Your Voice is Important - Coalition for Nurses in Advanced Practice

Your Voice is Important!
What Legislators Need to Hear
Monday, February 10, 2014
Presented by
Kathy Hutto, CNAP Lobbyist
Jackson Walker L.L.P.
John Hubbard, CNAP Public Policy Director
Events Leading to SB 406
 2005-2007 Moratorium
 2009-2011 Unsuccessful negotiations and
 2013 New dynamics
Nursing decision to pursue collaborative agreement
Medicine acknowledges deficiencies in current law
Perryman report
Sen. Nelson and Rep. Kolkhorst involvement
SB 406 Passes
 Key dates
 October 17-18, 2013 - BON and TMB adopt final rules
 November 1, 2013 - Effective date of SB 406
 Practices must be in compliance with changes
 January 1, 2014 - Boards issue FAQs
 BON -
 TMB -
What Is Next and
How Do We Get There?
 October 25, 2013 – CNAP Retreat – Leadership of all
APRN organizations bring priorities.
 Started with 27 Priorities!!
 Common themes:
 Independent practice
 Practice-related issues
 Prescription-related issues
 Higher-education related issues
 Third-party reimbursement issues
Why Not Independent Practice in
 Political Reality – Legislature thinks we got a
 Look at 2009 and 2011
 Leadership wanted continued forward
movement and changes to benefit as many
practices as possible
8 Priorities
 Ensure that APRNs have the ability to contract directly with
insurance providers and serve as Primary Care Providers
whether the delegating physician is in network or a contracted
 Expand authority to prescribe Schedule II medications to
Psychiatric APRNs and APRNs providing Palliative Care.
 SB 406 clean- up: Clarify that APRNs with at least three years of
delegated prescriptive authority with the same physician can go
directly to quarterly face-to-face meetings. Other clarifications,
if needed.
 Allow APRNs to sign Do Not Resuscitate Orders (DNRs).
8 Priorities (cont’d)
 Allow APRNs to sign death certificates.
 Eliminate having physician identifiers included on APRN-authored
prescriptions; i.e. eliminate physician’s name, address, phone
number & DEA number from the prescription.
 Stop any new restrictions on APRNs’ ability to provide pain
management services (not related to prescribing Schedule IIs).
 Resolve issue relating to the number of prescription refills for
Controlled Substances, Schedules III-V, that APRNs can write;
Statute says “the prescription, including a refill…not to exceed 90
Good News
 Resolution of 90 day issue is near!
 7 priorities are more than enough! DO NOT EXPECT
 Key message is simple.
APRNs Can Improve Access to Health
 Texas faces a severe shortage of primary care
 APRNs are a safe, cost-effective solution as they
already diagnose & prescribe, but face unnecessary
 Practical solutions are needed in Texas law to address
the problems that delay and prevent APRNs from
caring for Texans.
The Priority Issue:
Authorizing APRNs as PCPs
 Ensure that APRNs have the ability to contract
directly with insurance providers and serve as their
patient’s Primary Care Provider whether or not the
delegating physician is in-network or a contracted
Authorizing APRNs as PCPs:
The Current Situation
 Two provisions of current Texas law state that a managed
care organization (MCO) may not refuse a request made
by an in-network physician and an advanced practice
registered nurse (APRN), authorized by the physician to
provide care, to identify the APRN as a network provider.
 Section 843.312 of the Texas Insurance Code
 Section 1301.052 of the Texas Insurance Code
Authorizing APRNs as PCPs:
The Current Situation
 Texas faces a physician shortage. As a matter of fact,
according to the Texas Medical Association (TMA)
fewer than 1/3 of all doctors are willing to accept new
Medicaid patients, down from 2/3 in 2000.
 As a result of this situation, a provision was added to
SB 406 with the intent to allow APRNs to be a PCP for
Medicaid managed care patients even if the physician
who delegates prescriptive authority to them is not in
that Medicaid plan.
 This provision was agreed to by HHSC and TDI staff,
as well as TMA, TAFP, TACHC, CNAP, TNP, and TNA.
Authorizing APRNs as PCPs:
The Problem
 Despite the agreed upon changes in SB 406 Medicaid
managed care plans deny credentialing APRNs when the
delegating physician is not an in-network provider.
 In addition, HHSC is not changing the Uniform Managed
Care Contract because HHSC staff think SB 406 does not
supersede the in-network requirements for APRNs
supervising physicians found in the Insurance Code.
 As a result, APRNs willing to serve the Medicaid population
are unable to do so, leaving many people unable to find
the health care they need. This is especially true of the
elderly, people with disabilities and children – the most
vulnerable Texans.
Authorizing APRNs as PCPs:
The Solution
 The Insurance Code needs to be amended to require
APRNs be recognized as PCPs whether the delegating
physician is in-network or not.

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