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ANA works to remove legal barriers to APRN practice


While advanced practice registered nurses (APRNs) have been increasing in number and expanding their impact on the healthcare system, federal law continues to contain many barriers to full APRN practice. ANA is currently working to educate members of Congress about the fact that APRNs should be recognized as an important and growing proportion of the healthcare workforce, often practicing in rural and other underserved areas where physicians are scarce. Numerous studies have shown that APRNs are able to provide care that is at least as high in quality as that provided by physicians. Two ANA-endorsed bills introduced in 2007 would target specific programs that continue to deny access to APRN services.

Medicare home health authority
Last summer, Senators Susan Collins (R-ME), Kent Conrad (D-ND), Daniel Inouye (D-HI), Barbara Mikulski (D-MD), and Gordon Smith (R-OR) introduced the Home Health Care Planning Improvement Act of 2007 (S. 1678). This legislation would change Medicare law to grant nurse practitioners, clinical nurse specialists, and certified nurse midwives the ability to order and certify home health services and to sign home health plans of care.Medical advances have made it possible for a growing number of patients to receive care in the comfort of their own homes. In 2004, 2.8 million Medicare patients received home health services. In order to qualify for these services, Medicare beneficiaries must be certified as “homebound.” This means that patients must leave their homes infrequently and only with considerable and taxing effort. In addition, patients must require at least one skilled nursing or therapy service, and a plan of care must be developed and submitted to Medicare. Today, only physicians and podiatrists may sign plans of care or certify a patient as qualifying for home health services.
Frequently, patients experience delays in obtaining home health due to the need for discharge planners and other referring entities to locate a physician to complete Medicare paperwork. These delays in care inconvenience patients and their families, and can result in increased cost to the Medicare system when patients are unnecessarily left in more expensive institutional settings. In many cases, the certifying physician may not even have a relationship with the patient and must rely upon the input of the nurse practitioner, clinical nurse specialist, or certified nurse midwife to order the medically necessary home health care.
ANA maintains that these restrictions on the ability of APRNs to order home health services are anachronistic and should be removed.
Federal Employees Compensation Act
On December 13, 2007, Representatives Phil Hare (D-IL) and Mark Souder (R-IN) introduced a bill that would allow APRNs to be reimbursed for healthcare services provided to federal employees injured on the job. The Improving Access to Workers’ Compensation for Injured Federal Workers Act (H.R. 4651) addresses one of the few remaining federal healthcare programs that continue to deny access to APRNs. To date, the Federal Employees Compensation Act (FECA) recognizes only physicians, podiatrists, dentists, clinical psychologists, optometrists, and chiropractors. FECA claims signed by APRNs have been denied by the Department of Labor.ANA has worked to educate members of Congress about the fact that APRNs are covered providers in Medicare, Medicaid, Tri-Care, and private insurance plans. They also serve as medical providers in the Veterans Administration, the Department of Defense, and the Indian Health Service. In fact, most federal employees have access to APRNs through their federal employee health benefit plan. There is no reason to deny injured federal workers access to these providers.
ANA has pointed out that APRNs are often the only available providers in rural and inner-city areas, and that their exclusion from FECA limits patient access to healthcare services, disrupts continuity of care, and creates unnecessary costs for the Department of Labor. H.R. 4651 would address this situation by specifically adding nurse practitioners, clinical nurse specialists, certified nurse midwives, certified registered nurse anesthetists, and physician assistants to the definition of ‘medical, surgical, and hospital services’ in FECA law.
You can follow developments on these bills by logging onto the ANA government affairs website at www.anapoliticalpower.org.

Erin McKeon is Associate Director of ANA’s Department of Government Affairs.

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