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APN alert--value your services.

There is general agreement that we are in a health-care crisis, not only in this state, but in this country. Nevada has a State University System that is preparing advance practice nurses, and hospitals and physicians who are actively recruiting for APN services. Nevada has laws that, if they were being enforced, would help convince nurses to obtain advanced training, provide more sophisticated services, and remain active in the profession of Nursing. There are ever-expanding opportunities for APNs on the horizon, opportunities that will wither and fade away if we do not pay attention to what is and is not happening. If we are not vigilant about the expenditures of our health-care dollars, both as consumers and as providers, I believe it will have dire consequences.

In the early 1980's, several Nurse Practitioners lobbied the Legislature to pass NRS 689B.045; perhaps one of the most important Nevada Statutes affecting Nurse Practitioners. In essence, "689" states that when an APN provides a service to a patient, an insurer can not pay her/him less than the insurer would pay another provider for the same or similar service. The language in the statute addresses the value of the service provided, not the value of the provider, and it is a clear and concise statement.

In the twenty-plus years that I have worked as a Psychiatric APN in Nevada, I have always been an independent contractor, rather than an employee of my collaborating physician. Therefore I have had multiple contacts directly with the insurers that contact for my services; accordingly I have billed and collected fees under my own name and tax ID.

In 1998, I contacted the office of the Insurance Commissioner with a complaint that NRS 689 was not being enforced, and that various insurers were offering contracts and payments not congruent with the mandate of the bill and that were in fact in direct violation of NRS 689. The basic response from that office was that I was incorrect, and it wasn't their business anyway.

In light of this, I asked for and received the generous assistance of Senator Townsend in resolving this issue. It was not fully resolved until 2000. Written opinions were generated by the State Attorney General's Office, the Legislative Counsel Bureau and the Insurance Commissioner's Office validating that NRS 689 meant what I claimed it mandated; that insurers could not pay for the services of an APN at a lesser rate than they paid for the services of another provider.

At that time, UNR and the State System claimed they were exempt from NRS 689 because they were self-funded. Somehow, my suggestion that it wouldn't look good for them if I wrote a letter to the newspapers reporting their stance on the issue was sufficient to persuade them it would be best if a State agency was in compliance with a State law. Others insurance companies such as those gathered under the Universal Health Network, and Value Options did not offer to renew my contracts when they learned of theses rulings.

This past year, Hometown Health Plan (HHP) offered contracts to APNs working outside the hospital, at a rate in violation of 689. I shared my documentation with the APNs involved in negotiations, and HHP brought their contracts into compliance. This year, St. Mary's (SMHF) is no longer farming out their mental-health coverage to Behavioral Healthcare Options, and so as of June 1, 2007, they will move into compliance with NRS 689 for the first time in at least the past 6 years. As far as I can tell, these are the only two providers of group health insurance mental health coverage in the State of Nevada that are in compliance with the provisions of NRS 689.

Again I have filed a complaint with the Insurance Commissioner's Office, and again I have received a response that this does not involve "insurers" and so it is not their concern. Again, I have invoked the support of Senator Townsend, the Attorney General and the LCB. To this date a statute passed in 1983 is being blatantly ignored by most parties concerned. Sadly, I am fighting this battle alone.

I urge every APN in this state to become familiar not only with NRS 689 and the legal opinions, but with every insurance contract and payment system that involves their practice. Every APN should know what he/she is being paid for every service rendered, and whether that payment is in compliance with the law. All APN's should be alert to, and take action about, violations of the laws that affect their practice

This has been my battle to date. It should not be my individual personal concern, nor even my individual professional concern. I suggest that each one of you needs to be responsible not only for your own practice, but for the future of Advance Practice Nursing in Nevada. If one APN is treated in violation of the law, then all APNs are at risk and so is the future of advanced practice nursing.

Beverly G. Cleff, Ed.D, APN Fax: 775-329-2550 E: bcleff941@aol.com W#: 775-329-4284
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Title Annotation:District/State News; Advanced Practice Nurse
Author:Cleff, Beverly G.
Publication:Nevada RNformation
Geographic Code:1USA
Date:Aug 1, 2007
Words:851
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