Nurse Practitioner Issues Overview
by Sarah Baessler, BS, BA, Director of Health Policy and Government Relations
The highlight of the session for Oregon’s nurse practitioners was passage of House Bill 2902. (link to: https://olis.leg.state.or.us/liz/2013R1/Measures/Text/HB2902/Enrolled). While this is a historic achievement, there is still work to be done to fully implement this law. This bill was very contentious, and had 21 different amendments drafted. The amendments that were eventually added to the bill require the governor to appoint a task force on mental health and primary care reimbursement that will further study the issue and make policy recommendations to the legislature in 2014 and 2015. This group will start meeting this fall and ONA and the Nurse Practitioners of Oregon (NPO) will be a part of this task force. The full reimbursement provision begins in January 2014 and ends in January 2018. At that point, the legislature will need to act to extend the date or implement a recommendation from the task force that addresses the problem.
While that was certainly the highlight, there were a number of other significant achievements for Oregon’s NPs this session.
Oregon’s Workers’ Compensation system has lagged behind the rest of the state in embracing NPs as the competent, independent providers they are. In Workers’ Comp, NPs have a variety of arbitrary restrictions on their practice which not only frustrate the provider, but impede access to and continuity of care for the patient. This session, the legislature unanimously passed Senate Bill 533, which extends the time NPs can treat Workers’ Compensation patients from 90 to 180 days, and extends the time NPs can authorize time loss from 60 to 180 days. A similar bill died last session. SB 533’s changes will dramatically improve the continuity of care for Oregon’s injured workers who choose to be treated by an NP, and will allow NPs to continue to care for their patients who are dealing with on–the-job injuries.
Working together with ZoomCare, ONA and NPO helped pass Senate Bill 8, which removed outdated restrictions on NP dispensing. Previously, NPs applying for dispensing privileges had to demonstrate that pharmacy services were not readily available in their area, and prove that having dispensing privileges would remedy that problem. The passage of SB 8 allows all advanced practice nurses to apply for dispensing privileges to help their patients fill prescriptions in a timely manner and without unnecessary hassle.
The legislature also took action and passed or extended a number of incentives for primary care and rural providers, including NPs.
The legislature passed Senate Bill 440 which creates a loan repayment program for primary care providers who practice in qualified rural or underserved areas. This program was a condition of Oregon’s waiver with the Centers for Medicare and Medicaid Services (CMS) to create Coordinated Care Organizations (CCOs).
The legislature funded the Primary Care Loan Forgiveness Program, which was first created in 2011. Participants in this program must be enrolled in a school that has a qualified rural track and they will be eligible for student loans to be forgiven in exchange for qualified rural practice.
Rural Provider Tax Credit:
In the closing hours of the session, the legislature renewed the $5,000 annual tax credit for rural providers that is a recruitment and retention tool for rural practice. Changes to the program will require qualified providers to treat a certain percentage of Medicaid and Medicare patients, and to practice at least half-time in a qualified area.
Scholars for a Healthy Oregon:
The legislature passed Senate Bill 2, which creates a new full ride scholarship program at OHSU for a limited number of MD, NP, PA, and DMD students, in exchange for a commitment to practice in rural or underserved areas of Oregon for a set amount of time. This program will prioritize funding for students coming from rural areas, first-generation college students, and students from underrepresented backgrounds. Data has shown that students from rural areas are most likely to return to and continue to practice in rural areas. This program was funded at $2.5 million and the first scholarships will be awarded to students entering health professional programs at OHSU in 2014.