1. Health Policy Susan Lynch MSN NP-C 1Copyright Susan Lynch 2012

2. Power is the Potential to Exert Influence Sheila Abood PHD RN “The ability to successfully exert influence…and to take advantage of opportunities to present nursing’s perspective…depends on having a power base and knowing where and when to exert that influence. Power is an inevitable part of human interaction and those…nurses…who deny this fact will be at a serious disadvantage when trying to make change” (Abood 2007) Copyright Susan Lynch 20122

3. Some recent APRN studies and reports  IOM report: Let APRNs practice independently  FTC Opinions: Florida 2011 first NP opinion in nation  OPPAGA study: FL saves $350,000annually  Florida Tax Watch Brief: FL should remove restrictions  Florida Senate Interim Report 2009:DEA authority Copyright Susan Lynch 20123

4. Texas Economic Study 2012  Perryman APRN Utilization Economic Impact Report for Texas: Utilizing Advanced Practice Registered Nurses more efficiently in the system of health care provision can enhance patient care while reducing costs. These efficiencies generate substantial economic benefits which permeate the entire state and facilitate a broader and more effective health care delivery model. Copyright Susan Lynch 20124

5. Real and Present Danger A real threat currently exists. ARNPs at risk of having their clinics close. Patients access to care at risk. This threat could be an opportunity. Copyright Susan Lynch 20125

6. What is the Threat? Florida’s 2011 Medicaid Waiver Copyright Susan Lynch 20126

7. Current Medicaid Options  20 percent of Medicaid PCPs are NPs  3.2 million people now receive Medicaid in Florida  ARNPs can currently directly bill Fee for Service Medicaid  Patients can choose APRN as primary care provider  APRN must follow state Practice Act  Under Affordable Care Act estimated 1 million more people eligible Copyright Susan Lynch 20127

8. Imminent Threat to ARNPs Florida’s 2011 Medicaid Waiver  2011 Medicaid Waiver expansion passed  Places all recipients in HMO plans  Restrictive language stated patients could only have physician as PCP  Will eliminate direct billing by ARNPs and direct reimbursement for ARNPs  ARNPs will have to contract through a physician to see Medicaid patients Copyright Susan Lynch 20128

9. Imminent Threat to ARNPs Florida’s 2011 Medicaid Waiver  Waiver eliminates the Fee for Service Program  Many APRN owned practices will be forced to shut down as a result.  Will restrict Pt. access to care  Campaign and policy actions begun aimed at getting these restrictions changed  Reaching out to CMS, AHCA and Governor’s office Copyright Susan Lynch 20129

10. Medicaid Continuing Problems  Agency for Health Care Administration (AHCA) Lawyer sends CAP-PAC inc. a letter explaining Nurse Practice Act and DEA laws must change in order for HMOs to contract with ARNPs Unless we change Nurse Practice Act  Medicaid billing restrictions will remain  ARNP will have to contract through physician to get paid in Medicaid Waiver Law.  Patients will loose providers  ARNPs will go out of business Copyright Susan Lynch 201210

11. Medicaid Waiver Opportunity for APRNs  CAP-PAC partnering with ACNP to engage CMS on Waiver Issue: asks CMS to deny Waiver based on decreased access to care, asks for change in PCP language  AHCA involvement continues  Governor’s office involved  TEA Party informed of issue: votes to support  LWVF supportive Copyright Susan Lynch 201211

12. Power is the Potential to Exert Influence Sheila Abood PHD RN “The ability to successfully exert influence…and to take advantage of opportunities to present nursing’s perspective…depends on having a power base and knowing where and when to exert that influence. Power is an inevitable part of human interaction and those…nurses…who deny this fact will be at a serious disadvantage when trying to make change” (Abood 2007) Copyright Susan Lynch 201212

13. Medicaid in 2012 Legislative Session  Medicaid language changed  ARNPs now recognized as PCP. Patients can choose ARNP as PCP  Was placed as an amendment by “high level” legislative supporters three days before session ends.  Was praised by national NP groups a significant legislative change Copyright Susan Lynch 201213

14. Medicaid in 2012 Legislative Session Still need to change Nurse Practice Act Still need DEA authority Copyright Susan Lynch 201214

15. Medicaid Waiver Opportunity for APRNs This is a priority issue. If the waiver is approved by CMS as it is currently written, we believe patient access to care will decrease It also has serious implications for ARNP practice in Florida as ARNPs will no longer be able to direct bill for services and must contract under a physician Copyright Susan Lynch 201215

16. Medicaid Waiver Stay Tuned Our governor wants to stimulate the economy and does not want further job losses. The Texas Perryman report shows the economic gains in job creation if NPs are allowed to practice independently Florida is almost exactly like Texas as far a rural counties and number of practitioners in the state. Copyright Susan Lynch 201216

17. 2012 Legislative Session  Medicaid language changed: ARNPs now recognized as PCP. Patients can choose ARNP as PCP  Bill to allow APRNs to Baker Act almost passes.  Death Certificate Bill passes one committee  NPs allowed to certify diagnosis of Alzheimer's for persons attending adult day care centers  ARNPs allowed to clear sports head injuries to return to practice Copyright Susan Lynch 201217

18. 2013 Legislative Session  Baker Act will be re-filed  Medicaid Issue  Other issues TBA Copyright Susan Lynch 201218

19. National NP issues Home Health Care Planning Improvement Act of 2011 (H.R. 2267 and S. 227). A bipartisan group of 107 Representatives and 15 Senators signed on to cosponsor the legislation last year, but more support is needed to improve the bill’s chance of passage.H.R. 2267S. 227 Copyright Susan Lynch 201219

20. National NP issues Denial of Portable X-Ray Services Ordered by Nurse Practitioners Even though the Medicare program recognizes the authority of nurse practitioners to order diagnostic x-rays, conflicting rules have limited Medicare payment for portable x-ray examination to those "performed only on the order of a doctor of medicine or doctor of osteopathy licensed to practice in the State (42 CRF § 486.106). Copyright Susan Lynch 201220

21. Professional Activism What you can do now: Sign petition Copyright Susan Lynch 201221

22. References copyright Susan Lynch 201222 Abood, Sheila (January 31, 2007) Influencing Health Care in the Legislative Arena” OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1 Manuscript 2