicaid, we are strengthening these programs for the nation’s most vulnerable health care consumers,” Blakeney said.

For updates on these bills, as well as the other government affairs activities, visit the Government Affairs section of this web site.

Erin McKeon is an associate director of the ANA’s Department of Government Affairs.

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