Moreover, the ANA points out that the language in the proposed rule is vague, saying, "Given that the network adequacy language adopted in the Affordable Care Act is not exactly definitive, a great deal of time and money could be occupied with litigation in this regard. ANA proposes a simpler pre-qualifying standard that would obviate much of the need for time and money in litigation."
It says the minimum, pre-qualifying standard should be 10% of the number of APRNs who independently bill Medicare Part B in a particular state. Because the requirement would be a percentage, the number of APRNs would vary widely by state. For example, citing 2011 CMS data, the ANA says the minimums per plan would range from a low of 16 APRNs in Hawaii to a high of 654 in Florida.
The ANA says that the 10% minimum standard is one that "is easy to understand, easy to police, and easy to meet," as well as "quite modest." When framed in a larger context of the current crop of recommendations regarding APRNs, it seems incredibly modest.
The comments to CMS cite the familiar recommendations from the IOM Future of Nursing report and studies showing that APRNs provide safe and effective care. They also point to the National Governors Association Center for Best Practices' recommendation that states ease APRN practice restrictions.
Even HHS Secretary Kathleen Sebelius recently got in on the APRN act.
"In medically underserved communities, and particularly in rural areas, PAs are an incredible lifeline to patients who might not have regular access to other healthcare providers," she said at a general session at the American Academy of Physician Assistants' annual conference in May. "So it's vital to do everything we can to bolster the work done by PAs."
Let's see if CMS will follow that vital call to action.