APRN Advocacy: states scope of practice, legislative policy, ACA

Psychcns · Mar 3, 2014

AN has been asked to start an APRN Advocacy forum. Please start posting topics about APRN advocacy in Advanced Practice Nursing section to gauge interest.
Some topics have already been mentioned here:
1. Individual states' rules on licensure and scope of practice.
2. Legislative policy
3. New health care act
4. Different formularies for insurance coverage.
5. Advanced Practice Continuing education requirements
Please add any advocacy topics you desire as this is YOUR forum.

My pet peeve is how in the late 90's the psych NP came along and pushed aside and took over the Psych CNS role. The Psych CNS didn't see it coming and we did not properly advocate for ourselves. My education was mostly what Psych NP is today and I can work in that role in many states. I think there is a lesson here-I am not sure what it is but we were blindsided at the time. I think there may be other weird historical things like this that we should take note of--I don't know what the topic would be.

Trauma Columnist · Mar 3, 2014

I'm a CNS also and I find out info from my states APRN organization.

i have found NACNS less than helpful

sadiemae1123 · Mar 3, 2014

I currently work in a state that opted out of the Medicaid expansion. I would like to here from those who practice in a state that opted in. Has there been a real reduction in the uninsured in your daily practice? Has it been effective is getting patients referrals, test, meds, etc? What has changed in your daily practice?

futureeastcoastNP · Mar 3, 2014

I currently work in a state that opted out of the Medicaid expansion. I would like to here from those who practice in a state that opted in. Has there been a real reduction in the uninsured in your daily practice? Has it been effective is getting patients referrals, test, meds, etc? What has changed in your daily practice?

I'm in an opt in state and have a few NPs and physicians in my family. All have said they have had a huge increase in patient visits since ACA took effect. Some of those are Medicaid, some are private insurance paid by subsidies. I think the ACA is going to really increase NP demand.

Trauma Columnist · Mar 3, 2014

I work in IL where my Medicaid-only patients now have commercial coverage. However, the fun thing (not!) is that very little is covered in their formulary. And...oh did I forget to mention? The formulary has changed monthly since Jan!

That said, all my patients are dialysis dependent with many co-morbidities. They are usually on 3-5 BP meds, 1-2 types of insulin if DM, binders for phosphate control, statins, GERD med. What a mess for these pts. I spend at least one hour out of my day trying to get prior auths done, obtaining meds on the $4 list at Walmart or some other pharmacy related issue.

futureeastcoastNP · Mar 3, 2014

I work in IL where my Medicaid-only patients now have commercial coverage. However, the fun thing (not!) is that very little is covered in their formulary. And...oh did I forget to mention? The formulary has changed monthly since Jan!
That said, all my patients are dialysis dependent with many co-morbidities. They are usually on 3-5 BP meds, 1-2 types of insulin if DM, binders for phosphate control, statins, GERD med. What a mess for these pts. I spend at least one hour out of my day trying to get prior auths done, obtaining meds on the $4 list at Walmart or some other pharmacy related issue.

It's odd - does the ACA commercial patients have different coverage than the private pay patients with the same company? I assume the subsidy from the ACA went to buying commercial coverage the same as if you had bought it privately.

Trauma Columnist · Mar 3, 2014

Yes, they have different coverage because the state of IL has contracted with these insurance companies to provide service so yes, it is quite different from private pay pts and it changes frequently so that a service or med might be covered this month but not next month....

sadiemae1123 · Mar 3, 2014

I've seen pts who were getting assistance from pharmaceutical companies for meds get dropped because they should have prescription coverage. Unfortunately they don't because they can't afford even the cheapest ACA plans. It's been a mess. The 4$ list seems to be getting smaller as well.

allnurses Guide · Mar 4, 2014

I work in primary care in a state that has had mandated health insurance for two years but close to the border of a state that has not had mandatory health insurance. I am seeing quite an influx of people that have now enrolled in ACA coverage; several of these people were frequent fliers in the ED last year that are now establishing primary care. That's the good side.

The bad side is the juggling of formularies; this is actually stressing the system as patients juggle medications they are stable on because their new insurance doesn't cover them.