Bills would expand advanced practice nurses’ authority

Legislators filed four bills Tuesday that would give advanced practice registered nurses in Arkansas more authority to serve as primary care providers.

The bills were discussed in a press conference prior to their filing by five legislative sponsors and supporters: Rep. Kim Hammer, R-Benton; Rep. Dan Sullivan, R-Jonesboro; Rep. Karilyn Brown, R-Sherwood; Rep. Mary Bentley, R-Perryville; and Rep. Justin Gonzales, R-Okolona.

Sullivan’s House Bill 1182 would allow qualified advanced practice registered nurses – those with advanced degrees – to be listed as primary care providers in the Arkansas Medicaid program “for all purposes authorized for a primary care physician and a primary care case manager.”

The listing would give advanced practice nurses the same authority as physicians in a variety of areas, including initial diagnoses, serving as the team leader in a patient-centered medical home, maintaining medical records, and ordering laboratory tests.

Advanced practice nurses would be reimbursed at a rate of not less than 90% of the physician reimbursement rate for services performed within the nurse’s scope and licensure, and at 100% of the physician rate for out-of-pocket costs such as laboratory tests and x-rays.

Brown’s House Bill 1186 would allow advanced practice nurses to have full practice authority without a collaborative practice agreement with a physician. A collaborative agreement identifies a physician who works with the nurse to manage the nurse’s patients and outlines procedures for referrals to the physician. The bill would allow those nurses to have prescriptive authority for drugs listed in Schedules II-V without such an agreement, giving the nurse the ability to prescribe drugs and therapeutic devices appropriate for their practice.

Sullivan’s House Bill 1181 would allow the Arkansas State Board of Nursing to grant a certificate of prescriptive authority to advanced practice nurses who meet certain qualifications.

Bentley’s House Bill 1180 would give advanced practice nurses signature authority that currently exists only for physicians in areas such as disability parking permits, sports physicals for student athletes, forms related to end-of-life care, and workers’ compensation forms.

In the press conference, Sullivan said advanced practice nurses can be primary care providers – as opposed to primary care physicians – under federal law, but Arkansas has chosen not to give them that authority.

Hammer said advanced practice nurses can help rural communities address a shortage of providers and that many other states already give advanced practice nurses the authority the legislators are seeking.

“We are not here speaking against doctors, physicians or other primary care providers. That is not our message. Our message is that we would like to have APRNs be unshackled from being able to offer their full scope of practice abilities to provide in all areas of the state of Arkansas, specifically to those who happen to be underserved,” he said.

Gonzalez said Arkansas has done much to try to increase the availability of health insurance but very little to increase access to care.

Bentley, a nurse, said, “We don’t know what the future holds with the (Affordable Care Act, otherwise known as Obamacare). None of us do. The future is very uncertain, so I want us to do everything we can to have as many health care providers out there as possible.”