According to the Institute of Medicine’s landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” the ability of nurse practitioners (NPs) to meet the nation’s health care needs and practice to the full extent of their education and clinical preparation continues to be limited by significant barriers in federal law and regulation. The American Association of Nurse Practitioners (AANP) urges the 115th Congress to improve patient access to less costly, more efficient health care by taking action to address the following priorities:
This legislation would authorize NPs to certify patient eligibility for Medicare home health services. NPs have been authorized Part B Medicare providers since 1998. They order physical and occupational therapy, bill as consultants when providing services through telemedicine, perform and interpret diagnostic tests within their scope of practice and certify patients eligible for skilled nursing care. Despite this recognition, NPs with patients who need home health care services still have to locate a physician to certify that the NP has conducted the required face-to-face certification examination to document eligibility for care. NPs can provide face-to-face assessments of the patient’s needs, yet current law requires that a physician document that the encounter has taken place, even if the physician is not involved. AANP calls on members of Congress to cosponsor SB 445/HR 1825 to Amend Title XVIII of the Social Security Act to Ensure More Timely Access to Home Health Services for Medicare Beneficiaries Under the Medicare Program.
This legislation would allow the assignment of NP patients to Medicare Shared Savings Program Accountable Care Organizations (ACOs). NPs are recognized in the Medicare Shared Savings Program as “ACO professionals,” yet their patients cannot be assigned as beneficiaries in that program. Congress should amend current law to allow Medicare beneficiaries who receive their primary care services from NPs to be assigned to Shared Savings Program ACOs without arbitrarily requiring the patient to see a physician. Likewise, NPs should be recognized to lead and participate fully in the design, management and operation of patient-centered medical homes and ACOs. AANP calls on members of Congress to cosponsor HR 1160 to improve the way beneficiaries are assigned under the Medicare Shared Savings Program.
AANP calls on members of Congress to ensure that diabetic patients who need therapeutic shoes receive care in a timely fashion. Currently, NPs must send their diabetic patients who need therapeutic shoes to a physician to certify that need. Additionally, according to current statute, the certifying physician must be the provider treating the patient’s diabetic condition going forward. Delays in treatment, caused by this burdensome statute, jeopardize the health of patients and cause the Medicare program to incur additional costs by requiring the participation of an additional provider. AANP calls on members of Congress to cosponsor HR 1617, which would authorize NPs to certify their diabetic patients’ need for therapeutic shoes.
As Congress considers changes to the health care system, NPs request that any reform or replacement legislation is patient centric and includes NPs as high-quality health care providers. We encourage Congress to craft legislation that: protects patient choice by ensuring that health care delivered by NPs is covered by insurance and other health care options; uses provider-neutral language; ensures patients have access to health care with affordable coverage options, regardless of their preexisting conditions; upholds the principles of Essential Health Benefits; maintains the nation’s commitment to strengthening its health care workforce by continuing to invest in the preparation of health care providers such as NPs; ensures access to value-based care opportunities; and creates greater efficiency in the Medicare system by retiring barriers to practice and eliminating unnecessary duplication of health care providers’ efforts.
Despite their ability to provide and bill for services rendered in all of these areas, as well as serve as attending providers and recertify Medicare patients’ eligibility for hospice care, NPs are still unable to provide the initial certification of patients for hospice care. Instead, they must find a physician to certify eligibility at an additional cost. A language change or an expanded interpretation of the word “physician” is needed in Part A, Section 1814, of the Medicare law in order for hospice programs to accept initial certifications from NPs. Congress should enact legislation that will authorize hospice care programs to accept initial certification of eligibility orders from NPs for Medicare beneficiaries.
AANP calls on members of Congress to enact legislation amending the Medicare conditions of participation for SNFs to authorize NPs to perform admitting examinations and to provide monthly patient assessments.
Congress needs to monitor and ensure that NPs in all states are able to fully participate as providers in the qualified health plans made available on the Health Insurance Marketplace, commercial plans, Medicare Advantage plans and Medicaid Managed Care plans. This includes enforcing all applicable provider nondiscrimination laws and regulations.
Amid growing awareness that NPs are essential to meeting the increased demand for health care as millions of Americans qualify for insurance coverage, nurse education programs are facing extreme pressure as Congress wrestles with reducing the federal deficit. It is critical for Congress to reauthorize and provide sustained stable funding to maintain nurse education programs. These programs must be protected from deeper spending cuts in any effort to replace sequestration with targeted reductions. Funding must be sufficient to enable these programs to sustain current NP education and faculty preparation programs, support education of advanced practice nurses and fund clinical training programs in nurse-managed health centers.
NPs hold prescriptive authority in all 50 states and the District of Columbia and have been providing high-quality health care to patients for over half a century. With the passage of the Comprehensive Addiction and Recovery Act (CARA) in 2016, NPs were authorized, for a five-year period, to prescribe MATs after taking the necessary training and obtaining the required Drug Enforcement Agency (DEA) waiver to do so. AANP has provided thousands of NPs with the required education to obtain this waiver and treat these patients. It is essential that this authorization be made permanent in order to ensure these patients receive this critical treatment from their provider of choice.
AANP supports legislation to reform the Medicare hospital conditions of participation rules to provide nondiscriminatory guidance to hospitals on the process to be used in evaluating NPs for membership on hospital medical staffs and granting hospital clinical privileges. We believe uniform procedures for medical staffing and clinical privileging can benefit all health professionals and the patients they serve. These steps will reinforce the efforts by the Centers for Medicare & Medicaid Services (CMS) and many hospitals to improve patient care by expanding the use of NPs to provide more timely and appropriate care while ensuring a fair marketplace for NPs to practice to the full extent of their education and clinical preparation.
AANP calls on members of Congress to enact legislation to allow NPs to order and supervise cardiac and pulmonary rehabilitation so that Medicare patients treated by NPs have access to this treatment. NPs are fully qualified based on their education and clinical training to provide these services and this obsolete barrier to care harms patients by causing unnecessary delays in treatment.
For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or firstname.lastname@example.org.