August 22, 2005
The Honorable Charles Grassley
Chairman, Committee on Finance
United States Senate
Washington, DC 20510
Dear Chairman Grassley:
The organizations listed below urge you to increase access to services provided by advanced practice registered nurses (APRNs) and physician assistants (PAs) in your Medicaid reform efforts. We strongly support the inclusion of the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (S. 1515) in the Medicaid reconciliation legislation that you are developing. This legislation will increase access to essential health care services while helping to control Medicaid spending.
Current law requires fee-for-service Medicaid to cover health care services provided by some APRNs. The Balanced Budget Act of 1997 (BBA, P.L. 105-33) encouraged states to move Medicaid recipients into managed care and to use primary care case managers as gatekeepers in fee-for-service. However, it failed to fully recognize APRNs as participants in these plans. H.R. 2716 would alter Medicaid law in the following three respects:
- Fee-for-service Medicaid would be expanded to include direct payment for services provided by all nurse practitioners (NPs) and clinical nurse specialists (CNSs), and reimbursement for services provided by physician assistants (PAs). Current federal law provides for the direct fee-for-service reimbursement of family NPs, pediatric NPs, and certified nurse midwives (CNMs).
- All NPs, CNMs, and PAs would be recognized as primary care case managers.
- Medicaid managed care panels would be required to include NPs, CNSs, certified registered nurse anesthetists (CRNAs), CNMs, and PAs.
Taken together, these changes will greatly increase access to care for Medicaid patients. Many studies have shown that APRNs and PAs provide cost-effective, high quality care. In addition, they are often willing to provide services in rural and inner-city areas where access to physicians is limited. By including the Medicaid Advanced Practice Nurses and Physician Assistants Access Act in Medicaid reconciliation, you will ensure that Medicaid patients receive care in a timely and cost-efficient manner. We look forward to working with you on this important matter.
American Academy of Physician Assistants
American Association of Colleges of Nursing
American College of Nurse-Midwives
American College of Nurse Practitioners
American Nephrology Nurses' Association
American Nurses Association
Association of Women's Health, Obstetric and Neonatal Nurses
Emergency Nurses Association
National Association of Clinical Nurse Specialists
National Association of Pediatric Nurse Practitioners
National Nursing Centers Consortium
Preventive Cardiovascular Nurses Association
Society of Urologic Nurses and Associates
Wound, Ostomy & Continence Nurses Society