A Nurse Practitioner’s scope of practice depends on the specialty of that individual, and the state in which he or she practice. The AANP divides states into three categories which include Full practice, reduced practice, and restricted practice. Full practice gives the Nurse practitioner the right to assess patients, diagnose conditions, order diagnostic exams, and provide treatments under the authority of their regional state board of nursing. Reduced practice means that the states require the Nurse Practitioner must collaborate with another healthcare provider in at least one aspect of Nurse Practitioner practice. Restricted practice for Nurse Practitioners are concentrated mainly in the Pacific Northwest in which those states require direct supervision or team management of at least one element of Nurse Practitioner practice (Ventures, 2014-2018).
Medicare reimbursement for Nurse Practitioner’s has gone into effective 1-1-98. There is direct reimbursement to NPs for providing Medicare Part B services that would normally be provided by physicians. Reimbursement is not restricted by site or geographic location; there is no limitation on CPT codes as long as visits meet the established Medicare E and M requirements. Nurse Practitioners must be reimbursed for assisting at surgery. Nurse Practitioners must work under a collaboration practice agreement with a physician. The agreement between the Nurse Practitioner and physician must outline the Nurse Practitioners prescriptive authority, a plan for patient’s requiring admission, arrangements, for diagnostic testing and a plan for documentation of patient’s visits and interactions. The copy of the agreement must be kept on site and reviewed and signed by the Nurse Practitioner and physician at least annually (n.p, 2013). The collaborating physician is not required to practice on-site or within a certain distance. The collaborating physician must be available by phone or another method of communication to consult with Nurse Practitioner at all times if needed. Louisiana requires Nurse Practitioners to have a secondary or “back up” physician designated in case the Nurse Practitioner is unable to locate the primary collaborating physician. The Louisiana Nurse Practice Act restricts Nurse Practitioners from prescribing for that period of time if unable to locate primary or secondary collaborating physician (Nurse Practitioner Scope of Practice Louisiana, 2012-2018).
Louisiana is known as a reduced practice state. This state practice and licensure laws reduces the ability of Nurse Practitioners to engage in at least one element of Nurse Practice. State law also requires a career-long regulated collaborative agreement with another health provider in order for Nurse Practitioner to provide patient care or limits the setting of one or more elements of Nurse Practice (n.d, 2012-2018). Medicaid pays for 80% of Nurse Practitioner services except for physician administered injections, long-acting reversible contraceptives, immunization, and EPSDT preventive medical, vision, and hearing screening reimburse at 100%. (n.d., Louisiana Medicaid Managment information system, 2018).
I feel as though our state laws of Louisiana are delinquent. There are ways too many restrictions. I believe all states should operate on the same level. Therefore, there won’t be any confusion on how a Nurse Practitioner is able to practice. I would love for Louisiana to become a full practicing state. I do there are some individuals who like Louisiana law as is but the law does not fully let us practice to our full potential. Oregon and Washington are full practice states, Alabama is a reduced practice, and Georgia is a restricted state as well as Louisiana. The differences among the states covered services are mentioned above.