Health Policy Report July 2011

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July 19, 2011

Advanced Practice Nurses in Arkansas may be enrolled as providers of care for recipients of the Medicaid program. However, barriers prevent APNs from delivering the best care to the full extent of our educational and experiential preparation. First, many of the reimbursement codes for services, procedures, and laboratory diagnostics are not paid to APNs. Second, when APNs are reimbursed for care, they received a reduced amount based solely because the fact an APN was the provider (regardless of the quality). And although advanced practice nurses are recognized by the Center for Medicaid and Medicare Services (national) as providers of essential fee for service providers, Arkansas Medicaid has failed to enroll APNs as Primary Care Case Managers (PCCM, currently Primary Care Physicians). Conversations were initiated by Arkansas Nurses Association regarding these and other issues in the Fall 2010. Currently, our discussions are focused on the fact that projections for current and new enrollees far exceed available primary/specialty care providers. APNs are prepared to meet the responsibilities of a PCCM and are seeking eligibility and appropriate code reimbursement for the role. APNs and Mr. Gene Gessow, Director of the Division of Medical Services are committed to our negotiations and decisions that will best meet the needs of AR and Medicaid recipients.

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