The New Year brought with it a flurry of newly introduced bills aimed at increasing access to nurse practitioners (NPs) and PAs. In Colorado, PAs are pushing to move from supervision agreements to collaborative agreements with physicians. On a federal level, The Promoting Access to Diabetic Shoes Act (S 260 and HR 704), was introduced to the US Senate and House, respectively, to allow NPs and PAs to order diabetic shoes. Another bill, The Improving Access to Workers’ Compensation for Injured Federal Workers Act (S 131 and HR 618), aims to allow NPs and PAs to certify and oversee the care of federal employees’ workplace-related injuries. Also, NAPNAP released a position statement urging all NPs to use their own National Provider Identifier number, Drug Enforcement Agency number, and controlled substance license for transparency and accountability when prescribing.
Promoting Access to Diabetic Shoes Act Introduced
The Promoting Access to Diabetic Shoes Act was introduced in both the US Senate and the House of Representatives by Senators Brown (D, Ohio) and Collins (R, Maine) and Representatives Blumenauer (D, Oregon) and LaHood (R, Illinois).1,2 Currently, NPs and PAs treating Medicare patients in need of diabetic shoes must refer them to a physician who can certify that need. This legislation would allow patients to continue receiving care from their chosen health care provider by authorizing NPs and PAs to certify their patients’ need for diabetic shoes.
“This legislation would streamline health care delivery, ensuring that patients with diabetes receive the care they need when they need it — from their provider of choice,” said April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “Patients should not have to endure outdated barriers to care that come between them and their health care provider. Requiring a physician to certify that a patient requires diabetic shoes — after the patient’s NP has already made that determination — leads to delays in treatment and increases costs to the Medicare program by requiring the participation of an additional provider. We thank Senators Brown and Collins as well as Representatives Blumenauer and LaHood for their efforts and look forward to the passage of this legislation.”1
“Laying the foundation for legislative success is critical during the first few months of Congress, and building a relationship with lawmakers is the first step,” wrote Kristin Butterfield, Director, Grassroots and Political Advocacy, American Academy of Physician Associates (AAPA). All PAs are encouraged to be advocates for the profession, and AAPA has numerous tools available for PAs and PA students who want to become involved in grassroots advocacy — go to AAPA’s Advocacy Central and click Grassroots. Additionally, you can help raise awareness of and support for our 2priority bills introduced in the House and Senate by taking action on our advocacy alerts that we have created in AAPA’s Advocacy Action Center.2
Injured Federal Workers Act Introduced
The Improving Access to Workers’ Compensation for Injured Federal Workers Act was reintroduced in both the US Senate and House of Representatives by Senators Brown (D-OH) and Collins (R-ME) and Representatives Walberg (R-MI) and Courtney (D-CT) on January 31, 2023.2,3 Currently, federal employees can choose an NP or PA as their health care provider under the Federal Employees Health Benefits Program, yet federal law prevents these clinicians from certifying and overseeing the care of federal employees’ workplace-related injuries. This bill would ensure federal workers receive access to high-quality health care for work-related injuries from their chosen health care provider.
“This bipartisan legislation would give federal workers timely access to the care they need when they need it most,” said Dr Kapu. “The bill would authorize NPs to certify federal workplace injuries and oversee treatment of injured workers. I urge all members of Congress to support this legislation and reduce unnecessary barriers to timely care delivery.”
“Last year, the Improving Access to Workers’ Compensation for Injured Federal Workers Act passed the House of Representatives on an overwhelmingly bipartisan vote during the 117th Congress,” explained Tate Heuer, Vice President, Federal Advocacy, at the American Association of PAs (AAPA). “Although the bill didn’t make it across the finish line before the close of the Congress, AAPA and our Congressional champions have continued to increase support for the legislation and worked with the bill’s Congressional sponsors on its recent reintroduction in the new 118th Congress.”
“The Improving Access to Workers’ Compensation for Injured Federal Workers Act would expand access to high-quality, cost-effective healthcare delivered by PAs and will ensure PAs are recognized under the Federal Employees’ Compensation Program to diagnose medical conditions, certify injury and extent of disability, and oversee patient treatment and care. The current law excludes PAs from this program and creates an outdated, overly burdensome barrier that reduces access to care for approximately 2 million federal employees,” said Jennifer Orozco, DMSc, PA-C, DFAAPA, president and chair of the board at AAPA, in a statement issued by the sponsors of the bill.
