Scope of Practice
States can increase capacity by ensuring payment policies encourage providers to deliver the full scope of services, defining scopes as broadly as evidence and good medical practice support, and establishing new provider types to fill specific niches.
*Milestone details:
*Full name: Develop a plan to examine scope of practice and/or provider reimbursement policies to improve access to care.
*Relevance to the ACA:
Though the ACA does not require changes to scope of practice or reimbursement policies, these policies can be tools to achieve the increased health system capacity that will be needed to serve the newly insured. The ACA includes programs to expand the use of ancillary providers.
§5208 – Grants to support Nurse Managed Health Clinics.
§5304 – A demonstration program to train or employ alternative dental health care providers.
§5313 – Grants to promote the use of Community Health Workers.
§5507 – Grants to develop certification programs for personal care aides.
§10321 – Allows non-physician providers to serve as primary care providers on health teams.
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Massachusetts
Community Catalyst has a Medicaid Report Card that captures scope of practice laws across states. This is one way to expand primary care access - the report card also includes other cost savings measures related to Medicaid.
District of Columbia
The National Institute for Health Care Reform has released a brief examining scope of practice laws and payment policies for nurse practitioners across the United States. It examines the scope of these laws, their impact on how nurse practitioners are recognized by health plans in provider networks and whether or not they can bill carriers directly. NIHCR asserts consideration of these issues is important to make the use of nurse practitioners effective in primary care settings.
Arkansas
I appreciate the sentiment of the study and it has some valid points. I am afraid, however, that the characterization of Arkansas's environment for practicing NPs in the study rest on a flawed legal assumption. In Arkansas, Registered Nurse Practitioners (who are required by law to be supervised by physicians) are truly a relic and were largely replaced by those with the title Advanced Practice Nurses in the late 1990s (who do not require physician supervision to diagnose and treat but must have a collaborative practice agreement to prescribe). It seems the study relied on the Pearson Report, which describes both, but the study went with the more restrictive yet far less prevalent of the two. Arkansas is actually among the 7-8 states between complete supervision and no supervision, and the collaborative practice agreement is just that--a collaboration. It requires the physician to be available and accessible but does not dictate the means for doing so. In a sense, we are in what some would call the sweet spot: we have retained a formal mechanism for team-based care with the agreement but have not restricted where or how APNs practice.
Illinois
The Scope of Practice (SOP) Legislation Tracking Database tracks current legislation in all 50 states, territories and the District of Columbia, regarding commissions and boards, licensure and credentialing, Medicaid/health insurance plan reimbursement, practice autonomy, prescriptive authority, truth in medical education, and truth in advertising for 22 distinct health care professions.
District of Columbia
This Wall Street Journal article discusses the issues of scope of practice for physician assistance and other midlevel professionals and considers their impact in the face of coverage expansions in 2014.
Connecticut
Public Act 11-209 addresses the issue of Scope of Practice.
District of Columbia
This October 5 presentation by Athena Dodd of the Colorado Health Institute outlines some activities and options for Colorado to meet primary care workforce needs.
Colorado
This magazine article by the National Conference of State Legislatures is focused on provider and health systems capacity under the Affordable Care Act.
District of Columbia
On April 6, 2011, the Institute of Medicine released "Oral Health in America." This consensus report includes recommendations to build an oral health workforce that includes non-dentist professionals, and for Medicaid to reimburse for oral health care services. The report can be read on line here: http://www.iom.edu/Reports/2011/Advancing-Oral-Health-in-America.aspx
District of Columbia
The Citizen Advocacy Center (CAC) has launched an initiative to involve consumers, consumer advocacy groups, and citizen organizations in scope of practice (SOP) reform in state legislatures and before state health licensing boards when they engage in rule making to implement legislative initiatives. The mission of our scope of practice initiative is to provide independent, third party, economically disinterested input into processes and criteria for removing unjustified scope of practice restrictions. Posted here is a CAC white paper discussing the importance of scope of practice reform in better assuring the public access to a wide variety of healthcare professionals. A number of other papers can be downloaded from our website: http://www.cacenter.org/cac/SOP.
District of Columbia
This issue brief from the Kaiser Family Foundation explores the roles NPs and PAs could play in serving adults who will be newly eligible for Medicaid when eligibility is expanded.
District of Columbia
This presentation from NASHP's 2010 Annual Conference discusses the workforce challenges that MA faces. It includes information on strategies the state is pursuing to address access to primary care.
Access the presentation here:
http://www.statereforum.org/sites/default/files/ma_dyck.pdf
District of Columbia
This report provides an overview of policy opportunities that the state would like to take advantage of when implementing the ACA, including workforce issues. Access the report here: http://www.statereforum.org/sites/default/files/ca_aca_implementation_de...
District of Columbia
This report presents a summary of public input received and workgroup recommendations on issues relating to delivery system reform, including payment reform, insurance product regulation, behavioral health, controlling costs, and many others.
Access the report here:
http://www.statereforum.org/sites/default/files/md_finalreportdeliverysy...