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ANA Recommends Requiring Health Plans to Include APRNs to Qualify for Insurance Exchanges


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July 29, 2013 - The American Nurses Association (ANA) has recommended to a federal agency that health insurers seeking to offer plans on state health insurance exchanges must include a certain number of advanced practice registered nurses (APRNs) in each plan’s network of health care providers for the plans to qualify.

“Findings from several decades of research consistently demonstrate that APRNs provide safe, quality care with comparable patient outcomes to physicians and even higher patient satisfaction rates,” said ANA President Karen A. Daley, PhD, RN, FAAN. “As many more millions of uninsured or underinsured seek primary care services through these exchanges, they will need access to qualified primary care providers. That will not happen if private insurers continue to exclude or restrict APRNs from their provider networks.”

In comments submitted to the Centers for Medicare & Medicaid Services (CMS) on a proposed rule governing the exchanges, ANA proposed that each health insurance plan in a particular state include at least a minimum number of APRNs in its provider network to qualify for the exchange. That minimum would be set equal to 10 percent of the number of APRNs who independently bill Medicare Part B in that state.  About 100,000 APRNs nationwide are qualified and enrolled as independent Medicare providers and bill Medicare for services provided to Medicare patients under their own National Provider Identifier. More than 250,000 APRNs--nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists--are licensed nationally.

“This standard is easy to monitor and enforce, and easy to understand and meet for health insurance plans that are serious about addressing the real burden of patient access to primary care,” Daley said. “Recruiting and credentialing APRNs in these plans has to be a top priority.”

For Connecticut, which ranks as the median of the 50 states in APRN participation in Medicare Part B, ANA’s recommendation would require exchange plans to include 178 APRNs in their networks.  Under ANA’s proposal, the required minimums per plan would range from a low of 16 APRNs in Hawaii to a high of 654 in Florida, according to CMS data from 2011.

Many private insurers traditionally have focused on forming networks of physicians and have not placed the same priority on credentialing other health care professions, including APRNs. This lack of inclusion in provider networks, combined with other barriers to practice such as restrictions in some state regulations, prevent many APRNs from offering the full range of services for which they are educated and licensed to provide. Consequently, APRNs are restricted from contributing to their fullest capabilities to alleviating the nation’s shortage of primary care providers, especially for certain patient populations such as the elderly, lower-income groups, and rural residents. 

The exchanges, a key provision of the Affordable Care Act, will be online marketplaces where individuals and small businesses can compare and buy among a range of health insurance plans that cover at least a minimum baseline of essential services, but vary in cost and other factors. The exchanges are designed to enhance competition, improve choice of affordable health insurance to individuals, and give small businesses the same purchasing clout as large businesses. Exchanges are scheduled to start open enrollments October 1, for insurance that becomes effective January 1, 2014.

Source: American Nurses Association (ANA)