Trends In APRN Practice Authority

Transcription

1 Trends In APRN Practice Authority SUSANNE J. PHILLIPS, MSN, FNP- BC CONSULTING EDITOR, THE NURSE PRACTITIONER CLINICAL PROFESSOR, UC IRVINE 2015 Annual Educational Conference Newport Beach, California

2 Objectives By the end of the presentation, the attendee will be able to: Discuss national trends in APRN practice authority; Differentiate practice authority trends among the four APRN roles; Identify states with full practice authority, transition to full practice authority, and those with collaborative / supervisory / attestation / consultation requirements; Describe APRN transition to full practice authority in seven states; Discuss upcoming APRN legislation across the nation.

3 APRN Practice Authority The Nurse Practitioner, 27 th Annual APRN Legislative Update Legislative & Regulatory Updates State-by-state review: Legal authority Reimbursement Prescriptive Authority Now includes all APRN Roles 2016 Edition: US Territories Image retrieved on 3/11/2015 from:

4 NP Practice Authority: AANP AANP 2015 State Practice Environment Map. Image retrieved on 3/11/2015 from:

5 APRN Practice Authority 2014 State Legislative Highlights Practice Authority Connecticut CNP & CNS full practice authority following transition-topractice period Minnesota Full practice authority for all 4 APRN roles CNPs and CNSs require a transition-to-practice period New York Eliminates collaborative practice agreement for CNPs following a transition-to-practice period Requires filing an attestation of collaboration with a physician Phillips, 2015

6 APRN Practice Authority 2014 State Legislative Highlights Reimbursement Authority Hawaii Identifies delaying payment of claims to an APRN by cooperative corporations or indemnity arrangements as deceptive and unfair Utah Requires Medicaid to empanel and reimburse ALL boardcertified CNP specialties Washington Maintains an enhanced reimbursement for ARNPs for primary care services under Medicaid Expansion through 12/2014 Mirrors federal enhancement for MDs and NPs in states with supervision requirements Phillips, 2015

7 APRN Practice Authority 2014 State Legislative Highlights Prescriptive Authority Alabama BOME-authorized CS II Authority Kentucky Removal of the CAPA-NS after 4 years practice Texas CS II authority in hospice & certain hospital settings Maine Authorizes CNPs to certify patients to receive therapeutic or palliative benefits from medical use of marijuana Did NOT expand authority to prescribe marijuana Phillips, 2015

8 APRN Practice Authority National Council of State Boards of Nursing Campaign for APRN Consensus Consensus Model for APRN Authority 2008 Publication Consensus Categories: Licensure Accreditation Certification Education

9 Image retrieved 3/12/2015 from:

10 APRN Practice Authority: CRNA Image retrieved 3/12/2015 from:

11 CRNA Independent Prescriptive Authority Image retrieved 3/12/2015 from:

12 APRN Practice Authority: CNM Image retrieved 3/12/2015 from:

13 CNM Independent Prescriptive Authority Image retrieved 3/12/2015 from:

14 APRN Practice Authority: CNS Image retrieved 3/12/2015 from:

15 CNS Independent Prescriptive Authority Image retrieved 3/12/2015 from:

16 Full Practice Authority Defined implies autonomous authority to provide healthcare within a legally-defined scope of practice, granted to a healthcare provider by a regulatory board upon successful completion of a formal academic program and demonstration of competency in that profession. Phillips, 2015

17 Figure. Summary of Practice Authority for NPs 27th Annual APRN Legislative Update: Advancements continue for APRN practice Phillips, Susanne J. The Nurse Practitioner. 40(1):16-42, January 16, doi: /01.NPR ec Copyright 2015 The Nurse Practitioner. Published by Lippincott Williams & Wilkins. 17

18 Practice Authority: Transition to Practice Period of practice prior to full practice authority with varying degrees of oversight. Completion following education, demonstration of competence and licensure. Full practice authority granted following this period Mandatory legal requirement. State variability. Lack of evidence.

19 Practice Authority: Growing Variability? Full practice authority Upon licensure & certification Following completion of a transition to practice period Attestation of Collaboration with a physician Filed with the BON/BRN Collaboration Defined mechanism Delegation of practice Team-based practice Supervision Direct Indirect

20 National Trends Slide intentionally left blank Phillips, 2015

21 Transition Legislation Across the Nation Slide intentionally left blank Phillips, 2015

22 Transition Legislation Across the Nation Slide intentionally left blank Phillips, 2015

23 Ongoing POLITICAL Debate (Not Policy) Political Compromise to mitigate turf-battles by well-funded opponents 6 states pass transition-to-practice legislation since ACA roll-out Several states plan to use this strategy for the 2015 legislative sessions

24 Figure. Summary of Practice Authority for NPs 27th Annual APRN Legislative Update: Advancements continue for APRN practice Phillips, Susanne J. The Nurse Practitioner. 40(1):16-42, January 16, doi: /01.NPR ec Copyright 2015 The Nurse Practitioner. Published by Lippincott Williams & Wilkins. 24

25 Thank You!