Capitol Beat

By Janet Haebler and Sam Hewitt

Last week, Sens. Marco Rubio (R-FL) and Elizabeth Warren (D-MA) reintroduced the Protecting JOBs Act (S. 609). Under the bill, any state that receives federal funding through the Higher Education Act would be barred from denying, suspending, or revoking an occupational license or a driver’s license “solely” because a borrower defaulted on their federal student loans.

As early as the 1990’s, states were urged by the U.S. Department of Education and select member organizations representing government, to adopt laws requiring regulatory boards to suspend professional licenses, and even driver’s licenses, if the board received notice informing them an applicant held outstanding student loans. Around 2010, at the height of this legislative trend, roughly half of states had some form of license suspension for default in place.

Although several states rescinded laws seizing or suspending licenses, barriers remain for some license holders. As of 2018, the National Conference of State Legislatures (NCSL) reports at least eight states—Alaska, Georgia, Hawaii, Iowa, Kentucky, Massachusetts, Tennessee and Texas—maintain laws requiring all occupational boards to revoke licenses for defaulting on any type of federal or state education loan. Louisiana will only revoke a license if the professional has defaulted on an education loan issued by the state. An additional five states—Arkansas, California, Mississippi, Minnesota and Florida—revoke only the licenses of health care professionals for defaulting on education loans. In Arkansas and Mississippi, the laws are more narrow, applying only to state health care education loans and scholarship agreements. Two states—Iowa and South Dakota—revoke all state-issued licenses, including driver’s and recreational hunting licenses.

According to the Institute for College Access and Success, 8.9 million federal student loan borrowers now in default with over 1 million borrowers added each year. With a continued increase in the percentage of Americans working in occupations requiring licensure, approximately 25%, combined with rising student loan default rates, there has been renewed interest. The Protecting JOBs Act is a bi-partisan effort at the federal level to address this counterproductive policy.

Watch for ANA updates and requests for grassroots efforts in the interest of advancing this policy. You can read more about this issue at Forbes.

The value of nurses continues to be seen at the federal level. Paralleling the Administrations’ December report, that recognized the role registered nurses and advance practice registered nurses (APRNs) play in patient care, the Medicare Payment Advisory Commission (MedPAC), also made recommendations to show the value of nurses. At the most recent MedPAC meeting in January, the 17 commission members, including two nurses, unanimously voted to recommend that “The Congress should require APRNs and Physician Assistants (PAs) to bill the Medicare program directly, eliminating ‘incident to’ billing for services they provide.” The goal of this recommendation is to reduce costs in the Medicare program as well as improve Medicare’s data on who furnishes care to beneficiaries. Currently, APRNs and PAs are paid 85 percent of the rate that physicians receive under the physician fee schedule when they bill Medicare directly for the same services. Therefore, practices may be reimbursed less overall, but accurate data can be collected to show the value of nursing.

The second recommendation from the Commission reads that, “The Secretary [of Health and Human Services] should refine Medicare’s specialty designations for APRNs and PAs.” Medicare has limited information on the specialties of practice for these clinicians and therefore cannot target resources appropriately to areas of concern, such as primary care.

It is important to note that nothing in either of the recommendations would determine what services clinicians can perform, which is up to state statutes and the physicians with whom they practice. MedPAC can only make recommendations to Congress for consideration to changes to the Medicare system.

These recommendations closely parallel the Administration’s Reforming America’s Healthcare System Through Choice and Competition Report that endorses broader state and federal scope-of-practice (SOP) statutes for all health care providers, including APRNs, that allow them to practice to the top of their license and full skill set. The report also advises eliminating “collaborative practice” and supervision requirements which can impede access to care and limit the ability of providers to diagnose and treat myriad health care issues, especially in underserved populations and in rural areas where patients rely on APRNs for timely care and lifesaving treatment.

Individual states will have to determine SOP statutes, but if all APRNs who bill Medicare are designating their areas of practice as well as services provided, increased data will be available to better determine patient outcomes and highlight quality nursing services. Moreover, better data will be available for services provided by communities to allow for more informed choices at the local and state level.

ANA continues to participate in discussions regarding APRN SOP and has provided comment to MedPAC and the Administration on issues, such as expansion of telehealth services to Medicare beneficiaries, that can affect nurses and the care they provide to patients across the country.