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Midsummer Update
The NPAM Board of Directors hope you are enjoying your summer, and possibly a hard earned vacation. While we are enjoying (or not) these hot, steamy days of summer following out whirlwind state legislative session, the Maryland health care scene is really heating up. Several major projects are under way, and NPAM is staying on top of them.
Patient Centered Medical Home
Patient centered medical home is not a new idea, in fact, many nurse practitioners practice this way in primary care. A pilot project is commencing in Maryland to provide continuous, comprehensive, coordinated care through a partnership between patients and their healthcare team. The hope is that money will be saved. Participating practices will provide patient-centered care through:
- Evidence-based medicine
- Expanded access and communication
- Wellness and prevention
- Care coordination and integration
- Culturally and linguistically sensitive care.
Nurse practitioners were included in the bill which established this pilot program in Maryland. So NPs can act as medical home leaders, or participate within their group practices with other physicians. The pilot project is enrolling 200 providers in 50 practices to reach 200,000 patients. Insurance carriers such as Aetna, CareFirst, CIGNA, Coventry, United Health Care, and Medicaid will be providing enhanced payments (per member per month) to practice in this way and gather data. Medicare has designed its own pilot project.
Eligibility requirements to participate include providing primary care in Maryland, accepting at least 2 private insurance carriers, being able to enroll at least 50% of patients (participation is voluntary), providing 24/7 phone response, use an electronic health record, use e-prescribing, and reporting on relevant clinical measures. Practices must submit an expression of interest by August 31st . For more information, see http://mhcc.maryland.gov/pcmh.
Health Care Reform in Maryland
While federal health care reform will provide a first step towards assuring access to health care for many uninsured or underinsured individuals, each state must work to ensure that the legislation is implemented effectively and efficiently and educate the public about changes in getting coverage. Approximately 800,000 Maryland residents who do not have insurance could be added to the health care rolls, and 700.000 seniors could get free preventive services. The Maryland insurance commissioner, Elizabeth Sammis, is working hard to make sure that Maryland complies with the changes as they must occur. The lieutenant governor, Anthony Brown, and Health Secretary, John Colmers are heading a task force to ensure that Maryland will make an easy transition. You can read a draft of the interim report Comprehensive Evaluation of the Federal Health Reform and Foundation for Implementation in Maryland at www.healthreform.maryland.gov, sign up for email updates, and submit comments. Here is a brief rundown of federal health care reform:
The first wave of changes will occur in 2010 and 2011 to include:
- All new insurance plans will have to provide prevention and wellness services with no deductibles and cost sharing.
- Annual and lifetime limits will be prohibited.
- A state risk pool will be set up for those with pre-existing conditions who are unable to get insurance.
- Insurance companies will have to justify premium increases and must spend 80 to 85 cents for every premium dollar.
- Seniors who fall into the prescription drug coverage gap (donut hole) will be eligible for reimbursement (starting at $250 a year).
By 2014:
Poor families making up to 133% of the federal poverty level (a family of four making $29,000 or less) will be eligible for Medicaid.
A new state health insurance exchange will provide consumers with more choices.
Families making up to 400% of the federal poverty level will be eligible for subsidies.
Pre-existing condition exclusions and gender rating will be barred.
Dependents up to age 26 can stay on parents plan.
Plans must cover a minimal set of benefits (mental health care, prescriptions, prevention, maternity). Small business tax credits will be given to provide insurance.
After 2014:
Small business tax credits will be given to provide insurance.
Phase out donut hole by 2018.
NP Reimbursement Issues
NPAM is part of the Multistate Reimbursement Alliance, with the NP groups from Ohio, Illinois, Pennsylvania, Virginia, West Virginia, and several other states. We have been learning about the insurance industry and plan to make this a priority in the coming year. Thanks to Susan Delean Botkin, NPAM president-elect, for setting up a meeting with Carefirst. We learned that some problems, such as patients seeing NPs in primary care but having to pay a specialist co-pay, are just mistakes; however the problem of NPs getting reimbursed at a percentage of physician reimbursement is not going to be easy to change. We will keep working on these issues but need to hear from you if you are having specific problems or would like to offer your help. If there is enough interest, we will start a Forum Discussion on this topic on our website.
Phasing out the Collaborative Agreement
As you know, we succeeded in passing legislation that will end the collaborative agreement as we know it as of October 1.
