CNAP Interim Update #4
Coalition for Nurses in Advanced Practice
Lynda Woolbert, MSN, RN, PNP, FAANP
December 15, 2011
In this Issue:
Final Days for Texas APRN Practice Survey
Register Now for Legislative Day: Group Leaders Needed
CNAP’s New Executive Director - Jennifer Fontana, CAE
Medicaid Provider Update: Attention CNMs & THS providers
Regulatory Update
Legislative Districts for 2012 Elections Not Final
20 Years with CNAP and What’s Next
APRN Practice Survey
In order to represent APRNs at the Texas Capitol, CNAP needs to know where APRNs practice and what populations they serve. The only way to get that information is through regular surveys.
Our new APRN survey is brief and will just take 3 to 5 minutes of your time. We announced the survey with a bright yellow insert in CNAP’s fund raising letter sent in early November, and announced the survey would close on December 1. However, we extended the active dates for the survey through the remainder of the year. If you have not already completed the survey, please Click Here. The survey will close at midnight on December 31.
Legislative Day Registration Open: Group Leaders Needed
Registration is now open for APRN Legislative Day 2012 in Austin on Monday February 13, 2012. CNAP is planning another great day beginning at the AT&T conference center. State Representative Lois Kolkhorst, Chair of the House Public Health Committee, will be the keynote speaker. The rest of the content for the morning seminar will give attendees the knowledge they need to visit legislators and staff at the Capitol in the afternoon.Click Here to view the schedule and register.
Registration is limited to 450, and registration will close when we reach that number. The registration fee is $50. Late registration, on or after February 1, is $75. The special CNAP room rate of $139.00/ night is a great price for the AT&T conference center. The last date to receive that rate is January 23, 2012. However, the block of rooms we reserved is filling quickly. To be assured the special rate, we recommend you reserve your room ASAP. Call 877-744-8822 and reference CNAPLD0212 or register for a hotel room online.
We need lots of APRNs who are willing to serve as group leaders for the visits to the Capitol. As usual, we will have an optional orientation for group leaders on Sunday evening. Lisa Campbell, DNP-PHN, GNP, graciously volunteered to recruit and organize group leaders for 2012. If you are willing to lead a small group on Legislative Day and have not already volunteered, please email Lisa at lisacampbelldnp@gmail.com. Please include your phone number and home address.
Changes at CNAP Continue
The REAL New CNAP Executive Director is Jennifer Fontana
Occasional false starts are inevitable and CNAP just experienced one with our new Executive Director. Fortunately, CNAP had several outstanding applicants and Jennifer Fontana was a person who clearly landed at the top of the search committee’s list. This time the contract is definitely signed and CNAP is delighted to welcome Jennifer Fontana as CNAP’s real Executive Director.
Jennifer has worked in association management since graduating from UT. She received a Bachelor of Science degree in Communication from the University of Texas at Austin, and she is a Certified Association Executive. Jennifer is the perfect person to lead CNAP through the changes and challenges ahead as I retire from CNAP.
Public Policy Director Search
CNAP will interview candidates to fill the position of Public Policy Director in January. APRNs with experience in advocacy and public policy are encouraged to apply now. For more information contact the chair of CNAP’s search committee, Sandi Peters, CRNA.
Medicaid Provider Update
New Requirement for CNM Medicaid Providers
CNMs enrolled in Texas Medicaid or CHIP are required to report the physician with whom they have an agreement for consultation and referral by March 18, 2012. Currently, the Texas Medicaid & Healthcare Partnership (TMHP) is not planning to withhold payments to CNMs who have not reported that information, but TMHP could do so at a later date. In most cases, CNMs will report the physician who delegates prescriptive authority.
CNMs who are current Medicaid providers must complete and submit a Provider Information Change (PIC) from. Under “Type of Change” check “Other” and then in the “Comments” field report the physician’s name, Texas Medical License # and the effective date for the consultation and referral agreement. The CNM must also enter her TPI or NPI number, the primary taxonomy code, physical address, benefit code (if applicable) and then sign and date the form. (A benefit code is a data element that TMHP uses to identify certain state programs. Examples are benefit code EP1 for Texas Health Steps Medical providers and CCP for Comprehensive Care Program providers.)
For more information, see the TMHP Banner Message dated November 10, 2011, and the correction published as banner message #8 and #16 in the messages dated 12/5/11 and 12/9/11).
APRNs May Not Direct and Bill for THS Exams Performed by RNs
Some APRNs who are Texas Health Steps (THS) providers would like to be able to hire specially trained RNs to perform THS exams. Unfortunately, this is only possible if a physician is on site or immediately available to offer direction and assistance and the service can be billed under the physician’s provider number.
