Let's Talk: Conversations About APNs

This month we will address international advanced practice issues, and specifically European curriculum  standardization efforts with Donna Rae Richardson, RN, JD.

Donna Rae Richardson is the Director of Governmental Affairs and Professional Standards for CGFNS. Previously, she was the Community Outreach Coordinator for the Women’s Health Initiative of the Nation’s Capital and Director of Clinical Trials Programs at Howard University Cancer Center that increased minority physician and patient participation in clinical trials. She also served as an Assistant Professor of Nursing and Medicine at Howard University. A registered nurse and attorney, Ms. Richardson is counsel to the law firm of Joan Wilbon and Associates. As Director of Governmental Affairs of the American Nurses Association, she directed the legislative and regulatory policies that led to the Nursing Immigration Relief Act and occupational health protections for nurses. Prior to that, she was an attorney at the Department of Labor. She is a recognized speaker and resource on foreign-educated nurses, HIV policy, women’s health research, occupational health for nurses and clinical trial recruitment. Ms. Richardson was honored by Washington High School in Massillon, Ohio, in 2007 as a Distinguished Citizen for her career in health and law.

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We discuss the recent development of insurers lowering the reimbursement rates for NPs to 85% of the physician rate. Our guests this month are Tom Hampton and Bob Smithing ARNP.

Tom Hampton, the former Commissioner for the DC Department of Insurance, Securities and Banking, a role in which, most recently, he was responsible for providing oversight and direction of the agency that regulates all financial services industries in the District of Columbia.

Tom has advised clients on regulatory approvals required in insurance agency, insurance company, captive insurance and risk retention group licensing issues. He has assisted clients with captive insurance company formation and licensing issues. He has also advised clients with life and health policy form filings. Tom has advised a client that is coordinating with state insurance departments and state health departments on the establishment of their state health insurance exchange, as required under the Affordable Care Act.

Tom has advised clients on financial regulatory matters, including NAIC examination procedure concerns, accounting practices and procedures issues, and annual statement filing concerns. Tom also assisted clients with market conduct examination concerns and other market conduct regulatory issues.

Bob has been a Family Nurse Practitioner since his graduation from the University of Pennsylvania in 1981. He was granted a Master of Science in Nursing degree upon graduation and was subsequently certified by the American Nurses Credentialing Center as a Family Nurse Practitioner. He is a past president of the American Academy of Nurse Practitioners and served on the original board of the American College of Nurse Practitioners.

The first issue for today is DOJ Medicare Strike Force and Nurses.  The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. More than 500 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies have been deployed to this project.  

The second topic for this discussion is DEA Registrant Administrative Actions Against Nurse Prescribers.   With the registration of nurse prescribers, the DEA has begun conducting audits of nurse prescribing practices.  Until 2009, the DEA did not take administration action against “mid-level” prescribers, but instead relied on board of nursing to address nurse prescribing problems.  However, with continued focus on controlled substance prescribing, specifically abuses of prescribed controlled substances, the DEA began taking administrative action against nurse prescribers.

This conference call builds on the FTC approach related to advanced practice --– how do we get advanced practice nursing organizations to support FTC research on collaboration?

 And, we covered changes in Texas law.  Texas and a number of other states have attempted to adopt legislation which would allow exemptions of health care collaborative from antitrust law. Under senate bill 8, state-certified healthcare collaboratives comprised of hospitals, physicians and other providers would be exempt from state and federal antitrust laws. The way these laws have been structured, they could be used to keep advanced practice nurses from pursuing practice arrangements within the ACO structure, although federal law and regulation has be structured to incorporate APNs into this delivery arrangement.