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Minutes for HB2256 - Committee on Health and Human Services
Short Title
Updating scope of practice requirements for advanced practice registered nurses without a supervising physician, imposing requirements therefor and updating certain licensure requirements.
Minutes Content for Wed, Feb 17, 2021
Scott Abbott, Revisor of Statutes, provided the committee with an overview of HB2256.
Amy Siple, President, Kansas Advanced Practical Nurses Association, provided testimony in support of HB2256. The bill as introduces would remove the requirement for a collaborative practice agreement (CPA)/written protocol with a physician. This requirement creates barriers to access of care and quality of care. It is difficult to find physicians willing to sign an agreement. 23 states never have had or have eliminated the need for an agreement. Hundreds of studies have shown there is no negative impact on patient care when an agreement does not exist. The bill also requires 4,000 hours of transition to practice which includes a collaborative practice agreement with a physician. HB2256 also requires APRNs to be nationally certified and carry malpractice insurance. APRN regulation remains with the Board of Nursing. HB2256 does not change the scope of practice for APRNs, nor does it change the requirement that APRNs collaborate with physicians. Ms. Siple provide a brochure regarding states with full practice authority (Attachment 1).
Sonia Slaba, APRN, provided personal testimony in support of HB2256. Ms. Slaba is part owner of a clinic that provides mental health services. Her supervising physician is 73 years old. If he would stop practicing, the clinic would have to close until another physician could be found to sign a CPA. If none was located, the clinic would have to close permanently and all of the patients would have to find services elsewhere. Ms. Slaba also has a CPA with a different physician that collaborates with her when she is servicing homeless individuals. That physician limits her on who she can treat. Information regarding increasing access to mental health in Kansas provided by APRNs was provided to the committee (Attachment 2).
Merilyn Douglass, APRN, noted that access to effective primary care is the goal of HB2256. The Veterans Administration removed the requirement for collaborative practice agreement contracts in 2016. Many of the 87,000 veterans enrolled in the VA system receive quality care as do patients in 23 states that permit APRNs to practice to the full scope of their training and education. This has allowed for an increased access to care, reduced wait times and reduced delays in care. The Bureau of Indian Affairs, the Military Clinics and Military hospitals recognize full practice authority for APRNs. There are more than 20 federal health clinics in Kansas that have APRNs providing patient care exclusively under their own license. Hundreds of studies confirm APRNs with Full Practice Authority are safe and effective healthcare providers. Excerpts from these studies were provided (Attachment 3).
Matthew Allen, a private citizen, provided a case study conducted in Garden City, Kansas in support of HB2256. The study provided evidence of the transformative impact that can be expected when unshackling Nurse Practitioners to do what they are trained to do. A copy of the case study was provided for the committee to review. Mr. Allen encouraged the committee to help Kansas minimize or potentially eliminate its health care deserts by removing barriers that limit supply of qualified individuals to provide quality health care (Attachment 4).
Cathy Gordon, APRN, provided personal experience testimony in support of HB2256. It was stated that it took a pandemic to recognize the value of nurse practitioners in Kansas. While working in emergency departments (ED) it was noted that the ED was used as the primary care services option for many Kansas. These people did not have a primary care physician, were uninsured and believed the hospital would cover the expense. Taking a leap of faith, Ms. Gordon started the first nurse practitioner based clinic in Johnson County in 2001. The clinic expanded throughout Wyandotte county. It has become a consistent restrictive burden to seek out a physician to sign a collaborative agreement in order to continue to render services. Removing the restriction would open nurse practitioners to serve many counties where there is no provider able to serve currently (Attachment 5).
NIcole Livanos, Associate Director of Legislative Affairs, National Council of State Boards of Nursing, provided supporting testimony of HB2256. It was noted that 23 states, including Nebraska and Colorado, have enacted similar legislation. Studies conducted have shown that APRNs are safe and quality care providers. APRNs are more likely to relocate to states that have eliminated restrictions. This bill will remove restrictions that will lead to increased access of care while maintaining quality and safety. A balloon amendment is available that has language requiring APRNs maintain national certification throughout their time licensed in the state. This is a national standard that promotes continued competency and safe practice. Ms. Livanos also provided testimony on a FTC ruling regarding regulation of APRNs being moved from the Board of Nursing to the Board of Healing Arts. A copy of the letter sent to Representative Dan Hawkins, Majority Leader of the House, was attached to Ms. Livanos' testimony (Attachment 6).