Earlier this year, CNAP requested that HHSC review and revise its policy that requires a physician to delegate performance of the THS exam to RNs. HHSC declined to do so and recently published a banner message affirming HHSC’s current policy.
For 20 years NPs, CNSs and CNMs have been permitted to enroll as independent Texas Health Steps (previously EPSDT) Medical providers. Nothing in this announcement changes that fact. However, CNAP still believes HHSC should revise its policy to allow APRNs to direct specially trained RNs who provide TSH exams and allow the APRN to bill for those services.
Changes if the THS Medical Checkup Schedule Effective 12/1/11
All providers must comply with the THS periodicity schedule. Changes to that schedule are listed in theJanuary/February 2012 Texas Medicaid Bulletin (No. 239), pages 67 - 69. The article also informs providers they may be reimbursed for a new patient THS checkup and a new evaluation and management visit performed on the same date of service, as long as the client meets the requirements as a new patient.
Wound Debridement may be Billed by NPs and CNSs in Outpatient Settings
Effective for dates of service on or after January 1, 2012, NPs and CNSs are among the providers who may be directly reimbursed for wound care management procedure codes 97597 and 97598 performed in office and outpatients settings. However, only physician, dentists and podiatrists will be reimbursed for the same procedures in inpatient settings. For more information on this and other changes and explanations concerning the wound care management services benefit, see the notice posted on November 11, 2011.
HCPCS Changes Posted by December 31
The first day of each year brings changes to the Healthcare Common Procedure Coding System (HCPCS). Look for changes in benefits for the Texas Medicaid and the Children with Special Health Care Needs Programs published in the January 2012 HCPCS Special Bulletin, No. 4, on the TMHP Website by December 31, 2011.
Regulation Update
Safe Harbor and Whistleblower Protections Open for Comment
The BON proposed rule amendments to implement provisions in SB 192 passed by the Texas Legislature earlier this year. The amendments expand safe harbor and whistleblower protections for nurses by extending protections to persons who advise nurses of their rights and obligations to invoke safe harbor and request nursing peer review as permitted in BON Rule 217.20. The proposed amendments also expand the protections to include any type of retaliation that results from a nurse’s good faith request for peer review of an assignment the nurse believes is not in the best interest of the patient, or otherwise violates the Nursing Practice Act or Board rules. You can find the proposed rules in the November 18th issue of the Texas Register.
Pharmacy Board Adopts Accelerated Refill Rule
Consistent with H.B. 2069, the Texas State Board of Pharmacy (TSBP) proposed rules allowing pharmacists to dispense up to a 90-day supply of a “dangerous drug” if the prescription and refills totaled 90 days or greater. CNAP was concerned about the wording in the rules. The rules proposed on September 23rd refer only to physicians being permitted to prohibit dispensing a 90-day supply. Also, pharmacists are only required to notify physicians that a 90-day supply was dispensed. To read the amended rule, see 22 TAC §291.34(b)(9).
I discussed the problem with the TSBP’s Director of Professional Services, Allison Benz, R.Ph, M.S. She assured me that, despite the inconsistency in the language of the bill and the rules, pharmacists are expected to follow the directions of any licensed prescriber who specifies on the prescription that dispensing the initial quantity followed by refills is medically necessary. However, given the wording in the rule, it is only reasonable to assume that pharmacists may not notify APRNs when accelerating refills on a prescription signed by an APRN. If you encounter problems that affect patient care, please advise Ms. Benz. Her email address isAllison.Benz@tsbp.state.tx.us.
TMB Withdraws Office-Based Anesthesia Rules
While Texas Medical Board (TMB) Office-Based Anesthesia Rules only apply to anesthesia services provided by physicians, CNAP and the Texas Association of Nurse Anesthetists (TANA) always keep a close eye on those rules. Texas law requires that the TMB and BON office-based anesthesia rules are consistent with each other. In this case amendments proposed on September 16, mainly affected terminology so neither organization opposed the amendments. However, it is good that the TMB is not amending these rules without coordinating with the Board of Nursing as required by law.
Board of Pharmacy Proposes Electronic Prescriptions Rule for Schedule II Controlled Substances
While physicians in Texas are still prohibited from delegating prescriptive authority for Schedule II drugs, there is a more efficient way for APRNs’ patients who require these drugs to obtain them. The TSBP proposed rules on December 9th to implement provisions in SB 594 that allow electronic transmission of prescriptions for Schedule II drugs. SB 594 went into effect on 9/1/11 so delegating physicians who have e-prescribing applications that are certified to be compliant with DEA requirements can send prescriptions for Schedule II drugs directly to the patient’s pharmacy. This will save many patients a return to the office to pick up the signed triplicate prescription.
