Nurse Practitioners Unveil Federal Legislative Priorities for 2013
AUSTIN, TX (February 25, 2013) – The American Association of Nurse Practitioners (AANP), the largest professional membership organization in the country for nurse practitioners (NPs), said today that improving access to high-quality health care for all Americans can be achieved, in part, by easing restrictions on NPs – increasingly the health care providers of choice for individuals and families nationwide. This and other goals comprise AANP's federal legislative agenda, announced today in Washington, D.C. at the National Nurse
Practitioner Health Policy Conference. The event, taking place February 24-26, gives NPs from around the country the opportunity to meet with leaders on Capitol Hill and advocate for legislation affecting NP practice and patients.
"With the shortage of primary care physicians and increasing demand for health care services, it's critical that federal policy empower NPs to practice to the full extent of their education and experience," said Angela Golden, President of AANP. "Legislators should expect to hear more and more from AANP leaders and members about the necessity of key policy changes."
AANP's top federal legislative priorities for 2013 include:
Pass the Home Health Care Planning Improvement Act.
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; and certify patients eligible for skilled nursing care. Despite this recognition, NPs lack the authority to independently certify eligibility for home health care services. Medicare requires that physicians document that these assessments were conducted regardless of whether they are involved.
AANP supports the "Home Health Care Planning Improvement Act," legislation that would remove these barriers and improve the timeliness of care for patients. Soon to be reintroduced to the 113th Congress, the bill received the broad bipartisan endorsement of 123 Representatives and 18 Senators last year.
Include NPs in Medicaid Primary Care Incentive Payments.
Section 1202 of the "Health Care and Education Reconciliation Act of 2010" (PL 111-152) requires that this year and next, payment for certain physicians' Medicaid primary care services are at least equal to Medicare payments for the same services. In proposed regulations, the Centers for Medicare & Medicaid Services (CMS) further recognized, "In the Medicaid program, a significant proportion of primary care services are actually rendered by advance practice nurses, and other types of independently practicing non-physicians. We recognize the importance of these non-physician practitioners in the provision of primary care services in many States."
However, CMS interpreted Section 1202 to include only services provided under the "personal supervision" of an eligible physician. In final regulations, CMS said, "Services provided by...independently practicing non-physician providers not under the supervision of an eligible physician are excluded."
AANP urges Congress to enact legislation as soon as possible to correct this restrictive interpretation and clearly authorize NPs practicing autonomously in accordance with their state law to qualify for inclusion in this payment system. Extending this incentive to NPs would help to reduce delays in treatment and improve access to cost-effective primary care services for Medicaid enrollees.
Provide Stable, Sufficient Funding for Nurse Education Programs.
Amid growing awareness that nurse practitioners are essential to meeting the increased demand for health care, as millions of Americans qualify for insurance coverage in 2014, nurse education programs are facing extreme pressure as Congress wrestles with reducing the federal deficit. Last September, a six-month continuing resolution (H.J. Res. 117) extended funding for Title VIII nurse education programs at fiscal year 2012 levels, a reduction of more than four percent from 2011. These programs now face the uncertainty of sequestration, which could eliminate 645 training opportunities for NPs and limit scholarships and training for more than 4,100 nursing students.
AANP believes it is critical for Congress to 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. Further, funding for the rest of fiscal years 2013 and 2014 must be sufficient to enable these programs to sustain current NP education and faculty preparation, and fund clinical training in nurse-managed health centers.
Enable NP Patients to be Beneficiaries in Medicare Shared Savings 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. Many NP practices already qualify and are recognized as medical homes, a key component of Medicare Shared Savings Accountable Care Organizations.
AANP urges Congress to amend current law, allowing Medicare beneficiaries who receive their primary care services from NPs to be assigned to Shared Savings ACOs without arbitrarily requiring the patients to see a physician. This change would allow NPs to contribute fully to the development of these programs and practice arrangements.
Authorize NPs to Complete Admission Examinations for Patients Referred to Skilled Nursing Facilities.
Currently NPs are authorized to certify eligibility for Medicare patients needing skilled nursing care. However, they must have a physician conduct the admitting physical examination despite being able to attend to any problems of medical necessity in the skilled facility. This requirement has led to delays and lapses in care, prolonged hospital stays and unnecessarily hospitalizations.
AANP requests that the Medicare conditions of participation be changed so that NPs are authorized to conduct these admitting physical examinations.
Authorize NPs to Certify Medicare Patients' Eligibility for Initial Admission to Hospice Care.
Legislation authorizing direct Medicare reimbursement to NPs providing reimbursable Part B Medicare services has been in place since January 1998. NPs are authorized to write orders and recertify patients in Medicare Hospice Programs. Despite their ability to order, implement and bill for a broad range of services, they are still unable to determine initial eligibility for hospice care.
AANP favors a language change or an expanded interpretation of the word "physician" in Part A, Section 1814 of the Medicare law in order for hospice programs to accept the certification of NPs.
Follow Recommendations of the Institute of Medicine.
In accordance with the Institute of Medicine's landmark 2010 report, "The Future of Nursing: Leading Change, Advancing Health," AANP supports removing arbitrary barriers that restrict NPs. This can be widely achieved by correcting terminology in all appropriate legislation so that language is consistent with Medicare payment policies that authorize Part B payment to NPs for services within their scope of practice and that "would be covered if furnished by a physician" [63 Fed. Reg. 58814, 58908-58909 (Nov. 2, 1998)].
The report also clearly defines primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patient and practicing in the context of family and community." AANP believes this definition should serve as a benchmark for any legislation that aims to expand access to primary care services, thus recognizing NPs as primary care providers in all health care plans and programs.
The American Association of Nurse Practitioners (AANP) is the largest professional membership organization for NPs of all specialties. It represents the interests of the nation's 155,000 NPs, including more than 42,000 members, providing a unified networking platform, and advocating for their role as providers of high-quality, cost-effective, comprehensive, patient-centered and personalized health care. The organization provides legislative leadership at the local, state and national levels, advancing health policy; promoting excellence n practice, education and research; and establishing standards that best serve NP patients and other health care consumers.