2010 Invitational Leadership Meeting

Legislative and Practice Issues Summary and Planning

Current  Policy Concerns,

Challenges and Opportunities


Patient and

NP Practice Impact


Next Steps for Attendees

and AANP Support


Inconsistent, Limited and/or Restricted Access to Insurance Credentialing , Contracting and Reimbursement




*Increases  care access

*Improves patient choice

*Facilitates  transparency and outcomes tracking of NP provided services

MSRA for resources and support

AANP has linked with the initial MSRA from Ohio to provide added support and advocacy for insurance related issues. The November 2010 MSRA meeting summary will be available shortly. Contact your regional director to learn more.


NP EDUCATION on topic:

  1. AANP CE Center offers “CPT Coding:  Beyond the Basics” by Barbara Pierce, CCS-P, ACS-EM. Access under the “professional Development” topic at the CE Center website
  2. Medicare Learning Network:  "Medicare Information for Advanced Practice Nurses and Physician Assistants" Booklet  http://www.cms.gov/MLNProducts/downloads/Medicare_Information_for_APNs_and_PAs_Booklet_ICN901623.pdf

Medicare Requirements on home health, nursing home care, DME




*Increased access

*Eliminates unnecessary delays in care, system redundancies and costs

*Utilizes the healthcare workforce more effectively.

AANP will continue to address and advocate for these issues on the Hill and with key stakeholders (including partnerships with other nursing associations)


CONNECT WITH YOUR FEDERAL LEGISLATORS NOW to let them know how this issue impacts patients.

H.R. 4993 / S. 2814  Home Health Care Planning Improvement Act of 2010 Would update the Social Security Act to Adds APN and PA language to list of authorized providers to order home health (potential to move by end of year…need grassroots to drive the need to add this on to a larger bill package.)

Hospital Bylaws:

Limitations on joining hospital staff,

Admission Barriers,

Bylaws that limit the skills NPs can provide (increasing issues for utilization of  Acute Care NPs)


*Utilizes the  healthcare workforce more effectively

*Address mismatch between the “can” and “may” of care delivery in the in-patient setting

Shared strategies from meeting:

1.      Seek to use “APRN” language instead of “midlevel provider” in bylaws to clarify the statutory differences between NP and PA physician oversight where grouped professional classifications are care barriers.

2.      Seek out bylaw language from institutions that have effective bylaws to use as examples

3.      Discuss liability concerns with hospital risk management (for situations where an NP is the only provider of a service in the facility and bylaws limit the ability of the NP to provide emergent/life-saving care without physician oversight)

Medicaid Provider Pool:

Participation restrictions on managed-care plans

Some states continue to limit to FNP and PNP—and not full NP population of providers


*Increases  care access/decrease utilization of higher cost care settings

*Improves patient choice

*Facilitates  transparency and outcomes tracking of NP provided services


Shared strategies from meeting:

1.      Meet with State Medicaid agency to discuss updates

2.      Address the concern that added NPs would be added costs—“adding NPs would not add costs because it would not increase the number of patients in the Medicaid program. Added providers would increase access to primary care services, and could reduce the use of higher cost urgent care and emergency room visits for care that could be given in these NP settings” (Shared by Gwen Wetzel, Region 8 Director at another meeting, but excellent insight to use in any state.)

3.      Continue to work to address issue with the MSRA (managed care)

Statutory autonomy:

Plans and actions to seek legislative and regulatory changes


*Increases  care access

*Improves patient choice

*Update statute and regulation for effective workforce utilization

*Increase the transparency and accountability of NPs



Shared strategies from meeting:

1.      Use the NCSBN Model Nurse Practice Act as a language template (would aid in decreasing the variability of care provided and regulatory practices between states—See last page)

2.      Leverage recent publications and reports that support updating practice acts and rules to reflect NP preparation


Utilize AANP State Government Affairs for strategic and support planning

Workforce Study Commissions:

State and Federal level studies looking to indentify NP workforce—numbers, locations, and practice patterns to plan for future development

*Need accurate numbers of NPs to gauge pipeline

*Provides opportunity to share how both adequate numbers AND utilization of NPs at the top of their education and skill are needed to address care needs.

*Studies are being used to help influence and guide state policy development

Shared strategies from meeting:

1.      Work on getting NPs to these policy tables. May of the attendees (or their represented associations are currently engaged)

2.      Partner with AANP for NP practice data when serving on these commissions

3.      Ensure that all ARPN roles have voice at table given the diversity of practice needs

4.      Emphasize the need to have NPs (and other care providers) practicing at the top of their license to meet care needs

Global Signature/signature recognition:

Several states looking to address signature recognition on multiple forms


(AKA: “treating the paperwork” that completes the care NPs are already able to provide.)


*Facilitates  transparency in care

* Streamlines care process for patients

* Eliminates redundancies in care due to paperwork requirements

* Reduces care delays by allowing paperwork to be competed at the point of care


Excellent updates have occurred in the last few legislative sessions in this area. Some items and states continue to need updates.

Shared strategies from meeting:

1.      Keep at it…it is worth it!

2.      Global Signature language has been successful in a few states (Here’s one example from Maine on global signature language http://mainelegislature.org/legis/bills/bills_124th/chappdfs/PUBLIC259.pdf )

3.      Others have had to go item by item in a “laundry list” bill (Here’s one example from Colorado’s “signature bill” 


  1. Enlist stakeholder support from outside the nursing community


Healthcare (Medical) Homes/ACO

Emerging models of care and reimbursement

Shared strategies from meeting:

1.      Seek opportunities for NP leaders to shape the Healthcare Home and ACO policies on state and organizational levels. To find healthcare home pilots in your area visit, http://www.pcpcc.net/pcpcc-pilot-projects

2.      Monitor and engage in legislation related to these models to ensure that NPs will be full participants

3.      AANP will continue to participate at the national level with organizations that influence and develop policy in these areas

BOM rules limit practice  (examples: pain management and dermatologic care)


Would limit patient access to services and unnecessarily restrict practice


Shared strategies from meeting:

1.      Monitor BOM rules and respond to proposals that would interfere with appropriate care delivery

2.      Continue dialog with regulators on the overlapping scopes of practice/skills of both disciplines in caring for patients

3.      AANP to continue to monitor state-level trends and share with state representatives and group members

Several states looking at transitions to NCSBN language, planning updates to licensure and regulation of NP practice, and modernizing policies for effective NP utilization in care delivery.


*Clarity  of role

*Increased avenues to care

*Improved patient choice

*Effective and efficient workforce utilization

Shared strategies from meeting:

  1. AANP Policy Office is developing a database to facilitate sharing of regulatory language from various states.
  2. AANP Policy Office also looking at developing tool kit with best practices from states
  3. Partner on talking points, maps and workforce supports around this issue
  4. Work with other stakeholders in NP and nursing community on these goals