House rejects attempts to expand nurse practitioners’ authority
Attempts to expand Arkansas nurse practitioners’ authority to prescribe drugs and ability to receive Medicaid reimbursement failed to clear a House committee on Thursday.
But Arkansas nurses scored a victory when the House Public Health, Welfare and Labor committee rejected a bill allowing anesthesiologist assistants — a potential competitor to nurse anesthetists — to practice in the state.
Physicians and their advocates spoke against the legislation allowing advanced-practice nurses to prescribe drugs without oversight from a physician, to prescribe a greater variety of narcotics and to be designated by the state’s Medicaid program as primary care providers.
Advocates for the bills argued they would improve access to medical care by allowing nurse practitioners to more easily operate family practice clinics in rural parts of the state.
But David Wroten, executive vice president of the Arkansas Medical Society, said nurses, like doctors, are more likely to operate in urban than rural areas.
He said nurse practitioners “have a major, important role to play in our health care system” but should collaborate with physicians.
“That’s the way that you ensure that patients get the absolute best care,” Wroten said.
Advanced-practice registered nurses, including nurse practitioners, are registered nurses who have completed a master’s degree in nursing and have obtained certification from a national organization.
House Bill 1228, sponsored by Rep. Kim Hammer, R-Benton, would have removed a restriction preventing such nurses from prescribing drugs such as Oxy-Contin and Adderall classified as Schedule II controlled substances.
Hydrocodone, which was once listed as a Schedule III drug, is the only Schedule II drug Arkansas allows nurse practitioners to prescribe.
House Bill 1181, sponsored by Rep. Dan Sullivan, R- Jonesboro, would have removed the restriction on Schedule II drugs while also removing a requirement for advanced-practice nurses who prescribe drugs of any kind to enter “collaborative practice agreements” with physicians.
Sullivan said 21 states don’t limit nurse practitioners’ prescribing authority, and other states are considering removing limits.
“There is no reason for Arkansas not to move forward with this,” Sullivan said.
The committee also rejected Sullivan’s House Bill 1182, which allows advanced-practice nurses to be designated as primary care providers by the state Medicaid program.
The bill would have also increased the Medicaid reimbursement rate for nurse practitioners from 80 percent to 100 percent of the rate paid to physicians.
House Bills 1228 and 1182 each fell one vote short of the 11 needed from the 20-member committee, while HB1181 received nine favorable votes.
In a voice vote, the committee also rejected HB1205, by Rep. Stephen Magie, D- Conway, to allow anesthesiologist assistants to administer anesthesia under the supervision of an anesthesiologist.
Magie said 17 states license such workers, who must earn a bachelor’s degree and complete a two-year training program.
Arkansas licenses nurse anesthetists, who must also work under the supervision of a physician, but not necessarily an anesthesiologist.
Those nurses must complete a master’s degree in a nurse anesthesia program and obtain certification from a national organization.
Nurse anesthetist Anne Cousins of Pine Bluff told committee members the care provided by anesthesiologist assistants is “grossly inferior.”
“When seconds count, Arkansans deserve and expect an anesthesia provider who can think and perform independently,” Cousins said.