Happy Election Day! 3 National Legislative Issues Affecting NPs

Good morning! What are you up to on this election day? I neglected to vote early in some sort of an illusion that it would be a patriotic experience to hit the polls on actual election day, but am now regretting my decision. So, I will face the crowds this afternoon to make my opinion count. On the agenda? Voting “Yes” to allow wine in Tennessee grocery stores (one less errand to run!) and supporting a few of my local politicians, of course.

Concerning nurse practitioners, it seems there are always a few legislative issues on the books. While I am not aware of any states voting on key NP-related legislation today, I wanted to take advantage of today’s focus on politics to take a quick look at some pending legislative issues relating to nurse practitioners you might not be aware of. While these issues might seem petty, they may affect your everyday practice.

1. Nurse Practitioners and Durable Medical Equipment

Durable Medical Equipment (DME) is any medical equipment used at home to aid quality of living and health. Home glucose monitors, home oxygen, wheelchairs, hospital beds, and transfer devices, to name a few, qualify as DME.

In an effort to reduce Medicare fraud, the Affordable Care Act requires that a physician document that the physician him/herself or a nurse practitioner or physician assistant has had a face-to-face encounter with the Medicare beneficiary within the past six months before writing an order for durable medical equipment. This means that nurse practitioners will no longer be able to order items like blood glucose monitors for Medicare patients without a physician signing off on the order.

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Nurse practitioners have been able to order DME without a physician co-signature since 1997. Requiring that physicians be the ones to sign orders for DME increases cost of care for Medicare beneficiaries and limits nurse practitioner’s scope of practice. Bill H.R. 3833, introduced by congressman Jim McDermott, would allow nurse practitioners and clinical nurse specialists to sign that a face-to-face patient encounter has taken place in ordering DME helping provide more timely and lower cost care to Medicare patients.

2. Veteran’s Health Administration Plan to Recognize Nurse Practitioner’s Full Scope of Practice

The Veteran’s Health Administration (VHA), the largest health system in the country, last year proposed allowing nurse practitioners within the system to practice without physician oversight. Because the VA is a federal organization, it can determine how NPs practice without regard to individual state’s scope of practice laws, except for when it comes to prescribing controlled substances.

Decisions regarding nurse practitioner’s scope of practice within the VA system are under close scrutiny given the VA scandal of 2014. At least 40 veterans reportedly died while waiting for care in the taxed system. Nurse practitioner advocates say that allowing NPs greater autonomy could help curb further delays in care for veterans. The VA has been developing guidelines in regards to nurse practitioner practice since 2011 and has not given a date as to when a decision regarding APRNs and physician oversight will be made official. 

3. Nurse Practitioner Role in Skilled Nursing Facilities

Skilled nursing facilities (SNF’s) provide care to patients with intensive medical needs. They may participate in stroke recovery, general rehabilitation, or long-term acute care. Upon admission to a SNF, Medicare regulations require that a physician perform an initial admitting exam within 30 days of admission as well as alternating monthly assessments on the patient. These restrictions do not apply to other types of facilities, but remain in place for skilled nursing facilities.

Nurse practitioners are permitted to bill Medicare for medically necessary visits in SNFs, but not the initial evaluation. This inconsistency may increase the cost of care for patients admitted to SNF’s as well as delay an initial medical evaluation. The American Academy of Nurse Practitioners has been outspoken in advocating congress to change these Medicare restrictions based on nurse practitioner’s 25-year track record of providing outstanding care to patients in long term care facilities.

Writing to your state’s representatives regarding these concerns can help change these and other legislative issues affecting nurse practitioner practice.

What legislative issues affecting NPs are on the table in your state? Happy voting!


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