The New York State Assembly released its one-house budget bills on Friday night, March 8th, 2013.  As you may recall from our January 23, 2013 email, the Governor's original budget called for the removal of the written practice collaborative agreement and written guidelines for nurse practitioners practicing in primary care only. The Assembly rejected the Governor's proposal regarding the limitation for only "primary care" nurse practitioners.  Instead, they inserted a new Part Y to the Education, Labor, and Family Assistance Article VII Bill.  Part Y is the Nurse Practitioner Modernization Act with some modifications from what previously passed the Assembly in June 2012. The modifications include: 

1. Based on NPA member feedback and input, the streamlined modified language provides that experienced NPs (defined as having greater than 3 years and 3600 practice hours) do not need a written collaborative agreement, but shall merely sign some State Education Department (SED) developed form that references written practice protocols (consistent with existing regulations), methods of consultation and referral with one or more physicians or hospitals, including emergency plans.  The form will NOT be filed with SED, but must be maintained by the NP and made available to SED or any patient, upon request.  The language regarding written practice guidelines was deleted.
    
2. The requirement that there be a study was eliminated, but the language maintains that SED, in consultation with DOH, shall issue a report by September 1, 2017. The report shall include certain NP related statistics and may include recommendations regarding collaboration, including amendments to this statute. 
    
3. This bill language (as opposed to the underlying statute) would sunset June 30, 2019. 

We believe that this language is consistent with the federal Medicare language regarding collaboration which currently states: 

"Collaboration is a process in which an NP works with one or more physicians (MD/DO) to deliver health care services, with medical direction and appropriate supervision as required by the law of the State in which the services are furnished. In the absence of State law governing collaboration, collaboration is to be evidenced by NPs documenting their scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. 

The collaborating physician does not need to be present with the NP when the services are furnished or to make an independent evaluation of each patient who is seen by the NP." 

What happens next: As long as the Senate includes some language referencing eliminating the written collaborative agreement in their budget proposal, this will mean both houses of the Legislative Branch and Executive Branch included removing the written collaborative agreement for nurse practitioners. All three versions of the budget will then be streamlined and negotiated into one final bill, assuming everyone can agree on the same language. 

If the Senate does not include any language referencing nurse practitioners or if the issue is rejected due to time limitations given the tight budget schedule, then all is not lost. We will continue to work on inserting the above referenced modifications into the Assembly and Senate  versions of the Nurse Practitioner Modernization Act with the hope of it passing later on in this Legislative session. 

When would this take effect? If negotiated into the final budget, 180 days after the budget is signed into law. 

What is the time frame of the budget? The New York State Budget is due on April 1st, 2013. It is widely expected that the budget will be passed on or before this date. 

Is there any action to take? Our Governmental Affairs team advises no formal action alerts at this time. We will continue to keep you apprised of any developments if urgent action is needed. 

We are certain there will be many questions given these developments. Please click here to read the FAQs that were previously circulated and send any additional questions to info@thenpa.org. The Senate proposals have not yet been released but are expected soon. We will continue to provide updates on these very exciting developments. For a summary of the New York State budget process, click here. 

Message from NPA President, Jeanne Martin (see below) 

As you know, we are in the final stages of preparing for our Capitol Day (aka Lobby Day) on April 9, 2013. If you are still considering whether or not to join us in Albany that day, I am wholeheartedly encouraging you to say "yes". This is a wonderful and unique opportunity to not only to meet with your local legislators but to see the legislative process at work, up close and personal. Do not take for granted the power of constituency; when legislators meet those who live in their voting districts and voice a concern or an opinion, that goes a long way towards helping them shape their own views and ultimately, their policies. This particular day will also feature our keynote speaker, Carolyn Buppert, NP, JD who is an expert on nurse practitioner practice issues and policy issues as well. You will also get to meet and converse with our lobbying team who works closely with the NPA leadership. Their insights and advice are invaluable. Additionally, you will meet other nurse practitioner colleagues from around NY State and be able to share your experiences with them. I attended my first "Lobby Day" as a nurse practitioner student back in 1996 and it left a lasting impression on me. It was definitely an inspiring day and demonstrated to me that our legislators definitely listen to a group of well-organized and committed constituents who voice real life issues that impede their livelihood. 

The take-home message from this: You can make a difference! Please join us on April 9th.There is still time to register to attend on our website. Registration closes at the end of day on March 14, 2013 so don't hesitate. I hope to see many of you there! Register for this free event by going to http://thenpa.org or click here.