Medicaid Coverage of Advanced Practice Registered Nurses

Advanced Practice RNs in Medicaid

Ask your Members of Congress to cosponsor the Medicaid Advanced Practice Nurses and Physician Assistants Access Act of 2007 (S. 59/H.R. 2066). The Medicaid APN Access Act changes federal Medicaid law to improve the recognition of health care services provided by advanced practice registered nurses (APRNs). This bill will increase access to essential health care services and increase state flexibility while removing current legal barriers to advanced practice registered nurses (APRNs).

Background
Current federal law requires fee-for-service Medicaid to cover health care services provided by some APRNs (pediatric nurse practitioners, family nurse practitioners and certified nurse midwives). Some states have opted to also cover the services of certified registered nurse anesthetists and clinical nurse specialists - mainly because these practitioners are willing to provide needed services in physician shortage areas. 

The Balanced Budget Act of 1997 made many changes to Medicaid law, and in the process erected new barriers to APRN practice. S. 59/ H.R. 2066 would remove the following barriers:

• Current law requires fee-for-service Medicaid to recognize pediatric and family nurse practitioners, and certified nurse midwives. The Medicaid APN and PA Access Act would change this law to require Medicaid fee-for-service plans to recognize all nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants.

• Current law also gives states the option to recognize family and pediatric nurse practitioners, certified nurse midwives, and physician assistants as primary care case managers in their fee for service program.  S. 59/H.R. 2066 would change the law by removing the state option - therefore requiring states that offer case management services to recognize non-physician providers. It would also expand the definition of nurse practitioner to include all NPs.

• Many states have moved their Medicaid population into managed care. Current law only requires that these managed care plans enroll “a sufficient number, mix, and geographic distribution of providers.” In reality, many plans do not enroll APRNs. The Medicaid APN and PA Access Act would change the law to require Medicaid managed care plans to include the services of nurse practitioners, clinical nurse specialists, certified nurse midwives, certified registered nurse anesthetists, and physician assistants.

Rationale

Many studies have shown that APRNs provide cost-effective, high quality care. In addition, APRNs are often willing to provide services in rural and inner-city areas where access to physicians is limited. APRNs increase access to health care and decrease preventable acute care admissions and emergency room visits. By supporting S. 59/ H.R. 2066, your Members of Congress would help ensure that Medicaid patients receive care in a timely and cost-efficient manner.