Hi. This bill will have a huge positive impact on Advance Practice Nurses like Certified Nurse-Midwives and their ability to participate independently with insurance plans.
SB205 – Concerning Parity in Status Between Health Care Providers Under Health Benefit Plans
Your immediate assistance is needed in contacting members of the Senate Health and Human Services Committee to support the bill.
Please make sure all contacts and communications are courteous despite any feedback you may receive. Talking points are attached to help guide some of the dialogue…do not try to cover them all – focus on a few that are meaningful to you. Keep written and oral communications brief and to the point. Identify yourself as a nurse please. Your personal experiences in any denial by an insurance carrier would also be helpful. Please try to complete contacts by early next week.
Summary SB205 – will address many of the barriers for APNs applying for provider status on insurance plans under state authority. Carriers will need to notify the APN of its determination on an application within a 90 day time frame, to specify reasons for denials, and provide written explanations of objective and reasonable criteria used. There are prohibitions from requirements that exceed state statutory requirements for APNs. APNs will also now have a mechanism for redress if they identify concerns with unfair denials. The association has fielded complaints from APNs in the past year, largely from nurse practitioners, but also from certified nurse midwives. All APNs serve critical roles in providing care in Colorado. The barriers and concerns are:
Administrative Barriers for APNs Applying for Provider Status
-No response on final determination or on current status of an application
-Prolonged waiting for a response
-Lost applications, Requests for resubmissions
-Refusal to identify reasons for the denial (Required under 10-16-125) and to provide in writing
Requirements by carriers that exceed current statutory authority for APNs
-APNs are currently required to have articulated plans for prescriptive authority
-Collaborative agreements have been eliminated as a requirement in statute for APNs
-Carriers requiring physician supervision of APNs. APNs have independent practice authority
-Health plans requiring collaborative agreements and physician supervision are erecting barriers to APNs ability to practice to the full extent of their education, training, and scope of practice.
Restrictions that limit economic opportunity, access to APN providers, and are restrictive
-Unfair targeting of APNs that are trying to establish independent practice
-Nurse practitioners are the fastest growing category of primary care providers
-Rural vs. Urban restrictions – carriers refusing to credential an APN unless they are in a rural setting. This limits full utilization of providers in the context of provider shortages. APNs may elect to work in a variety of settings, and may wish to split their practice time in both rural and urban areas.
-There are underserved populations in urban areas. APNs are an additional source of providers.
-APNs invest time and money in their role preparation and education. They should have opportunity to practice in many settings. Economic opportunity for the profession should not be restricted.
Consumers should also have the right to choose an APN provider under their insurance plans.
-APNs frequently take on the role of primary care provider for clients that other providers reject.
-Currently an APN practicing in a designated rural setting would be paid for their services, but if they saw the same patient several miles away in an urban setting, would be denied reimbursement by the same carrier.
-Several carriers are denying an entire role of provider – “do not credential any NPs”
-APNs are not “substitutes” or “alternate” providers for other providers – they have inherent value.
-Restrictive insurance policies targeting APNs will limit provider capacity and access for consumers.
- APNs are not “midlevel providers” or “physician extenders”. If qualified as a primary care provider, the APN should be identified as such by the carriers.
Senator Betty Boyd (D) betty.boyd.senate@state.co.us 303 866 4857
Senator Linda Newell (D) linda.newell.senate@gmail.com 303 866 4846
Senator Ellen Roberts (R) ellen.roberts.senate@state.co.us 303 866 4884
Senator Irene Aguilar (D) irene.aguilar.senate@state.co.us 303 866 4852
Senator Morgan Carroll (D) morgan.carroll.senate@state.co.us 303 866 4879
Senator Joyce Foster (D) joyce.foster.senate@state.co.us 303 866 4875
Senator Kevin Lundberg (R) Kevin@kevinlundberg.com 303 866 4853
Senator Shawn Mitchell (R) shawnmitchell@aol.com 303 866 4876
Senator Jean White (R) jean.white.senate@state.co.us 303 866 5292