Health Policy
Susan Lynch MSN NP-C
Copyright Susan Lynch 2012
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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 2012
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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 2012
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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 2012
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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 2012
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What is the Threat?
Florida’s 2011 Medicaid Waiver
Copyright Susan Lynch 2012
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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 2012
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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 2012
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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 2012
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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 2012
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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 2012
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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 2012
12
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 2012
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Medicaid in 2012
Legislative Session
 Still need to change Nurse Practice Act
 Still need DEA authority
Copyright Susan Lynch 2012
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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 2012
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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 2012
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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 2012
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2013
Legislative Session
 Baker Act will be re-filed
 Medicaid Issue
 Other issues TBA
Copyright Susan Lynch 2012
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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.
Copyright Susan Lynch 2012
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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 2012
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Professional
Activism
What you can do now:
 Sign petition
Copyright Susan Lynch 2012
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References
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
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