Colorado Pushes for Collaborative Agreements
In Colorado, SB 23-083 would remove the statutory requirement that PAs must be supervised by a physician and can only provide the same scope of care as that provided by their supervising physician. The bill was introduced on January 23, 2023.4
The bill modifies the relationship between a PA and a physician by removing the requirement that a physician assistant must be supervised by a physician or podiatrist. Instead, a PA must enter into a collaborative agreement with an employer, physician, or podiatrist. Details of the collaborative agreement are outlined here. The bill has additional oversight requirements for PAs with fewer than 3000 practice hours and requires PAs who have been practicing for less than 3 years to satisfy certain financial responsibility requirements from which such PAs are exempt under current law.
“A colleague of mine practices in a rural part of Southeast Colorado, which recently experienced a large turnover among all health care providers,” explained Dr Orozco in an earlier interview with Clinical Advisor. “She’s worked as a PA there for nearly 20 years providing preventative HIV treatment, hepatitis treatment, and long-acting contraceptives among other services. Her supervising physician left and the new physician who was hired does not specialize in infectious disease or gynecologic care. Because these areas are not in the physician’s scope of practice, the PA is now no longer allowed to perform these services. She has to send her patients — whom she has been caring for years — hours away to access care.”
The bill will make it easier for PAs to practice in rural and medically underserved communities, according to the Colorado Academy for PAs (CAPA). “The bill will give the PA-physician team flexibility to determine the terms of collaboration for new PAs and PAs changing practice areas, while ensuring that protections like a collaborative agreement and performance evaluations are in place,” the organization said.
Similar bills were introduced in 2021 and 2022 but were not enacted. “We’re making it explicitly clear this year that they cannot be majority owner in any practice, which means they cannot run their own practice without a physician,” said bill cosponsor Senator Faith Winter (D, Westminster) in an interview with Denver 7.
“Under this legislation, PAs would continue to only be authorized to own up to 49% of a medical practice,” CAPA explained.
NAPNAP Releases Position Statement on NP Prescriptive Privileges
Nurse practitioners must continue to advocate for provider inclusive language in legislation at the state and national levels, including language that includes diagnosis, treatment, and prescriptive authority within an NP’s scope of practice, the National Association of Pediatric Nurse Practitioners (NAPNAP) wrote in a recent position statement published in the Journal of Pediatric Health Care.5,6
“NAPNAP believes that all NPs must obtain a National Provider Identifier number, Drug Enforcement Agency number, and controlled substance license for transparency and accountability,” the association noted. “It is important for NPs to have the ability to e-prescribe and have their name on prescription pads to better serve their patients. With continued advocacy and effective collaboration, NPs working in states that prohibit full prescriptive authority will hopefully see positive statutory and regulatory changes so they can provide complete and comprehensive high-quality health care for their patients.”
Removing restrictions on NPs’ prescriptive authority creates the opportunity to promote greater continuity and efficiency of care, increases cost-effectiveness, and augments safety and accountability, NAPNAP said. Current restrictions inhibit transparency in patients’ health care and limit accessibility to NPs.
“Nurse practitioner educational programs prepare students for advanced clinical assessment, management, and independent clinical decision-making,” said NAPNAP President Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, FAAN. “With a curriculum that includes advanced pathophysiology, pharmacology, and management of pediatric illness or disease, nurse practitioners are rigorously prepared to promote patient care and quality outcomes, including prescribing medications.”5
- Congress introduces legislation to improve care for patients with diabetes. American Association of Nurse Practitioners. February 6, 2023. Accessed February 6, 2023. https://www.aanp.org/news-feed/congress-introduces-legislation-to-improve-care-for-patients-with-diabetes
- Butterfield K. AAPA’s Priority Federal Legislation Reintroduced into 118th Congress. February 7, 2023. Accessed February 7, 2023. https://www.aapa.org/news-central/2023/02/aapas-priority-federal-legislation-reintroduced-into-118th-congress/
- AANP Statement on Federal Legislation to Improve Health Care for Injured Federal Workers. January 31, 2023. Accessed February 6, 2023. https://www.aanp.org/news-feed/aanp-statement-on-federal-legislation-to-improve-health-care-for-injured-federal-workers
- Support SB 83 (Senators Winter and Simpson) Physician Assistant Collaboration Requirements. https://www.coloradopas.org/resources/Documents/SB23-083%20Fact%20Sheet.pdf
- NAPNAP Position Statement on Nurse Practitioners Prescriptive Privileges. News release. NAPNAP; January 26, 2023. https://www.napnap.org/napnap-position-statement-on-nurse-practitioners-prescriptive-privileges/
- NAPNAP Position Statement on Nurse Practitioner Prescriptive Privileges. J Ped Health Care. 2023;37(1);90-91. https://www.jpedhc.org/article/S0891-5245(22)00247-4/pdf