Click the link to read the TSBP proposed amendment, 22 TAC §291.34(b)(4)(C). For more information on federal regulations regarding electronic prescribing for controlled substance, see the Q&A for practitioners on the Office of Diversion Control website.
Legislative Districts for 2012 Elections In Dispute
If you are following the news on redistricting, you know the boundaries for the Texas Congressional, Senate, and House Districts are not final. On November 23rd, the federal District Court for the Western District of Texas ordered new redistricting plans (posted on the Texas Legislative Council Redistricting webpage). Now the U.S. Supreme Court granted a stay on basing the 2012 Texas Congressional Elections on the Court-Ordered Interim Plan. The U.S. Supreme Court will hear that case on January 9th. A Washington D.C. federal court will hear testimony on January 17 – 26, to determine if the Congressional, Senate and House redistricting plans drawn by the Texas Legislature comply with the Voting Rights Act. Final arguments in that D.C. trial are not scheduled until February 5th.
In the meantime, the federal court in San Antonio extended the filing deadline for all federal, state, county and local offices in Texas from December 15th to the 19th, and will allow candidates to amend their filing applications when the redistricting maps are finalized by the courts. The date for the Primary Election (originally slated for March 6, 2012) is still in question. For more information on the controversy, see statesman.com and theWashington Post blog by Aaron Blake.
None of this changes who Represents you now until the start of the 2013 Congressional and Texas Legislative Sessions. Your current legislators remain in office until that time. To find your current legislators, go tohttp://www.fyi.legis.state.tx.us/. If you wish to see what districts you would live in if the court-ordered interim maps are upheld, go to http://www.tlc.state.tx.us/redist/redist.html and click on each of the interactive maps. From each map, click on “Find” in the upper left corner, and then click “Address” from the pull down menu. Then enter your address and zip code.
Reflections on Twenty Years with CNAP
I never envisioned a career advocating for APRNs, but life took an unexpected turn when I attended my first CNAP meeting in November 1991. I was inspired by CNAP’s founding mothers, Elaine Brightwater, CNM, Carol Cody, WHNP, Zo DeMarchi, WHNP, and Ira Gunn, CRNA. Their commitment to their professions and creating a vehicle for APRN organizations working together at the Texas Capitol was visionary.
As providence would have it, I also met another inspiring woman at my first CNAP meeting. CNAP interviewed Kathy Hutto to lobby for APRNs that day. By December 1, 1991, Kathy signed her first contract with CNAP. We all embarked on a journey that began with educating each other about our practices and learning about the legislative and regulatory language that can remove barriers or create setbacks for each type of APRN. (Click the links for more on CNAP’s history and achievements.)
Kathy took a group of legislative rookies and taught us how to educate legislators and state agency staff and board members about APRNs. I will always remember the masterful way in which Kathy led CNAP’s first successful effort at the Texas Department of Human Services (at that time the Board that established policy for the Texas Medicaid program). By the end of 1992, the Texas Medicaid program changed its rules from limiting reimbursement to only those groups of APRNs required by federal law to reimbursing all types of APRNs. The Texas Medicaid program also increased the reimbursement rate from 65% for CNMs and 70% for CRNAs, FNPs and PNPs to 85% for all APRNs. From that time, to now, Kathy’s knowledge about, and devotion to, APRNs far exceeded what CNAP’s founding mothers expected. She has been the ultimate mentor for me and a guiding light for CNAP.
Dozens of statutes and state agency regulations include APRNs because CNAP has been there to protect and advocate for all APRNs. I continue to believe wholeheartedly in the basic founding principle of CNAP…. APRNs can reach their potential to improve health care in Texas if all APRN organizations cooperate and continually advocate together.
Changing statutes and rules to permit APRNs to assume their appropriate role in health care is frustratingly difficult in Texas, where the most powerful and politically active medical associations in the country reside. Change in our health care system is inevitable, but APRNs will only take their rightful place in that system if APRNs relentlessly work together in politically astute organizations like CNAP. But the ultimate fate of APRNs depends on each of you. CNAP can only continue to work for APRNs, if APRNs contribute money and time. If you do not already donate regularly to CNAP, please Donate Now.
What’s Next for Lynda?
While retirement from CNAP means more time in my life for family and travel, supporting the health care services APRNs provide is still my professional focus. I will continue as a resource for APRNs through my consulting firm, APRN Consulting. I will focus on helping APRNs and those who employ APRNs, comply with the laws and regulations that govern APRN practices. I am taking December off to complete my work at CNAP and celebrate the Holidays. I will launch APRN Consulting in 2012.
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