Summary of a Nursing Policy Issue

Remove Barriers to Nurse Practitioners’ Ability to Practice

ACTION NEEDED: Enable NPs to practice to the full extent of their license

By amending current statutes or directing the Centers for Medicare and Medicaid Services to revise outdated rules and manuals, Congress should take action to remove obsolete limitations in federal laws and regulations that do not recognize nurse practitioners’ advanced education and clinical education to furnish the full range of services.

Background: The landmark Institute of Medicine 2011 report, The Future of Nursing: Leading Change, Advancing Health, includes recommendations for Congress and the Department of Health and Human Services to remove barriers limiting the ability of nurse practitioners and other advanced practice nurses to practice at the full extent of their license. These recommendations are supported by extensive evidence of the high quality, safety, and effectiveness of care provided by nurse practitioners. To ensure increased access to better care at lower cost in the U.S., federal health care programs must eliminate policies that prevent nurse practitioners from providing patient care at the fullest extent of their license.

In spite of their recognized scope of practice, Medicare does not permit nurse practitioners to conduct assessments to admit the patients to skilled nursing facilities even though it authorizes them to order skilled nursing care. Similarly, Medicare does not allow NPs to provide the initial certification for hospice care, although they are authorized to serve as attending providers and to recertify patients’ eligibility. The need to revise these and other Medicare policies are discussed in separate fact sheets. In addition, Congress should address the following barriers to NP practice:

• Provide coverage of nurse practitioners’ services as physician services are covered.

• Several outdated regulatory barriers to NP practice could be removed simply by correcting the interpretation of the term physician to be consistent with current Medicare payment policies that authorize Part B payment to NPs for services within their scope of practice. This simple change would enable nurse practitioners to certify Medicare beneficiaries for home health and hospice services and to conduct examinations to admit patients to skilled nursing facilities.

• Recognize NPs as primary care providers in all health care plans and programs.

• The Institute of Medicine’s definition of primary care should serve as a benchmark for any legislation to expand access to primary care services.

Request: Congress and CMS should update and revise statutes and regulations to ensure patient access to nurse practitioner services.

For additional information, please contact the AANP Federal Health Policy Office at (703) 740-2529 or