Updates provided by Legislative Chair, Mary Beth Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP
NAPNAP partners with The Nurse Practitioner Association NYS to advance the legislative agenda beneficial to all NPs and their patients. In 2022 the Nurse Practitioner Association New York State convinced Governor Hochul to advance revisions to Nurse Practitioner Modernization Act (NPMA) as part of 2022 budget proposal. This legislation would remove the need for collaborative practice in NYS. The executive language was not exactly what The NPA was hoping for which resulted in further negotiations with legislature, the Department of Health and the governor’s office. The ultimate agreement granted full practice authority and permanently adopted the 2014 language for the legislation. The statutory requirement for collaboration for senior NPs was eliminated. A sunset requirement was included to revisit the further changes to the NPMA.
Governor Hochul has acknowledged the need to increase Medicaid reimbursement rates for primary care, particularly for NPs. Ultimately, the DOH implemented a change to 95% of physician fee schedule – significant increase.
The 2023 legislative agenda included bills S.6800 (Rivera)/A.6445 (Paulin) which would make the 2022 budget action permanent. Statutory collaboration requirements for senior NPs will be permanently eliminated. The bill will also allow junior NPs to have a written collaborative agreement with a physician OR a senior NP. Currently the Senate has reported S.6800 out of Higher Education Committee to the Floor. In the Assembly A.6445 was referred to the Higher Education Committee. There continue to be meetings with Legislative Leadership, the Governor, and the State Education Department. This legislation is the number one priority for this legislative season. If it does not pass the statute regulating NP practice will revert to the previous requirement of a collaborative agreement to be maintained by the NP.
S.6801 (Rivera)/A.6446 (Paulin) amend a series of sections of State Law to clarify that NPs may sign forms related to healthcare services that are already within the NP scope. Certifying disabilities for purposes of Vehicle and Traffic Law, including parking permits for individuals with disabilities which includes provisions for temporary parking permits. NPs are already able to sign for permanent parking permits. This legislation would also include issuing excuse letters for jurors who are breastfeeding and clearing students to return to school after concussion protocols. The Senate has reported this bill out of the Health Committee to the Floor. In the Assembly the bill was referred to the Higher Education Committee.
Behavioral Health Initiatives. During the height of pandemic, Executive Order 202.10 permitted NPs to practice at the top of their license, unencumbered by administrative barriers. This order allowed NPs with the appropriate education, training, and experience to authorize orders that otherwise required a physician signature and was interpreted to include important behavioral health services. The NPA is seeking statutory changes to make it clear that NPs and psych NPs in particular may provide essential services that are within their scope of practice and issue certain orders (admission, seclusion), serve as expert witnesses to testify on behalf of a patient when they are managing the patient’s primary psychiatric care. In the Assembly A.6934 (Gunther) has been introduced to increase the authority for psychiatric nurse practitioners to complete admissions to licensed mental health facilities. The Assembly has referred this bill to the Higher Education Committee. A sponsor is still being sought in the Senate, but Senator Samra Brouk is considering introducing this bill.
There are still statutes in place that ‘require’ they must be signed by a physician. These statutes predate the creation of the NP profession. Other forms that still ‘require’ physician signatures are the MTA Police Physical Fitness Exam – Municipal Police Department which is required by the Criminal Justice Services regulations.
Federal Legislation proposed by the American Academy of Nurse Practitioners
H.R. 2713/S. 2418, the ICAN Act: The Improving Care and Access to Nurses (ICAN) Act promotes patient access to health care services delivered by the provider of their choice by removing outdated Medicare and Medicaid barriers on NPs and other advanced practice registered nurses (APRNs). This legislation covers the other federal bills being proposed but if ICAN does not pass then the other bills can be passed individually.
Improve Access for Patients Who Need Cardiac and Pulmonary Rehabilitation Services
Annually, heart disease and COPD kills nearly 850,000 Americans and costs the United States over $370 billion. Yet while recent studies have shown that cardiac and pulmonary rehabilitation increases positive patient outcomes and decrease costs, less than 25 percent of eligible Medicare patients receive these services. H.R. 2583/S.3481, the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023 would authorize NPs to order cardiac and pulmonary rehabilitation services beginning in 2024.
Improve Medicare Patient Access to Needed Therapeutic Shoes
S. 260/H.R. 704 would authorize nurse practitioners (NPs) to certify their patient's need for therapeutic shoes. Passage of this legislation will make it possible for NPs to provide this service, when necessary, for their Medicare patients. It will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for beneficiaries with diabetes who need therapeutic shoes.
Improve Federal Employees' Timely Access to Health Care for Workplace Injuries
Currently, federal employees can select an NP as their health care provider under the Federal Employees Health Benefits Program and the majority of states authorize NPs to provide the diagnosis and treatment for a workplace related injury. However, contrary to the workers’ compensation process in most states, FECA requires that only a physician can make the diagnosis, certify the injury and extent of the disability, and oversee the patient’s treatment and care. This barrier places an additional burden on the nearly 2 million federal employees, depriving them from receiving health care from their provider of choice as well as hindering timely access to care and continuity of care. The Improving Access to Workers’ Compensation for Injured Federal Workers Act, S. 131/H.R. 618, will authorize NPs to certify disabilities and oversee treatment for injured federal employees under FECA.