Legislative activity intensifies
Rachelle Colombo; KMS Director of Government Affairs
With the first major legislative deadline approaching, a flurry of activity is swirling around the statehouse. In addition to tracking each new issue as it emerges, is the challenge of differentiating between mere duplicates or "look-alikes" of already-authored bills, and those that are truly new proposals. A perfect example of this legislative phenomenon is demonstrated by the number of bills around the increasingly-complicated nurse practitioner issue.
A group claiming to represent the state's APRNs has introduced identical bills in both the House (HB 2122) and Senate (SB 69) to allow for independent practice for advanced practice registered nurses. The Kansas Medical Society opposes those bills, and has introduced an alternative proposal for regulating APRNs (HB 2205 and SB 218). The KMS-sponsored approach would direct the Board of Healing Arts and the Board of Nursing to jointly adopt regulations governing APRN scope of practice and the need for collaborative practice agreements in the differing clinical settings in which APRNs work. Adding to the confusion and controversy surrounding the APRN bills, a new bill (HB 2280) which only applies to nurse midwives has emerged which threatens to further complicate the discussions about APRN scope of practice. The bill was introduced by a Johnson County-based free-standing birthing center that seeks to allow nurse midwives to practice independent of any physician collaboration.
The nurse midwives hope to differentiate their proposal from the broader APRN proposal, contending that their bill is more limited and less controversial. They state that their goal is to limit their practice to low-risk, well-woman maternity care, arguing that pregnancy and childbirth are not a disease process and therefore their practice is not medical in nature. However, as with the other proposals for independent practice, their bill reaches far beyond their stated intent. HB 2280 would allow nurse midwives to:
provide a full range of primary health care services for women from adolescence to menopause and beyond, including primary care, gynecologic and family planning services, pre-conception care, care during pregnancy, childbirth and postpartum period, care of the normal newborn and treatment of male partners for sexually transmitted infections; and assessment, diagnosis, physical examinations, prescriptive authority; and the ability to admit, manage and discharge patients, order diagnostic testing, interpret results, and perform surgical procedures.
Simply put, their proposal lacks any legal distinction between the scope of practice of a nurse midwife and that of an obstetrician or family physician or any other medical doctor. Their proposal isn't any different than the other APRN bills which allow nurse practitioners to practice medicine without a requirement for physician collaboration or participation at any level.
Throughout all this the KMS policy has been clear: the independent practice of medicine should be limited to those with a medical education and training, to best ensure patient safety. APRN education and training lacks the clinical depth and breadth to prepare an APRN to practice medicine independent of any physician collaboration or involvement.
Many other issues remain before the legislature as we approach the end of the first third of the legislative session. On Monday the Senate Health committee will hear a bill to allow podiatrists to supervise PAs and APRNs (SB 141). Efforts to legalize hemp preparations for seizure disorders (HB 2282) will be considered by the House Health committee on Tuesday. On Wednesday, the Senate Public Health and Welfare committee will consider the KMS proposal (HB 2205/SB 218) that directs the Board of Healing Arts and the Board of Nursing to develop joint regulations governing APRN scope of practice. Also on Wednesday the Senate Commerce committee will consider a bill (SB 167) that would require physicians doing impairment ratings in workers compensation to use the older, 4th edition of the AMA Guides to the Evaluation of Permanent Impairment, instead of the most current 6th edition.
HB 2319, the Kansas Hospital Association's bill to implement Medicaid expansion was introduced last week and referred to the House Health committee. The bill directs the Brownback administration to develop a budget-neutral Medicaid expansion program, known as "KanCare 2.0," and submit it to the federal government for approval. The bill has not yet been scheduled for a hearing.