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Make APRNs a HIX Requirement

Alexandra Wilson Pecci, for HealthLeaders Media, July 30, 2013

The ANA wants health insurance plans to include a minimum number of advanced practice registered nurses in their provider networks in order to qualify for health insurance exchange certification.

The ANA is calling on the federal government to put its money where its mouth is when it comes to the importance of advanced practice registered nurses.

In comments submitted to CMS about its proposed rule on state health insurance exchanges, the ANA said that in order to qualify for participation, health insurers should have to include a certain number of APRNs in their networks of healthcare providers. Doing so would not only be meaningful for patients, but would also mark a significant step forward in the APRNs' fight to practice to the full extent of their licensure.  

The ANA has proposed that each health insurance plan in a particular state include at least a minimum number of APRNs in its provider network in order to qualify for the exchange. The proposal is one that makes sense in terms of streamlining the requirement process. The ANA points out that the current proposed rule would allow a Qualified Health Plan (QHP) to be decertified if it "substantially fails to meet the requirements under §156.230 related to network adequacy standards or, §156.235 related to inclusion of essential community providers."  

But this approach is backwards and time-consuming. The ANA argues that instead of decertifying plans that don't meet requirements, plans should be required to meet specific standards upfront. Doing it the other way around would be like accepting every student into a university and later un-accepting ones that didn't have a high enough GPA.  

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