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ACNM Policy Update - 3/14/2014

1.  FTC Issues Policy Paper Endorsing APRN Independence
2.  Supreme Court to Hear Precedent-Setting Case with Implications for Midwifery Advocacy
3.  Oral Arguments in Hobby Lobby Case to Begin Soon
4.  New Tool from the Guttmacher Institute
5.  Consumer-Oriented APRN Advocacy Video


1.  FTC Issues Policy Paper Endorsing APRN Independence

The Federal Trade Commission (FTC) has issued a "Policy Perspective:  Competition and the Regulation of Advance Practice Nurses," that strongly endorses independent practice for APRNs.  The document is very clearly aimed at state lawmakers and makes several pointed recommendations.  It should be reviewed by ACNM affiliates advocating for full practice authority in their states and talking points should be drawn from it for use in those efforts.   

In the introduction to the document the FTC states that:

FTC staff has consistently urged state legislators to avoid imposing restrictions on APRN scope of practice unless those restrictions are necessary to address well-founded patient safety concerns.

Based on substantial evidence and experience, expert bodies have concluded that ARPNs are safe and effective as independent providers of many health care services within the scope of their training, licensure, certification, and current practice.  Therefore, new or extended layers of mandatory physician supervision may not be justified.

Further, the FTC says that “Effective collaboration between APRNs and physicians does not necessarily require any physician supervision, much less any particular model of physician supervision.”  The FTC goes on to urge state legislators and policymakers to consider the following principles when evaluating proposed changes to APRN scope of practice:

  • Consumer access to safe and effective health care is of critical importance.
  • Licensure and scope of practice regulations can help to ensure that health care consumers (patients) receive treatment from properly trained professionals. APRN certification and state licensure requirements should reflect the types of services that APRNs can safely and effectively provide, based on their education, training, and experience.
  • Health care quality itself can be a locus of competition, and a lack of competition – not just regulatory failures – can have serious health and safety consequences. More generally, competition among health care providers yields important consumer benefits, as it tends to reduce costs, improve quality, and promote innovation and access to care.
  • Potential competitive effects can be especially striking where there are primary care shortages, as in medically underserved areas or with medically underserved populations. When APRNs are free from undue supervision requirements and other undue practice restrictions, they can more efficiently fulfill unmet health care needs.
  • APRNs typically collaborate with other health care practitioners. Effective collaboration between APRNs and physicians can come in many forms. It does not always require direct physician supervision of APRNs or some particular, fixed model of team-based care.
  • APRN scope of practice limitations should be narrowly tailored to address well-founded health and safety concerns, and should not be more restrictive than patient protection requires. Otherwise, such limits can deny health care consumers the benefits of competition, without providing significant countervailing benefits.
  • To promote competition in health care markets, it may be important to scrutinize relevant safety and quality evidence to determine whether or where legitimate safety concerns exist and, if so, whether physician supervision requirements or other regulatory interventions are likely to address them. That type of scrutiny can be applied not just to the general question whether the State requires physician supervision or collaborative practice agreements, but to the particular terms of those requirements as they are sometimes applied to, for example, APRN diagnosis of patient illnesses or other health conditions, APRN ordering of diagnostic tests or procedures, and APRN prescribing of medicines.

In addition to releasing this Policy Perspective, the FTC will be holding a workshop on March 20-21 to discuss competition in health care.  ACNM staff will attend and submit comments addressing the issues raised during that event.

2.  Supreme Court to Hear Precedent-Setting Case with Implications for Midwifery Advocacy

The Supreme Court has announced that it will review the decision of the North Carolina Board of Dental Examiners vs. FTC. The suit originally arose when the State Board of Dental Examiners tried to prevent non-dentists from offering teeth-whitening services, arguing that this service should only be performed by dentists. The FTC intervened to block the dental board in the name of fair competition. It argued that the board, composed mostly of practicing dentists chosen by their peers, functioned more as a trade association than an arm of state government. The board and its "market participants" — who also whitened teeth — acted without the state oversight and authorization that might have otherwise given it immunity from federal antitrust laws, according to the FTC. A federal administrative judge ruled in the FTC's favor in 2011, and the US Court of Appeals for the Fourth Circuit upheld its decision in May 2013.

ACNM and other advanced practice nursing organizations considered these rulings to be a victory with far-reaching implications for the role of medical boards versus nursing boards in the regulation of advanced practice nurses. The Supreme Court’s decision on the matter will likely have reverberations at the state level.  The Court has not yet announced when arguments will begin in the case.

3.  Oral Arguments in Hobby Lobby Case to Begin Soon

On March 25, the Supreme Court will begin to hear arguments in Sebelius v. Hobby Lobby, Inc., a much publicized case challenging the mandate for employer-sponsored contraceptive coverage as called for within the Affordable Care Act. A key question before the Court is whether a corporation is akin to an individual whose religious beliefs and rights can be violated by this provision. Interested members can find more information on the case here.

4.  New Tool from the Guttmacher Institute

The Guttmacher Institute has created a new online tool that allows users to create customized tables with data on the contraceptive needs and services within a given county or groups of counties in a state. All data included in the new tool are for 2010, the most recent year available. 

Among the key data points that can be downloaded into tables proposed changes to APRN scope of practice are:

  • women in need of contraceptive services (i.e., women aged 13–44 who are sexually active and able to become pregnant, but do not wish to become pregnant) by age, race/ethnicity and income;
  • women in need of publicly funded contraceptive services (i.e., those in need of contraception and also either younger than age 20, or age 20 and older with an income below 250% of the federal poverty level);
  • number of publicly funded clinics and the numbers of clients served, overall or among clinics receiving Title X funding.

The tool can be found here.  Once a table has been created, it can be downloaded in Excel format.

5.  Consumer-Oriented APRN Advocacy Video

Members may be interested in reviewing an APRN advocacy video aimed at consumers and produced my My Health Care Ohio, “an online resource to help Ohioans understand their healthcare options so they can make informed decisions about what’s best for them.” The video may be accessed here.

Should you have questions about any of these issues, please contact Jesse Bushman, ACNM’s Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.    

Don’t forget to register for ACNM’s 2014 annual conference.  Details are available at the conference website.



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American College of Nurse-Midwives.
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