Advocacy Through Legislation for Equity in Reimbursement.

The issue of how different levels of healthcare professionals and providers are remunerated or reimbursed by the different payers in the United States healthcare sector is one that has been controversial. When the Patient protection and Affordable Care Act 2010 or “Obamacare” came into force in the year 2010, it brought into healthcare coverage an additional 22 million Americans who had hitherto had no coverage. This meant that there was going to be an urgent need to bridge the provider gap that was going to be present at the primary care level.Advocacy Through Legislation for Equity in Reimbursement.

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This became the scenario since the numbers of physicians practicing at the primary care level is not and has never been sufficient to cover the entire population. For this reason, advanced practice registered nurses (APRNs) who are also trained clinicians and who can offer the same services as the physicians became the expected solution. Thus was to be especially true in states that have full practice authority (FPA) legislation for APRNs like nurse practitioners (NPs). FPA allows any APRN to practice autonomously without the need for supervision to the full extent of their training and knowledge. However, the problem was to come with the rates of remuneration for the same services provided by an APRN and a physician. In most states, this is not the same even though the service provided is the same. Definitely, this serves as a disincentive for APRNs like nurse practitioners. This paper examines the possibility of legislative advocacy for equitable reimbursement for APRNs just like physicians in the state of New Mexico that has a full practice authority policy.Advocacy Through Legislation for Equity in Reimbursement.

The Problem

The problem that requires legislative advocacy in the state of New Mexico is inequitable reimbursement for the same services rendered by APRNs and physicians. Being a FPA state, APRNs are allowed by the New Mexico Nursing Practice Act to independently examine patients, order investigations, interpret laboratory and other radiological investigations like magnetic resonance imaging or MRI and computed tomography or CT scans, write prescriptions including those of scheduled drugs, and review patients (DeCapua, n.d.). Despite this, they are not reimbursed at the same rates as physicians for the same services provided. This is a cause for advocacy at the legislative level to lobby legislators to amend the New Mexico Nursing Practice Act for equitable 100% remuneration (fee-for-service) regardless of title for the same services provided. This problem affects APRNs and the current ramifications are that many are not accepting more Medicaid patients as they would have (Barnes et al., 2016).Advocacy Through Legislation for Equity in Reimbursement.

The New Mexico Administrative Code (NMAC) clarifies and interprets the Nursing Practice Act of New Mexico (NMNPC, n.d.). The NMAC regulation number 8.310.3 (title 8, chapter 310, and part 3) on ‘Professional Providers, Services and Reimbursement’ presents the methodology for reimbursing APRNs. At NMAC number 8.310.3.11 precisely, the policy states that reimbursement for certified nurse practitioners (CNPs) and other certified nurse specialists (CNSs) in the state of New Mexico is “limited to” 90% of that of physicians for the same services provided (Human Services Department, n.d.). Many eligible poor Americans will not access primary healthcare services if the problem continues.Advocacy Through Legislation for Equity in Reimbursement.

Idea for Addressing the Problem

Reimbursement paid to nurse practitioners and other APRNs is calculated based on the physician rates in each of the states. For instance, at the federal level Medicare generally reimburses APRNs at 85% of the amounts they reimburse physicians. For Medicaid, that decision is taken by individual states and the amounts range from 75% to 100% of physician rates (ThriveAP, 2016). As seen above, in the state of New Mexico that amount is only 90% of the amount a physician is reimbursed for the same services provided. The author’s idea for addressing the issue is therefore to present the argument for raising this percentage from 90% to 100% of the physician rates. The argument will be that APRNs like NPs are disincentivized to accept more Medicaid patients under their care just because of these lower reimbursement rates for the same services rendered just like the physicians. The idea is to lobby the elected representatives of the New Mexico state legislature to consider amending the Nursing Practice Act of the state as well as the NMAC that clarifies and defines it to raise the reimbursement percentage from 90% to 100% for APRNs.Advocacy Through Legislation for Equity in Reimbursement.

For this idea for action, legislation is the best course for advocacy for the simple reason that the Nursing Practice Act of the state of New Mexico (just like in other states) is a legislative Act or law. Just like the scope of practice, reimbursement methodology is enshrined in law. Therefore, only the legislature has the authority and means to alter it.

