Nebraska State Issues:
Durable Medical Equipment (DME)/Nebraska Medicaid:
- Unlike many states, Nebraska Medicaid has not allowed NPs to write for DME despite the Centers for Medicare and Medicaid (CMS) no longer requiring a face-to-face visit by a physician. (See the document below) We are working with the Director of Nebraska Health and Human Services, DME providers, pharmacists, AANP and other specialties to help remove this barrier to current NP practice. https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/FacetoFaceEncounterRequirementforCertainDurableMedicalEquipment.html
- If DME Orders are Denied Use These Resources: If you encounter a supplier who will not fill your DME order, please provide them with the full CMS announcement found here.
- Ensure that you have provided all of the information required on the detailed written order and ask that they fill your order.
- We also ask that you email us at firstname.lastname@example.org so that we can track those suppliers that are not filling DME orders provided by NPs.
- Signature Authority: Global Signature Authority for any forms within our scope of practice.
- Modernize State Licensure Laws: Working with the Nebraska Board of Nursing and the National Council of State Boards of Nursing (NCSBN) towards implementation of the Consensus Model of
** AANP State Policy Toolkit:
Compact State Licensure
- Interstate compacts increase cooperation and collaboration between states.
- Allows an APRN to hold one multistate license in their home state, with the privilege to practice in other APRN Compact States.
- APRNs will no longer have to obtain additional state licenses in order to practice across state lines.
- Efficient and cost effective. Lessens burdensome regulations.
- Eases APRN availability for emergencies, telehealth, online education and primary care shortage areas.
- Does not change Nebraska State uniform licensing requirements for APRNs.
- Eases licensing for Military spouses who are APRNs.
APRN INTERSTATE COMPACT LB687
Interstate compacts have been increasing as a method to increase cooperation and collaboration between states, while still maintaining individual state control.
- An APRN (Advanced Practice Registered Nurse) Compact allows for an APRN to hold one multistate license in their home state, with the privilege to practice in other APRN Compact States.
- Nebraska is already a member of 31 compacts. These compacts have been proven safe and effective.
- The APRN Compact has numerous benefits that include:
- *Cost Effectiveness: APRNs will no longer have to obtain additional licenses, making practicing across state borders more affordable and convenient.
- *Telehealth: APRNs providing telehealth to patients in multiple states must hold multiple licenses. The APRN Compact would allow APRNs to hold a single multistate license, reducing costs, efficiently improving access to quality health care for rural and underserved communities, seniors, and the general population.
- * Emergencies: Allows APRNs to quickly cross state lines to provide vital services in the event of a natural disaster or emergency.
- *Expansion of Care: The shortage of primary care Providers, especially in rural areas, will continue to grow over the next decade. It is estimated that 65 million Americans live in a “primary care desert,” where 50% of the population’s needs are not met. The APRN Compact can expand care to these populations by allowing greater mobility and wider use of telehealth by APRNs.
- *0n-line Education: The Nursing Faculty Shortage is significant. Nurse educators that teach online students across the country must also obtain multiple licenses under the state licensure model, increasing the regulatory and financial burden on them and their organizations.
- *Patient Safety: The APRN Compact requires the use of uniform licensure requirements, including federal criminal background checks, for all Compact states, ensuring that all nurses practicing in a state have met a minimum set of requirements, regardless of licensure location. Less than 1% of nurses ever require discipline, but Boards of Nursing will maintain the ability to take action against a nurse, no matter where the nurse is licensed or practicing.
- *Military Spouses: Military spouses often relocate every two years and are required to get a different state license every time; significant fees and effort is required. The APRN Compact would eliminate the need to re-apply for licensure, dramatically aiding military families and their ability to work.
- Nebraska Facts:
- 1784 APRNs in Nebraska
- 66 Nebraska Counties are identified as Medically Underserved Areas; 86% of APRNs work in 44 of these 66 counties.
Consensus Model (Attach copy of Consensus Model document here)
Federal Issues: (per American Association of Nurse Practitioners)
- Home Health Care Planning Improvement Act of 2017 (S. 445/H.R. 1825) to make it possible for NPs to provide necessary services for their Medicare patients by allowing them to certify that patients under their care are eligible for home health care services. Passage of this legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for the beneficiaries who require home health services.
- Ask your Members of Congress cosponsor (H.R. 1617) which 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 diabetic beneficiaries who need therapeutic shoes.
- Encourage Members of Congress to Cosponsor H.R. 1160 to Allow NP Patients to be Counted in ACOs - The Affordable Care Act recognizes nurse practitioners as professionals eligible to participate in Accountable Care Organizations (ACOs). Under the Medicare Shared Savings Program, the statute prevents Medicare beneficiaries who receive their primary care services from NPs from being assigned to ACOs in the program. This restriction makes it impossible for NP practices to independently join or establish their own ACOs. If ACOs are to develop as practice models that improve patient access, quality and cost effectiveness, the exclusion of nurse practitioners patients must be eliminated.
- Urge Congress to ensure that any health care reform legislation is patient-centric and includes NPs as a high-quality health care provider. NPs have delivered high-quality health care to their patients for over half a century and are the health care provider of choice for millions of patients throughout the country. They are advanced practice registered nurses who are prepared at the masters or doctoral level to provide primary, acute, chronic and specialty care to patients of all ages and walks of life.
- For over 50 years, the Nursing Workforce Development programs (Title VIII of the Public Health Service Act) have supported the recruitment, retention, and distribution of our nation's nursing workforce. It is critical that these programs and the National Institutes of Health and National Institute of Nursing Research receive at least stable funding in Fiscal Year (FY) 2018.
** AANP Federal Policy Toolkit: