White doctor coats, CRNA badges and scrubs overflowed from the House Public Health Committee room Thursday as CRNAs and advanced practitioner registered nurses fought for multiple scope of practice bills.
Three bills failed to pass through the committee prior to recess for the General Assembly: House Bills 1181, 1182 and 1228. The bills focused on APRNs’ ability to write prescriptions and their visibility as primary care physicians to Medicaid.
House Bill 1181 would have “created the transition to Prescriptive Authority Act; and to amend the prescriptive authority of advanced practice registered nurses.” Representative Dan Sullivan, bill sponsor, suggested that 21 other states already have in place legislation granting APRNs the capability to write prescriptions. Ten other states currently are considering the legislation and South Dakota has the bill on their Governor’s desk awaiting a signature.
House Bill 1182 would “remove the collaborative practice agreement as applicable to advanced practice registered nurse to be a primary care provider.”
House Bill 1228 would have “amended the prescriptive authority of an advanced practice nurse.”
Discussion for the bills suggested that citizens struggle to get into a primary care physician because they are full so Medicaid patients seek medical care from APRNs. Some APRNs who are in a collaborative agreement with a physician say that they already write prescriptions for their patients and the bill would lessen some paperwork.
Several doctors and representatives stated the bills “give out more prescription pads” that could contribute to the already opioid epidemic in the state. Supporters said that since APRNs can only write prescriptions as high up as Hydrocodone, a Type II narcotic, they could not be attributed to the opioid epidemic. Fear was that APRNs could write more Type II prescriptions for narcotics including Xanax, Adderall and Oxycodone.
APRNs argued that through their education and testing they learn how to administer Type II narcotics and in other states, but Arkansas only allows them to prescribe Hydrocodone.
Proponents further stated with HB 1182, APRNs would want more money. Currently, though some patients use an APRN as a PCP, Medicaid does not reimbursement APRNs at the PCP rate in those situations. It was also stated that the collaborative agreement assists in accountability and a clinic “needs a captain on ship.” It was also argued that APRNs would not expand the access to care to rural areas. Approximately 2,200, APRNs are registered with Medicaid.
Though roll call votes showed two bills had more “yes’s,” they did not received the required “yes’s” to pass.