COVID-19 is presenting NPs, and the nation, with an unprecedented health care challenge while placing considerable demands and stressors on NPs, both professionally and personally. VCNP is working to share resources and support our members during this time. We hope you will refer to our dedicated web page to find valuable online resources and updates as they impact your practice during this time.

Please let us know how we can continue supporting you by contacting us at vcnp@vcnp.net.

For updates, check back regularly for an up-to-date resource list.

Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC on practicingclinicians.com |November 29, 2019

To access original post visit: https://practicingclinicians.com/the-exchange/cms-final-rule-np-and-pa-preceptor-documentation-updates–success-

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule final rule, which will positively affect the NP and PA preceptor documentation burden. For those of you providing clinical teaching rotations for advanced practice registered nurse (APRN) and/or PA students, you may be aware that in March 2018 CMS reduced the documentation burden for physician preceptors. This change authorized teaching physicians to verify and sign student documentation components of evaluation and management (E/M) services rather than have to re-document the work themselves. Unfortunately, this created unintended consequences for APRN and PA preceptors and the students they supervise.

In an era where productivity in patient care has been a major driver of reimbursement, the 2018 rule caused many practices to abruptly discontinue precepting APRN and PA students—creating a crisis in NP and PA education. As a result, the American Association of Nurse Practitioners (AANP), the American Academy of PAs (AAPA), nursing, and physician stakeholders worked diligently to mobilize their constituencies and to request changes to the 2020 final rule. Through lobbying efforts and regulatory comments, CMS revised the language, thereby creating documentation requirement parity among all clinician preceptors.

Effective January 1, 2020, APRN and PA preceptors may review and verify medical record documentation entered by other licensed health care providers and members of the health care team, as well as student APRNs and PAs. This update will ultimately improve patient access to high-quality health care.

There are additional changes affecting APRN and PA providers including, but not limited to, updates to Medicare telehealth service reimbursement, E/M services documentation and reimbursement, physician supervision requirements for PAs, and payment for transitional care management services. Click the links in the references below for additional information.

References

• Centers for Medicare and Medicaid Services. Finalized policy, payment, and quality provisions changes to the medicare physician fee schedule for calendar year 2020. www.cms.gov/newsroom/fact-sheets/finalized-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar Accessed November 26, 2019.
• Centers for Medicare and Medicaid Services. Final rule and interim final rule: 42 CFR parts 403, 409, 410, 411, 414, 415, 416, 418, 424, 425, 489, and 498. s3.amazonaws.com/public-inspection.federalregister.gov/2019-24086.pdf Accessed November 26, 2019.

The positive progress continues!
 
We are pleased to inform you that our reimbursement bills – House Bill 1640 and Senate Bill 1178 – have once again been warmly received by committees in both chambers of the Virginia Legislature!
 
In light of the February 5th “crossover,” all bills passed on the House side during the first half of the General Assembly session are now being considered in the Senate, and vice versa.
 
On Monday, February 11, 2019, HB 1640 was reported from the Senate Commerce & Labor Committee with a vote of 13-0, while SB 1178 passed out of the House Commerce & Labor Committee with another unanimously positive vote of 22-0 on Tuesday, February 12th.
 
Since the two bills were reported without opposition, we anticipate that they will be added to the Uncontested Calendar in the House and the Senate. Ultimately, should this legislation become law, it will go into effect on October 1, 2019.

On January 31st, our reimbursement bills – HB 1640 and SB 1178 – were heard in the Virginia House and Senate Commerce & Labor Committees.
 
SB 1178, sponsored by Sen. Glen Sturtevant, faced no opposition and was passed unanimously by the Senate Commerce & Labor Committee by a vote of 15-0. Similarly, during the House Commerce & Labor Committee meeting this afternoon, the companion bill HB 1640, sponsored by Del. Margaret Ransone, was reported by the Committee 19-0.
 
In both committees, the bill was amended so that the legislation does NOT require a study by the Health Insurance Reform Commission (HIRC) – thereby moving our legislation forward to the House and Senate floors!
 
We are delighted by these positive developments. Since the bills were reported without opposition, we anticipate that they will be added to the Uncontested Calendar in both the House and the Senate. Ultimately, should this legislation become law, it will go into effect on October 1, 2019.

As of January 7th, HB 793 regulations are in effect! Nurse practitioners with five or more years (that is, 9,000 hours or more) of clinical experience are now able to submit their applications for autonomous practice. You may find the attestation form and instructions for applying on the Virginia Board of Nursing website.
 
We will soon be debuting a special FAQ, as well as a “Roadmap to Autonomous Practice” that will outline the application process in an easy-to-read format. Further, don’t forget to register for one of our informative Town Hall webinars! Though the January 10th session is now full, space is still available on January 15 and January 30.

Governor Ralph Northam has officially signed the emergency regulations for HB 793! The regulations will go into effect on Monday, January 7, 2019. Per the Board of Nursing’s update, “[t]he application process will be implemented on or before 1/9/19,” at which point NPs throughout the Commonwealth will be able to apply for autonomous practice licensure.
 
