Physician supervision and insurance reimbursement: policy implications for nurse practitioner practice in North Carolina.

The presence of regulatory requirements that physicians supervise nurse practitioner (NP) practice and of policies that affect insurance reimbursement policies create barriers that limit North Carolina NPs from practicing to the full extent of their licensure, education, and certification. This article reviews these barriers and offers policy recommendations to ensure that NPs are equal partners in health reform innovations.

Mandatory malpractice insurance Increases CS rate & profitability of litigation, decreases planned homebirths.

Making malpractice insurance mandatory by law for homebirth midwives serves two purposes: to make lawsuits more profitable and to decrease the number of homebirth midwives. Malpractice insurance has encouraged and increased number of lawsuits, which increases maternal morbidity and mortality rates by promoting the practice of "defensive medicine" on healthy women experiencing normal pregnancies. No evidence shows that mandatory malpractice insurance has any effect on improvement birth outcomes or public health.

Medicaid payment for nonphysician practitioners: an access issue.

As part of congressional efforts in the 1980s to expand access to care for Medicaid mothers and children, states were required to pay for services provided by certain advanced practice nurses. These mandates created the impetus in many states to expand payment policies for nonphysician practitioners. State Medicaid payment policies are often less restrictive than those of the Medicare program. However, not all states have been receptive to policy expansions and do not cover nonphysician practitioner services to the extent that professional practice acts allow. A few states have yet to meet the 1989 federal mandates.

Reimbursement for acute care nurse practitioner services.

Until the passage of the Balanced Budget Act of 1997, acute care nurse practitioners could not be directly reimbursed for inpatient services provided to Medicare patients. With the enactment of this legislation, acute care nurse practitioners may now be directly compensated for care provided. The historical and contextual issues that surround reimbursement for nursing and advanced practice nursing services are reviewed to serve as a foundation for understanding the current Medicare reimbursement regulations. The implications of the Balanced Budget Act of 1997 for acute care nurse practitioners and their professional colleagues are critically examined. The language of the Balanced Budget Act of 1997 and the subsequent rules and regulations issued by the Health Care Financing Administration are reviewed with specific focus on implications for acute care nurse practitioners. The opportunities for reimbursement for services provided by acute care nurse practitioners are more extensive than ever before. Acute care nurse practitioners and their physician colleagues will be wise to become fully conversant with the changes in Medicare reimbursement regulations.

Medicaid program: nurse-midwife services--HCFA. Final rule.

In accordance with section 13605 of the Omnibus Budget Reconciliation Act of 1993, this final rule expands coverage of nurse-midwife services under the Medicaid program by including coverage for those services that nurse-midwives perform outside the maternity cycle as allowed by State law and regulation. In addition, this rule includes several clarifying revisions to the Medicaid regulations.