Evidence of the Need to Address the Identified Problem

There is enough evidence to support the need for advocacy for the resolution of this reimbursement disparity identified in this paper in the state of New Mexico. Barnes et al. (2016) have identified inequitable Medicaid fee-for-service reimbursement between APRNs and physicians as one of the factors that are compromising the access to healthcare for vulnerable populations. In 2019, none other than the Governor of the state of New Mexico recognized the need to raise the Medicaid reimbursement rates for healthcare providers in the state. This was done across the board for all providers regardless of cadre to the tune of USD 60 million. This can be taken to have been Governor Lujan Grisham’s way of acknowledging that reimbursement disparities existed among different cadres of providers in the state of New Mexico (Office of the Governor, 2019). Particularly, two sources of evidence can be provided here for the need to address this problem legislatively. These are:Advocacy Through Legislation for Equity in Reimbursement.

1. Evidence 1: In the year 2013, the state of Oregon became the first one to sign into law a reimbursement parity Bill (HB 2902) that sought to equally reimburse both APRNs and physicians the same amounts for the same services provided (Nurse Practitioners of Oregon, n.d.). This means that there is already a legal precedent in this matter for the state of New Mexico to emulate.
2. Evidence 2: The second piece of evidence in support of this issue to be addressed comes from a position statement by the National Association of Pediatric Nurse Practitioners or NAPNAP. The association strongly condemned the existing fee-for-service Medicaid reimbursement policy of an average of 85% of physician rates for APRNs as being biased and discriminatory (NAPNA, n.d.).

Stakeholder Support

In this advocacy movement to have equity in Medicaid reimbursement, there are important stakeholders that counted upon to support the action. These are stakeholders that are known, from their mission statements and their previous positions, to be in support of the improvement of the welfare of nurses. Two of these are the professional nurse associations discussed below:Advocacy Through Legislation for Equity in Reimbursement.

1. Stakeholder Supporting 1: The first stakeholder who would support this advocacy initiative for equity in reimbursement in the state of New Mexico would be the American Association of Nurse Practitioners or AANP. This is because the raison d’être of the association is to engage in advocacy for the welfare of all nurse practitioners in the United States of America. They would therefore lend support technically, financially, and morally to this cause.
2. Stakeholder Supporting 2: The American Nurses Association or ANA is the other professional nurse association that would readily support this advocacy action on the legislature in the state of New Mexico. This is because, just like the AANP, it is also in existence to advance the causes of all the nurses in the US. One of these causes that require intense advocacy and lobbying is the issue equality of Medicaid fee-for-service reimbursement.Advocacy Through Legislation for Equity in Reimbursement.

Stakeholder Opposition

Just like there are stakeholders that would readily offer support for the advocacy initiative for reimbursement equity in the state of New Mexico, there are also those who would oppose the same for their own selfish interests. Generally, the stakeholders that are normally opposed to parity in practice with APRNs (including on the matter of FPA) are state and federal physician associations. Two of these are as follows:Advocacy Through Legislation for Equity in Reimbursement.

1. Stakeholder Opposed 1: The New Mexico Medical Society (NMMS) would be one of the stakeholders that would oppose the legislative formalization of the policy of equitable fee-for-service Medicaid reimbursement between APRNs and physicians. The rationale for this belief is that other physician associations and groupings/ lobby groups across the US have also consistently opposed the granting of full practice authority to APRNs.
2. Stakeholder Opposed 2: The second stakeholder that would be opposed to this advocacy initiative would be the American Medical Association or AMA that brings together all the physicians practicing in the US. Their motivation for opposition would be the same as for the NMMS. Because they feel that they are superior to APRNs (there is no evidence in support of this assertion), they would want the APRNs to always remain below them including in terms of reimbursement.

The preparation to debate or converse about this advocacy issue with these opposers would involve collection and presentation of precedent legislations such as the one from Oregon (Nurse Practitioners of Oregon, n.d.), facts about the insufficiency of physician numbers to cover primary health care needs, and facts about the competence of APRNs to provide equal if not better primary care compared to physicians.Advocacy Through Legislation for Equity in Reimbursement.

The Financial Implications

The very fact that this advocacy issue is about reimbursement means that there will definitely be financial ramifications in the event that the idea and initiative succeeds. The first and obvious financial implications or incentive is that APRNs will earn extra income for the same services that they provided previously and received lesser pay for. This will be an incentive to accept more and more Medicaid patients under their care, thereby alleviating the problem of access to healthcare especially by the poorest Americans in marginalized communities. The other financial cost will be on the payer who will have to henceforth incur higher costs of reimbursement for the same services provided by APRNs. Because of the financial incentive, APRNs will perform more procedures and be entitled to greater reimbursement. This is the essence of the fee-for-service or volume-based payment system (Axene, n.d.).Advocacy Through Legislation for Equity in Reimbursement.