The regulations will be published in the Virginia Register on January 21, 2019, after which a public comment forum will open, remaining open through February 20, 2019. The Board of Nursing has also noted that their staff will provide a report about autonomous practice application process at the February 13th Joint Boards of Nursing and Medicine meeting, which will be open to the public.
 
Though we have not yet seen the attestation form, Jay Douglas, Executive Director of the Board of Nursing, has indicated that the form “will mirror the law and regulations” and will be posted on the Virginia Board of Nursing website in the near future.
 
Questions about the legislation and what autonomous practice licensure means for you? Join us for one of three town hall webinars in January! Click on the date you are interested in for more information and to register:

• Thursday, January 10
• Tuesday, January 15
• Wednesday, January 30

On Thursday, October 18, the Board of Medicine approved the proposed draft regulations that would replace emergency regulations for the prescribing of opioids and buprenorphine by NPs.
 
These regulations are favorable, as they permit SAMHSA-waivered NPs to prescribe buprenorphine outside of a practice agreement, so long as these NPs are autonomous – that is, having completed five years of full-time experience and the attestation process, per the requirements of HB 793.
 
On October 10, the Joint Boards of Medicine and Nursing had unanimously voted to approve these regulations, in spite of organized medicine’s opposition. The draft regulations will now be reviewed and voted on by the Board of Nursing at its November 13th meeting. To view a copy of the latest draft regulations on the prescribing of opioids and buprenorphine, please click here.
 
The Board of Medicine also voted to eliminate the separate license for NP prescriptive authority. The updated regulations repeal 18VAC90-40-50 (“Renewal of prescriptive authority”), as well as 18VAC90-40-60 (“Reinstatement of prescriptive authority”). There will be a one-time, $35 fee for the initial issuance of prescriptive authority. For additional information, please see the relevant Notice of Intended Regulatory Action (NOIRA).

Amended HB 793 Draft Regulations Passed Unanimously

 
At its September 18th meeting, the Board of Nursing voted 12-0 to adopt the HB 793 draft emergency regulations, as amended by the Board of Medicine at its August 3rd meeting. The Board of Nursing did not make any additional changes to the regulations. To view a copy of the updated emergency regulations, as passed, please click here.
 
Since the Board of Medicine and the Board of Nursing have now passed identical draft emergency regulations for HB 793, the regulations will now be reviewed by several state agencies before reaching the Governor’s desk. As soon as the Governor provides his signature, the legislation will go into effect! Per the law, the emergency regulations must be in place by the end of this year at the latest.
 
We are still waiting to learn more about the structure of the attestation form. Board of Nursing Executive Director Jay Douglas has indicated that the Board will keep licensees apprised of the latest developments, and we will continue to send updates as we discover more.
 
Looking forward: The emergency regulations will only remain in effect for 18 months, after which permanent regulations will be promulgated. This will be preceded by a Notice of Intended Regulatory Action (NOIRA) and additional opportunities for public comment.
 

Additional Developments at the Meeting

• The Board voted unanimously to adopt proposed regulations that will eliminate the separate license for NP prescriptive authority. The updated regulations repeal 18VAC90-40-50 (“Renewal of prescriptive authority”), as well as 18VAC90-40-60 (“Reinstatement of prescriptive authority”). There will be a one-time, $35 fee for the initial issuance of prescriptive authority. For additional information, please see the relevant Notice of Intended Regulatory Action (NOIRA).

 

• The Board of Nursing voted unanimously to extend the emergency regulations for the prescribing of opioids by NPs for another six months, beyond the expiration of November 7, 2018. Due to timing concerns, the Boards of Nursing and Medicine would have been unable to ensure the final regulations would take effect before the original expiration date. Please click here for more details about the motion.

 

• The Department of Health Professions (DHP) is in the process of developing a paperless initiative, under which any licenses issued/renewed by the Board of Nursing will be available electronically. The license lookup system will be updated in real time, reflecting any changes as soon as they happen; hard copies of a license may be available only “by request,” for a fee. The paperless initiative will go into effect in the near future, though the exact date is uncertain – all licensees will be notified about these developments via email.

Last Friday, August 3, the Virginia Board of Medicine convened and discussed the draft regulations for the Nurse Practitioner autonomous practice legislation, HB 793. The Committee of the Joint Boards and the Board of Nursing had both passed draft regulations that defined “five years of full-time experience” as 8,000 hours (an average of 1,600 hours/year) at their respective meetings. However, the Board of Medicine decided to amend the draft regulations, changing the definition of “five years of full-time experience” to 9,000 hours. To view the draft of the minutes from the meeting, please click here.
 
The amended regulations will now return to the Board of Nursing for their approval at their September 18th meeting. We will continue to keep VCNP membership apprised of any developments.
 
Thank you to everyone who came to the meeting in support of NPs!