ACNM Policy Update - 2/9/2015

The Ohio Association of Advanced Practice Nurses commissioned a RAND study to consider two key questions: 1). What effect do SOP laws for APRNs have on health-care access, quality, and costs?, and 2). According to estimates from the published literature, what effect might relaxing SOP laws have on health-care access, quality, and costs, specifically in the state of Ohio? The study's authors concluded that "granting APRNs full practice authority would likely increase access to healthcare services for Ohioans, with possible increases in quality and no clear increase in costs."

 

The report is largely focused on NPs, but does include some reference to CNMs. Key findings include:
*  "Although no studies of CNMs were included in our analyses, some studies have demonstrated that CNMs can deliver safe care with similar outcomes to those associated with obstetricians and gynecologists."
*  "Additionally, updated SOP laws might increase the number of Ohio CNMs, improving access to women's health-care services. If an increase in CNMs contributed to more CNM-attended births, evidence suggests that this might lead to lower costs."
*  "Furthermore, malpractice costs for obstetrics care are high, and supervisory requirements could affect malpractice costs for supervising physicians, as well as CNMs. Malpractice costs might go down if SOP regulations were relaxed."

Interested members can obtain a copy of the full report here.

 

 

Oregon H.2930 proposes to require hospitals to adopt rules granting admitting privileges to CNMs, among other things. The bill, which has bipartisan cosponsors, is supported by ACOG, the Oregon Medical Association, the Oregon Nurses Association, and the Oregon State Board of Nursing. 

 

 

Kansas S.69 received a hearing in the Senate Public Health and Welfare Committee last week. APRN testimony emphasized the barriers associated with the required collaborative practice agreement while physicians predictably countered their argument by focusing on patient safety and educational differences. The Kansas Health Institute reports that one committee member "pointedly told one of its supporters that legislators don't have the experience to do what you're asking us to do" while another said she doesn't "plan on going forward with this at this time because much more discussion needs to take place." Kansas APRNs are hoping the House committee will be more receptive to their bill, which is tentatively scheduled for a hearing the week of February 9. Interested members can read more about the hearing and anticipated next steps here.

 

Note: APRN strategy is expected to change in response to a bill introduced by the Kansas Medical Society, H.2205, which is discussed below.

 

4.  Multiple Full Practice Authority Bills Introduced

 

The state sessions are in full swing and ACNM affiliates are incredibly active with efforts to obtain full practice authority.
*  Illinois H.421 proposes to remove the requirement for a written practice agreement. The bill does not  currently require a transition to practice period for autonomous practice.
*   Michigan S.68 would create a pathway for independent prescriptive authority in addition to updating definitions of APRN and CNM, creating the APRN Health Resource Shortage Area Fund to encourage practice in shortage areas, and creating the APRN Task Force, among other things.
*  Florida H.547 would create a path to independent practice for APRNs who have obtained 2,000 hours of clinical practice within a 3 year period in any US jurisdiction, are free from disciplinary action in the previous 5 years, and have completed a graduate level course in pharmacology. The bill would also allow independent APRNs to admit, discharge, and manage the care of clients in a hospital, among other things.

 

 

*West Virginia H.2408 adds a brief section to the statute concerning collaborative practice agreements. The bill would require physicians to enter into collaborative relationships with APRNs when requested without charging a fee, among other things. This bill attempts to undermine current efforts at achieving full practice authority by identifying a false solution to the true problems associated with mandated collaborative requirements.
*  Kansas H.2205 has been submitted as possible compromise language in response to the APRN bill. The bill proposes to allow the Board of Nursing and the Board of Healing Arts to "jointly adopt rules and regulations relating to the role of advanced practice registered nurses including such conditions, limitations and restrictions that the boards determine to be necessary to protect the public health and safety, and to protect the public from advanced practice registered nurses performing functions and procedures for which they lack adequate education, training and qualifications." 
*  South Carolina H.3508 is a bill titled "Medical Aspects of Advanced Practice Registered Nursing Act." The bill would continue supervisory requirements for APRNs and require joint regulation of APRN practice by the Board of Nursing and Board of Medicine.  All required practice agreements would have to be approved by a joint committee before an APRN could begin practicing. Specific components of practice agreements, including minimum requirements for chart reviews, site visits, and a process for random auditing of practice relationships to ensure they are compliant with the approved agreement would be addressed during rulemaking.  Similarly restrictive requirements for determining what constitutes a "medical act" are also included in the bill.

 

 

Florida S.614 proposes to allow ARNPs to "prescribe, dispense, administer, or order any drug" as opposed to existing authority to "monitor and alter drug therapies." 
Mississippi S.2096, which would have deleted the collaborative requirement for CNMs, died in committee.
Missouri H.804 would require any person providing home birth services to secure a malpractice insurance policy of at least $500,000 prior to and for the duration of services. Failure to procure the policy would be a Class B misdemeanor.
Missouri S.415 would require, among other things, that when an APRN who utilizes a collaborative practice agreement to "diagnose or initiate treatment for an acutely or chronically ill or injured patient" the collaborating physician must be available either personally or electronically for consultation with the APRN.
Montana S.81, which slightly modifies the composition of the Board of Nursing by increasing RN members from four to five, passed the Senate.
Montana  LC.129, a draft bill, proposes to create a legislative committee to review requested scope of practice changes for new or currently recognized providers. The committee would determine whether a need exists for the new or proposed change and whether potential benefits of the change outweigh potential harm. This bill is similar to a bill already introduced in Washington.
Virginia S.901 proposes to create a new restricted volunteer license for NPs (the title encompasses CNMs) who practice in public health or community free clinics that provide services to underserved populations. The bill passed the Senate.

 

 

Arkansas H.1160 proposes to amend prescriptive authority scope and collaborative requirements for NPs who practice in medically underserved areas. The bill would allow Schedule II authority and allow NPs who have had a collaborative agreement in good standing for two years to practice autonomously. Additionally, NPs who obtain a medically underserved permit would be granted full scope practice (as defined by the statute), be a leader of a patient-care team, be recognized as the initial healthcare provider in the Arkansas Health Care Payment Improvement Initiative, and be reimbursed at the same rate as a physician.

 

 

1.  ACNM Joins Amicus Brief in King v. Burwell

 

ACNM has signed onto an amicus brief in the King v. Burwell case currently before the Supreme Court.  In this case, the plaintiff argues that the plain language of the ACA states that premium subsidies will be available only through state operated health insurance exchanges.  Since most health insurance exchanges are operated by the federal government, should the plaintiff win his case, the basis for the exchanges will be severely damaged.

The government contends that the entire context of the act assumes the availability of premium subsidies, regardless of whether the exchange is state operated or federally operated.

 

The amicus brief joined by ACNM argues that elimination of the subsidies would effectively take insurance away from millions of women who are benefiting in concrete ways from this new coverage option.  Arguments before the Supreme Court are scheduled for March 4 and a decision is expected by July. 

 

---

Should you have questions about state issues, please contact Cara Kinzelman, ACNM's Manager of State Government Affairs at [email protected] or 240-485-1841.  

If you have questions regarding federal issues, please contact Jesse Bushman, ACNM's Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.