1. HB 346: Helping to Improve Health Care Access in Virginia Virginia Petrikonis

2. HB 346: Background A consensus bill resulting from two years of discussions between the Medical Society of Virginia and the Virginia Council of Nurse Practitioners. A consensus bill resulting from two years of discussions between the Medical Society of Virginia and the Virginia Council of Nurse Practitioners. Changes the language of the statutes written in 1973 concerning the physician-nurse practitioner relationship by eliminating supervisory language. Changes the language of the statutes written in 1973 concerning the physician-nurse practitioner relationship by eliminating supervisory language. Created to address identified problems with current access to health care in Virginia with particular emphasis on underserved areas. Created to address identified problems with current access to health care in Virginia with particular emphasis on underserved areas. Reflects recommendations from the VHRI to address critical provider capacity issues. Reflects recommendations from the VHRI to address critical provider capacity issues.

3. HB 346: Purpose Emphasizes collaboration and consultation between physicians and nurse practitioners within patient care teams with a physician as the leader and manager. Emphasizes collaboration and consultation between physicians and nurse practitioners within patient care teams with a physician as the leader and manager. No longer requires physicians to practice at the same location as nurse practitioners on the same team. No longer requires physicians to practice at the same location as nurse practitioners on the same team. Collaboration and consultation can be done through the use of telemedicine, chart reviews of electronic medical records, or other mutually agreed upon forms of communication. Collaboration and consultation can be done through the use of telemedicine, chart reviews of electronic medical records, or other mutually agreed upon forms of communication.

4. HB 346: Purpose Physicians will be able to manage more nurse practitioners, an increase from four to six. Physicians will be able to manage more nurse practitioners, an increase from four to six. Aims to limit redundant paperwork, a previously identified problem with the care delivery of nurse practitioners. Aims to limit redundant paperwork, a previously identified problem with the care delivery of nurse practitioners. Anticipated patient benefits include increased access to quality health care with the use of advances in communication such as telemedicine so that geographic extension to previously underserved areas can be achieved. Anticipated patient benefits include increased access to quality health care with the use of advances in communication such as telemedicine so that geographic extension to previously underserved areas can be achieved.

5. HB 346: History The VCNP has attempted to remove the supervisory clause concerning the physician-nurse practitioner relationship in the past with SB 236. The VCNP has attempted to remove the supervisory clause concerning the physician-nurse practitioner relationship in the past with SB 236. SB 236 failed to make it out of the Senate Health Licensing subcommittee in 2010. SB 236 failed to make it out of the Senate Health Licensing subcommittee in 2010. Key differences between HB 346 and SB 263 are that the chief patron of HB 346 is a physician and the language was changed from “independent” to “collaborative.” Key differences between HB 346 and SB 263 are that the chief patron of HB 346 is a physician and the language was changed from “independent” to “collaborative.”

6. HB 346: Key Supporters The Medical Society of Virginia. The Medical Society of Virginia. The Virginia Council of Nurse Practitioners. The Virginia Council of Nurse Practitioners. Del. John O’Bannon, M.D. (R-73 rd, Henrico), chief patron of HB 346. Del. John O’Bannon, M.D. (R-73 rd, Henrico), chief patron of HB 346. Virginia Secretary of Health Bill Hazel, MD. Virginia Secretary of Health Bill Hazel, MD.

7. HB 346: Action Introduced by Delegate John O’Bannon, M.D. (R-73, Henrico), the chief patron. Introduced by Delegate John O’Bannon, M.D. (R-73, Henrico), the chief patron. Offered to the General Assembly of Virginia on 1/11/12. Offered to the General Assembly of Virginia on 1/11/12. Referred to the Committee on Health, Welfare and Institutions where it was heard on 1/17/12. Referred to the Committee on Health, Welfare and Institutions where it was heard on 1/17/12. Presented to the House where it was taken up and engrossed; passed by a majority block vote of 96-1 on 1/20/12. Presented to the House where it was taken up and engrossed; passed by a majority block vote of 96-1 on 1/20/12.

8. HB 346 in Action HB 346 went to the Senate where it was referred to the Committee on Education and Health on 1/23/12. HB 346 went to the Senate where it was referred to the Committee on Education and Health on 1/23/12. Presented to the Senate where it was taken up and engrossed; passed by a majority block vote of 40-0 on 2/28/12. Presented to the Senate where it was taken up and engrossed; passed by a majority block vote of 40-0 on 2/28/12. Governor McDonnell made recommendations that passed House and Senate on 3/10/12. Governor McDonnell made recommendations that passed House and Senate on 3/10/12.

