Maine Medicine Weekly Update - 02/19/2021 (Plain Text Version)
In this issue:
Maine Legislature Week 6 Update
The following is a summary of happenings during week 6 of the Maine Legislature.
Health Coverage, Insurance, and Financial Affairs
Nurse Practitioners are Seeking to Eliminate Post Graduate Training
The more important of the two was LD 295, “An Act To Repeal Restrictions That Prohibit Certain Advanced Practice Registered Nurses from Providing Essential Health Care Services”.
Nurse Practitioners are seeking to eliminate post-graduate training. Specifically, the 24-month mandate of supervised training. The most common rhetoric on the support side was regarding the rural primary care shortage and the necessity of nurse practitioners. The support side commonly sourced a study stating the 24-month period of supervised training did not improve patient safety or lead to better patient outcomes. This statement is analogous to stating residency time does not add to better patient care, it is simply not the case.
Other statements from proponents of the bill referred to other some other state laws which include no similar oversight The 24-month mandate is the only additional training piece for APRNs, no additional supervised postgraduate residency training is required should they seek licensure in Maine. The support, to which was primarily APRNs, stated many Nurse Practitioners are Registered Nurses prior to becoming a CNP and therefore would not need the additional training. Former Co-Chair of the Legislature’s Committee on Health and Human Services, Representative Patty Hymanson (a recently retired neurologist with experience working with APRNs) testified in opposition to the bill, and included with her comments, “The training as an ARNP differs from that of an RN as it requires independent decision-making.”
MMA Director of Communications and Government Affairs, Dan Morin gave testimony on behalf of MMA in opposition to LD 295; emphasizing that this bill would lower the threshold for qualifications for licensure of APRNs. There is a need for licensure consistency in Maine. Without this mandate, there will be no further post graduate training requirements in Maine state law for new APRN graduates, unlike for physicians or physician assistants. Lowering the qualification will not address the rural health crisis. The American Medical Association found that in states with no regulations there was no difference in where NPs practice. Dan closed by stating:
“Maintaining the statutory requirement to work alongside an experienced physician or supervising nurse practitioner will better ensure potential APRN licensees can apply learned concepts in a patient-centered environment when responsible for making a diagnosis and developing treatment, not to mention maintain consistency in state law across professions.”
On the question of how to address the nursing shortage and rural crisis James Bass, representing the Maine Osteopathic Association replied there are many other bills that would better address the issue.
“LD 295 does not present an administrative change to existing practices. Instead, it proposes the elimination of substantive clinical training requirements that are necessary and important for ensuring quality patient care” – James Bass
A minimum safety and quality requirement must be met, this cannot be disregarded. The MMA Board and staff urge you to reach out to Maine legislators and stop this bill to eliminate state requirements for post graduate training and supervision for nurse practitioners
LD254 “An Act To Allow Certified Registered Nurse Anesthetists To Bill for Their Services”, requires health insurance carriers to provide coverage for services provide by certified registered nurse anthesis’s. There were 11 testimonies for LD 254, 10 in support and 1 neither for nor against. Of the support, the most common sentiment was the concern for the surprise bill due to the inability of nurses to bill for anesthesia. Certified Register Nurse Anesthetist Paul Schneider stated the bill “would eliminate out of network or “surprise billing” and would level the playing field so that a surgical center could choose to utilize any qualified anesthesia professional without fear of unequal treatment by insurers and aggravation to their patients”. The one neither for nor against was on behalf of Anthem Blue Cross/Blue Shield. They stated they agreed with the bill as the language had not changed from the last session's bill that they agreed upon. MMA did not testify; the bill moves on to a work session on February 25.
Committee on Labor and Housing
On Wednesday, the Committee on Labor and Housing held a public hearing on LD 213, sponsored by Representative Millett of Cape Elizabeth. The bill would add gynecologic cancer to the list of other cancers with rebuttable presumptions that a firefighter contracting a cancer from the list contracted it as a result of the firefighter’s employment. The bill was met with strong support, especially from the Professional Firefighters of Maine. The bill moves on a work session, which has not yet been scheduled.
Committee on State and Local Government
The Maine Medical Association recognizes its members’ roles in promoting racial and ethnic equality, along with the American Medical Association’s pledge to confront systemic racism, racial injustice, and police brutality. MMA’s Dan Morin had an opportunity to testify in support of LD 2, a bill requiring racial impact statements to be used in the legislative process. The bill was widely supported, with over 120 testimonies being offered. A work session was held on February 10 and was continued to February 17 this week. During the second work session, and despite the overwhelming public support, the Committee voted Ought to Pass as Amended by a vote of 7-5 in a divided report.