ANA Hails Introduction of Bill to Expand Access to Nurse Practitioners

Alabama Nurse, Sep-Nov 2003

Medicaid Nursing Incentive Act of 2003 would restore a previous federal mandate

WASHINGTON, DC - The American Nurses Association (ANA) has commended Congressman John W. Olver (D-MA) for introducing legislation that would expand patient access to quality health care by requiring states to offer Medicaid coverage for primary health-care services provided by advanced practice registered nurses (APRNS). The Medicaid Nursing Incentive Act of 2003, introduced in the U.S. House of Representatives on June 3, would eliminate the option that state Medicaid plans currently have of denying APRNs as primary care case managers.

APRNs are registered nurses who have attained advanced education and expertise and specialize in such medical fields as pediatrics, anesthesiology, gerontology, neonatology and mental health. APRNs include nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists. However, Medicaid plans in many states currently recognize only physicians and do not cover primary care services provided by APRNS. The proposed measure would help to control Medicaid spending by offering Medicaid beneficiaries more and often less-expensive primary-care provider options.

Upon introducing the proposed legislation, Olver noted that it would particularly benefit rural and other medically underserved areas with a shortage of physicians, where nurse practitioners are often more accessible. "At a time when state Medicaid programs are in financial crisis and doctors who accept Medicaid are overburdened, APRNs offer a solution by providing high-quality, cost-effective care," he said.

ANA President Barbara Blakeney, MS, APRN,BC, ANP, agreed, noting that "studies have shown that advanced practice registered nurses provide cost-effective, high-quality care. In addition, APRNs are often willing to provide care in rural and inner-city areas where access to care is limited," she said. "The Medicaid Nursing Incentive Act will ensure that Medicaid patients receive quality care in a timely, cost-efficient manner."

The Medicaid Nursing Incentive Act of 2003 would restore a previous federal mandate to cover the primary care services of pediatric nurse practitioners, family nurse practitioners and certified nurse midwives. This mandate was eliminated by the Balanced Budget Act of 1997, which encouraged states to move Medicaid recipients into managed care but excluded APRNs as participants. The bill also proposes to expand Medicaid fee-for-service coverage to include direct reimbursement for all nurse practitioners and clinical nurse specialists (instead of only the family practitioners, pediatric practitioners and midwives who are currently covered). In addition, Medicaid managed care panels would be required to recognize the specialized services of select APRNs - such as the pain management services provided by nurse anesthetists and mental health services provided by clinical nurse specialists - thus clarifying the scope of providers required by managed care plans to specifically include APRNs.

Blakeney noted particular satisfaction with the move to restore Medicaid coverage for the case-management services of pediatric nurse practitioners, family nurse practitioners and certified nurse midwives. "This is a just action that provides greater clarity and final restitution for advanced practice nurses in these categories," she noted. "The ANA commends Rep. Olver for introducing this much-needed legislation, and we look forward to working with him to ensure its enactment."

The American Nurses Association is the only full-service professional organization representing the nation's 2.7 million Registered Nurses through its constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.