If you plan to start a new job before October 1, you will still need to submit a written agreement signed by a physician and go through the joint committee approval process according to the board of nursing website.
If you have a written agreement on file and do not change jobs, you will not need to do anything until you renew your license again. (License renewal is going to a 2 year cycle). When you renew your license after October 1, you will need to supply the new attestation to the board of nursing.
If you are planning to start a new job after October 1, you will need to simply submit an attestation (statement) that you “have a plan to collaborate and consult with a physician” to the board of nursing. You will need to name a physician and provide his or her license number. You will not have to wait for approval before working. The board of nursing will keep the attestation on file and check out the physician through the license number if necessary. This process should reflect reality, so you should name a physician or physicians who you realistically can consult with if needed. If you work in a group practice, It will likely be a physician in your group. If you are in an NP-only practice, it might be several specialists who you frequently call or refer to. It does not have to be someone in your geographic location or primary care specialty. You do not need to have any arrangements in writing or a physician signature. You just need to have a reasonable plan thought through ahead of time, as to how you will refer, consult when necessary. If you are volunteering at a homeless shelter, you may have a physician in the community who would take your referral, or you may just be using the emergency room, therefore you would submit an ER physician(s) name.
New regulations have been drafted reflecting all the legislative changes, and are awaiting final approval through DHMH. Information along with a new NP certification application and attestation form will be posted on the BON website closer to October 1. www.mdbon.org
Stay in Tune!
Members of NPAM receive weekly email updates on jobs, dinner meetings, policy changes, and other health care information (see below for standard announcements). There will be discounted registration to the 2 day continuing education event on November 8 and 9. This conference is co-sponsored with the University of Maryland Medical Center and contains three tracks—Acute care, pediatrics, and primary care—in addition to sessions on policy and practice considerations.
If you are an NPAM member, please consider joining a committee. We have active Membership, Public Relations, Reimbursement, Legislative, and Continuing Education committees that would love your input.
Action Alert!
We have 1 week to work on getting 25 more sponsors for H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010 sponsored by Rep. Allyson Schwartz/ Sen Susan B. Collins.
The bill has 75 sponsors but WE NEED 25 MORE CO-SPONSORS ASAP!!
We have to show Rep. Schwartz that we care about this bill!
I DO NOT SEE ANY MARYLAND CONGRESSIONAL REPRESENTATIVES OR SENATORS included in the 75 sponsors!!
DO WE CARE ABOUT THIS BILL???
Even if you have done so already, please, please call/write/email YOUR representative ASAP or on July 22 . Don't let this important bill die on the vine!!!
What is the Home Health Care Planning Improvement Act of 2010?
Currently, nurse practitioners are not able to order home health care services despite the fact that physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives are authorized Medicare providers. H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010, as introduced by Representative Allyson Schwartz in the House of Representatives and Senator Susan Collins in the Senate, recognizes and authorizes nurse practitioners as eligible health care professionals who can order home health services under Medicare, ensuring that Medicare patients requiring these services receive optimal continuity of care.
Participate in Virtual Capitol Hill Day
On Thursday, July 22, 2010, nursing organizations across the broad range of nursing specialties will join together in support of H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010. On that day, thousands of nurse practitioners from across the country will participate in a "Virtual Capitol Hill Day," by contacting their Members of Congress and asking them to cosponsor this important bill.
Dear Representative / Senator _________:
As a practicing nurse practitioner, I am writing/calling to request that, before you/Congressman _____ return(s) home for the August recess, you/he/she cosponsor H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010, as introduced by Representative Allyson Schwartz in the House of Representatives / Senator Susan Collins in the Senate.
Medicare policy is compromising my ability to provide adequate care for my patients because, under Medicare, I am not authorized to order home health services even though I can provide all other aspects of care for that patient leading up to and after the home health services order has been placed. This requirement necessitates inclusion of another provider who may indeed not be aware of the patient or their condition. In many cases, this means that my patient must come in for a second office visit, at considerable cost to both the patient and to Medicare.
[insert personal story here: (i.e. I live in a rural area and don't have access to a physician to sign off on my order. / I have my own practice and don't have a relationship with a physician. / I have a patient who was not able to get the services she needed because of this law.)]
Please help me to be able to serve my patients and help them to access the Medicare services they need by cosponsoring this important legislation.
Thank you,
If you do not know your representative, you can visit www.MDElect.net. All pertinent contact information is listed below.
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