Regulatory changes impacting ARNP practice

Parity Reimbursement

We applaud the recent decision by the Department of Labor & Industries to provide parity reimbursement for care by ARNPs to injured workers. L&I approval became effective November 15, 2016, reimbursing ARNPs at 100 percent of the physician rate. L&I especially hopes to increase the number of psychiatric nurse practitioners providing care to injured workers. ARNPs United of Washington State testified that equal pay for equal work by L&I could enhance ARNP interest in providing this care. Labor & Industries emphasizes the return to work as a treatment goal following a work-related injury. ARNPs are vital resources to workers trying to achieve this goal.

The Comprehensive Addictions and Recovery Act

Overdoses from heroin, prescription drugs and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control and Prevention. In Washington state, an average of two opioid overdose deaths occur daily. Not enough providers are authorized to assist in medication-assisted addiction recovery.

ARNPs are being recruited to participate in preventing unintentional overdoses and opioid addiction-related deaths. The federal Comprehensive Addictions and Recovery Act (CARA), signed into law by President Barack Obama on July 22, 2016, permits qualifying ARNPs to prescribe buprenorphine and methadone for opiate addiction treatment in a clinical setting after completing a specified 24 hours of continuing education in addiction and recovery.

The Nursing Care Quality Assurance Commission has determined current Washington state rules allow ARNPs to prescribe these medications for opioid drug addiction once the training is completed. Eight of the required 24 hours are mandatorily provided by a number of agencies listed on the Substance Abuse and Mental Health Services Administration website and can be taken online. Interested ARNPs can begin accruing those eight hours now. Guidelines for the remaining 16 hours are currently being developed and are anticipated early in 2017. Watch the website for ARNPs United of Washington State for more information on how to complete the training necessary to provide buprenorphine at your clinical site.

Treating addiction with buprenorphine is one method of preventing opioid overdoses. Another critical resource is the state Prescription Monitoring Program (PMP). The PMP allows a treating provider to access the prescription utilization of patients receiving controlled substances. By querying the PMP, a provider can see how many prescriptions a patient has received, from what pharmacy and which prescriber. This assures the prescriber that drugs are being used as intended. According to Gary Garrety, Operations Manager for the PMP, 32 percent of licensed ARNPs are signed up with the prescription monitoring program. We encourage every ARNP who prescribes scheduled drugs to sign up through Secure Access Washington at secureaccess.wa.gov and become familiar with querying the drug utilization of patients receiving prescriptions for controlled substances.

Another recommendation to reduce unintended overdoses and death is to expand the availability of naloxone , which can counter the effects of a heroin or opioid overdose. ARNPs need to become familiar with how naloxone is administered and make it available to patients and their family members when there is a risk for narcotic overdose.

Finally, be familiar with the opioid guidelines developed for chronic pain management, available on line from Washington State Labor & Industries at: lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/FINALOpioidGuideline010713.pdf