9. HB 346: Benefits Beneficiaries of the bill include patients throughout the Commonwealth of Virginia, in particular patients in underserved areas such as nursing homes and free clinics. Beneficiaries of the bill include patients throughout the Commonwealth of Virginia, in particular patients in underserved areas such as nursing homes and free clinics. Also benefits hospitals, health departments, employers, and private practices with the extension of geographic reach to patients throughout Virginia. Also benefits hospitals, health departments, employers, and private practices with the extension of geographic reach to patients throughout Virginia. Nurse practitioners also receive benefits in terms of increased job stability and a potential increase in jobs. Nurse practitioners also receive benefits in terms of increased job stability and a potential increase in jobs.

10. HB 346: Adverse Effects Potentially increases physician workload in terms of supervising an increased number of nurse practitioners. Potentially increases physician workload in terms of supervising an increased number of nurse practitioners. Potential financial issue regarding whether nurse practitioners will receive the same reimbursement from Medicare, Medicaid, and private insurance companies as physicians. Potential financial issue regarding whether nurse practitioners will receive the same reimbursement from Medicare, Medicaid, and private insurance companies as physicians.

11. HB 346: Significance More patients can gain access to health care, particularly those in previously underserved areas and rural areas. More patients can gain access to health care, particularly those in previously underserved areas and rural areas. Will increase access to patient care, thereby increasing the number of patients seen and billed for services, so employers and health care facilities will potentially make more money than in the past. Will increase access to patient care, thereby increasing the number of patients seen and billed for services, so employers and health care facilities will potentially make more money than in the past. Likely to save money through the streamlining of regulatory paperwork requirements. Likely to save money through the streamlining of regulatory paperwork requirements.

12. HB 346: Significance Will help with the influx of Medicaid patients that is anticipated with the implementation of the Affordable Care Act. Will help with the influx of Medicaid patients that is anticipated with the implementation of the Affordable Care Act. Allows nurse practitioners to have increased mobility to reach patients in need with the ability to respond to needs on a local as well as regional level. Allows nurse practitioners to have increased mobility to reach patients in need with the ability to respond to needs on a local as well as regional level. Great step forward in nurse practitioner independence! Great step forward in nurse practitioner independence!

13. HB 346: References Coles, M. (2012). Virginia Council of Nurse Practitioners. Retrieved from www.vcnp.net/members/documents/Jan11MessageReBill.pdf. Coles, M. (2012). Virginia Council of Nurse Practitioners. Retrieved from www.vcnp.net/members/documents/Jan11MessageReBill.pdf. www.vcnp.net/members/documents/Jan11MessageReBill.pdf Medical Society of Virginia. (2012). Health care delivery teams: Physicians and nurse practitioners-HB 346. Retrieved www. virginia acs.org/WCOCDay/msv_backgrounders.pdf. Medical Society of Virginia. (2012). Health care delivery teams: Physicians and nurse practitioners-HB 346. Retrieved www. virginia acs.org/WCOCDay/msv_backgrounders.pdf. www. virginia acs.org/WCOCDay/msv_backgrounders.pdf www. virginia acs.org/WCOCDay/msv_backgrounders.pdf Virginia’s Legislative Information System. (2012). HB 346 Nurse practitioners; practice as part of patient-care teams. Retrieved from http://leg1.state.va.us/cgi- bin/legp504.exe?121+cab+HC10118HB0346+RCHB1. Virginia’s Legislative Information System. (2012). HB 346 Nurse practitioners; practice as part of patient-care teams. Retrieved from http://leg1.state.va.us/cgi- bin/legp504.exe?121+cab+HC10118HB0346+RCHB1. http://leg1.state.va.us/cgi- bin/legp504.exe?121+cab+HC10118HB0346+RCHB1 http://leg1.state.va.us/cgi- bin/legp504.exe?121+cab+HC10118HB0346+RCHB1 Virginia’s Legislative Information System. (2010). SB 263 Nurse practitioners; moves responsibility for licensure and regulation to board of nursing. Retrieved from http://leg1.state.va.us/cgi- bin/legp504.exe?101+sum+SB263. Virginia’s Legislative Information System. (2010). SB 263 Nurse practitioners; moves responsibility for licensure and regulation to board of nursing. Retrieved from http://leg1.state.va.us/cgi- bin/legp504.exe?101+sum+SB263.http://leg1.state.va.us/cgi- bin/legp504.exe?101+sum+SB263http://leg1.state.va.us/cgi- bin/legp504.exe?101+sum+SB263