Ginger Breedlove,PhD, Founder and Principal Consultant, Grow Midwives, Inc., provided testimony in Support of HB2256. Ms. Breedlove began by stating that in the UK midwives provide 50% of the births and are the gatekeepers for all pregnant women. They outnumber physicians 3:1. It is the complete opposite in the United States where OB/GYNs outnumber midwives 3:1. Opinions vary. Some say it is a power play. Others say it is due to the difference in education. While the American College of Obstetricians and Gynecologists recognize the value and qualifications of midwives it does not recommend practicing without collaboration. Ms. Breedlove recommends that this legislation be passed or prove evidence why it should not (Attachment 7).
Jamie Harrington, Kansas Affiliate of the American College of Nurse Midwives (ACNM), provided testimony that the organization stands for improving and increasing access to quality care and coverage for for women throughout their lifespan. The United States has the highest maternal mortality rate on the industrial world and most are preventable. Studies show that the integration of midwives across the continuum of health care is integral to improving maternal needs. Removal of barriers is necessary to ensure high value and equitable access to healthcare. Over 70% of Kansas counties do not have maternal care. Lifting the restrictive collaborative agreement requirement would eliminate a hierarchy that is adverse to team based care and inhibits access to care for women in rural areas. Access to timely prenatal care and labor and delivery services continue to be a barrier for many woman in rural and urban areas. Kansas could benefit substantially from expanded access of care provided by highly skilled CNMs and APRNs (Attachment 8).
Judy Davis-Cole, RN, AARP Advocacy Volunteer, provided testimony in support of HB2256. The older population is a major consumer of health care. The number of Americans age 65 and older will reach 95 million by 2060. Life expectancy then will be 85.6 years. It is important that these individuals have access to quality health care. There is a shortage of primary care providers in the country and Kansas is no exception. An AARP Public Policy Institute survey ranks Kansas 40th in the nation for the number of physicians per 100,000 people.Some counties have no physicians and several only have one physician. These shortages are projected to worsen. It is noted that 87% of nurse practitioners specialize in primary care. Many studies have been conducted as to the need of collaborative practice agreements. What is know is APRN-delivered care is safe. This is documented by the lack of malpractice incidents. AARP respectfully asks that the committee offer all Kansans more easily accessible, high quality and safe health care by joining 22 other states that have removed this barrier (Attachment 9).
Elizabeth Patton, State Director, Americans for Prosperity, testified in Support of HB2256. It was noted that APRNs have played a key role helping hospitals and other facilities control the spread of Covid-19. Thanks to an emergency order, APRNs have been able to practice without a collaborative agreement during the pandemic. This has been extended into early 2021. Absent of this legislation, patients will lose access to essential services and support once the declaration ends. There are 800,000 Kansans in areas with limited medical access. The committee can ensure Kansans will receive high quality and affordable health care they need by moving this bill forward (Attachment 10).
Eric Stafford, Vice President of Government Affairs, Kansas Chamber, provided testimony in support of HB2256 by stating that this bill does not change the scope of practice for APRNs. The organization advocates for a strong regulatory climate that promotes a healthy business environment without limiting competition. As the state faces a shortage of health care providers. we must ensure that state laws and regulations do not served as a barrier to access (Attachment 11).
The conferees responded to questions from the committee.
The following provided written only testimony:
Sharon Foster, CNM (Attachment 12)
Dawna Huhman, APRN, Advanced Mobile Healthcare & Community Clinic (Attachment 13)
Kyanna Kuntz, APRN (Attachment 14)
Kristin Loyd, APRN (Attachment 15)
Dr. Uyen Dinh, APRN, PMHNP-BC (Attachment 16)
Carmine Di Palo, CEO, Revere Healthcare Solutions, Inc. (Attachment 17)
Michael Moore, APRN (Attachment 18)
Leslie Mack, MSN, RN, APRN (Attachment 19)
Sophia Thomas, President & Interim CEO, American Association of Nurse Practitioners (Attachment 20)
Carol Moreland, Executive Administrator, Kansas State Board of Nursing (Attachment 21)
Abigail Koch, BSN, RN (Attachment 22)
Samuel MacRoberts, Litigation Director & General Counsel, Kansas Justice League (Attachment 23)
Dustin Baker, MSN, APRN (Attachment 24)