Legislature: Information Needed and Proposal Process

The process of presenting this advocacy idea and making sure it reaches the right policy makers in the state of New Mexico will involve actually meeting the elected state legislator and lobbying them to bring an amendment Bill to the Nursing Practice Act and the New Mexico Administrative Code (NMAC). In this case, the legislator in the New Mexico House of Representatives who will be approached for this advocacy initiative is Democrat Representative Christine Trujillo of Bernalillo County District 25. The choice of this legislator is informed by the fact that she serves in an advisory capacity in the Legislative Health & Human Services Committee. She is also a member of the Behavioral Health Subcommittee. Her full contact details are:Advocacy Through Legislation for Equity in Reimbursement.

Address: 1923 Madeira Drive NE Albuquerque, NM 87110

Capitol Phone Number: (505) 986-4435

Capitol Room: 413A

Office Phone Number: (505) 235-8783

Email Address:

The steps of presenting this advocacy initiative to the above legislator will involve booking an appointment with her office, securing a meeting date, presenting the facts to her, and getting her commitment for presentation of an amendment Bill to the existing legislative framework governing reimbursement. In the event that the legislator agrees to introduce this idea as a Bill, the process will be (i) drafting and introduction by the sponsor (Representative Christine Trujillo), (ii) committee deliberation and public participation, (iii) final passage, (iv) sending to the other house (Senate) for debate and concurrence, (v) enrolling and engrossing, and finally (vi) the Governor’s approval or signature (State of New Mexico, n.d.).Advocacy Through Legislation for Equity in Reimbursement.

Christian Principles and Nursing Advocacy

Legislative advocacy as the one suggested above is explicitly supported by the Christian worldview. In this worldview, everyone is asked to “love their neighbor” as they love themselves and to be the Good Samaritan. In this context, therefore, by ensuring parity in reimbursement between the APRNs and physicians offering the same services, more and more poor and marginalized communities are enabled to access primary health care offered by APRNS like nurse practitioners. Specifically, without parity in reimbursement APRNs are reluctant to offer services to Medicaid patients. Unfortunately, these are some of the poorest Americans coming from marginalized minority communities (Hispanics, African Americans, and others). With parity in fee-for-service Medicaid reimbursement, these poor Americans will be treated en masse by these same APRNs and hence the social determinant of health (SDOH) of access to healthcare will have been addressed.Advocacy Through Legislation for Equity in Reimbursement.

Conclusion

The concept of advocacy is the mainstay of many groupings of professional nurses. This includes professional nurse organizations. With one voice, nurses can lobby legislators as the people’s representatives and policy makers to improve policy affecting aspects like healthcare access. One of these advocacy issues is long overdue in the state of New Mexico and it is about bringing about parity in reimbursement for ARNs and physicians for the same services provided.

Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.Advocacy Through Legislation for Equity in Reimbursement.

For this assignment, identify a problem or concern in your state, community, or organization that has the capacity for advocacy through legislation. Research the issue and use the “Advocacy Through Legislation” template to complete this assignment.STATE OF NEW MEXICO

Problem– In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.

Idea for Addressing Solution– In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.

Research the Issue-Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.Advocacy Through Legislation for Equity in Reimbursement.

Evidence 1 –

Evidence 2 –

Stakeholder Support – Discuss the stakeholders who would support the proposed idea and explain why they would be in support.Advocacy Through Legislation for Equity in Reimbursement.

Stakeholder(s) Supporting 1

Stakeholder(s) Supporting 2

Stakeholder Opposition – Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.

Stakeholder(s) Opposed 1

Stakeholder(s) Opposed 2

Financial Incentives/Costs – In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.Advocacy Through Legislation for Equity in Reimbursement.

Legislature: Information Needed and Process for Proposal – Discuss the how to advocate for your proposal using legislation. Include the following:

• Provide the name and complete contact information for the legislator.
• Describe the steps for how you would present this to your legislator.
• Outline the process if your legislator chooses to introduce your idea as a bill to congress.

Christian Principles and Nursing Advocacy – In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.Advocacy Through Legislation for Equity in Reimbursement.

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You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.Advocacy Through Legislation for Equity in Reimbursement.