HB 793 has passed the General Assembly, but the joint Boards of Nursing and Medicine are now seeking public comment on the enactment of regulations to implement the bill until 11:59 p.m. on May 4, 2018. HB 793 is legislation to authorize nurse practitioners who meet certain qualifications to practice without a practice agreement with a patient care team physician.
We have the opportunity to provide input on how regulations should be written. In order for the regulations to be implemented in the best favor of NPs, we need you to write a comment today. Topics that need to be commented on for consideration in adoption of regulations will be:
Equivalence of at least five years of full-time clinical experience
Routine practice in a practice area included within the category for which the NP was certified and licensed
Requirement of an attestation of practice
Fee associated with submission of attestation and issuance of autonomous designation
Acceptance of “other evidence” demonstrating that the applicant met the requirements
Endorsement of experience in other states
Unprofessional conduct – falsification of attestation
Note that the Boards are seeking public comment on the topics above. HB 793 has been signed into law – therefore, the Boards are NOT seeking public comment on changes to the legislation itself.
CLICK HERE to post a comment on the Virginia Regulatory Town Hall site. You may also email Ms. Elaine Yeatts directly: email@example.com. Please comment if you haven’t already and reach out to your colleagues asking them to do the same. Contact your region’s GR chair with questions.
TEMPLATE FOR PUBLIC COMMENTARY POST
Thank you for the opportunity to provide public comment. I have been a nurse practitioner (NP) for ___ years practicing in ________ setting in ________ county/city. Completion of graduate education and national board certification deem that I am a competent clinician. Please keep this in mind as rules are being promulgated.
Use any of the recommended talking points below to add to the template. NOTE: it is important that you personalize the talking points using your own words.
The five-year equivalent requirement creates a costly bottleneck to building provider workforce and equitable distribution in primary care delivery for underserved and vulnerable populations. Unduly burdensome regulations on top of this requirement will result in additional bottlenecks compromising access to care.
NPs already pay fees associated with RN, NP, and prescribing licenses. Any additional fees associated with submission of attestation and issuance of autonomous designation should not create a financial barrier for qualified NPs to practice.
Acceptance of “other evidence” demonstrating that the applicant has met the requirements must be broadly interpreted. We ask that the Joint boards issue a guidance document listing examples of supporting evidence that they would take into consideration. Office administrators, health system administrators, and credentialing documents should all be accepted as evidence that an applicant has met the necessary requirements.
The Boards should credit applicants by endorsement for all of their time employed and licensed in other states towards calculating their clinical experience requirement for practicing without a practice agreement.
NPs in any state or working for U.S. Armed Forces, U.S. Veterans Administration or the Public Health Service should be able to submit evidence that the five-year full-time equivalent collaborative requirements have been met with signature from employer, physician, practice administrator, etc.
There is no demonstrated need for additional requirements on the attestation in order to protect the public beyond what is listed in HB 793. The attestation should be used to document clinical experience under a sworn statement that this information is accurate and meets the requirements of the law.
Most, if not all, states requiring attestation of transitional clinical hours are not overly prescriptive in what they require in their regulations or on their attestation forms. Therefore, in Virginia it should not be necessary to further define what is meant by “the patient care team physician routinely practiced with a patient population and in a practice area included within the category for which the nurse practitioner was certified and licensed.”
Both the NP and the patient care team physician should be held to disciplinary standards for providing falsified documentation to the Boards.
HB 793 passed in the General Assembly and was signed by Governor Northam! The next steps involve the Department of Health Professions (including the Boards of Nursing and Medicine) promulgating the regulations for how this bill will be implemented. As this process unfolds, you may have questions about what this bill might mean for you and your practice. Let us know your questions!
VCNP has created hotline is for the use of the members of the Virginia Council of Nurse Practitioners, the professional organization representing NPs in Virginia. If you are not currently a member, we sincerely hope you will join us! Sign up today at https://www.vcnp.net/membership-application-and-renewal/ and stay informed about what is happening for NPs in Virginia!
If you are a member, please log in and look for the “Questions about HB 793” link in the “Advocacy” section.
We are delighted to announce that Governor Northam signed HB 793 yesterday evening, without any additional amendments!
THANK YOU to everyone who has dedicated themselves to advocating for the legislation by sending letters, placing phone calls, and being present at subcommittee hearings and other legislative events. Countless hours from VCNP leadership and membership – as well as the tenacious efforts of our patron, lobbyist, lawyer, and PR firm – have led to this spectacular moment!
Please take a moment to write and thank Governor Northam, as well as our bill patron Del. Roxann Robinson! We have created a VoterVoice thank you letter for the Governor Northam and have linked to Del. Robinson’s email, below. We will announce next steps for the legislation soon.
Our political opponents are trying to convince the Governor to amend HB 793 for their personal benefit.
The Medical Society of Virginia (MSV) has pushed an amendment to the Governor’s office that would convolute the Transition to Practice period as proposed by our version of HB 793. This amendment:
undermines the existing scope of practice of NPs
deteriorates the practice team model articulated in existing practice law
protects physician turf and limits consumer choice
circumvents the legislative process and substantively changes the legislation passed by the Virginia General Assembly
VCNP does not support the MSV amendment. In spite of repeated efforts to negotiate with MSV, their envoys have refused to see eye-to-eye with us. They remain determined to protect their turf, at the expense of Virginians’ access to care.
Without this amendment, the Department of Health Professions (DHP) has determined that nearly 50% of NPs currently practicing in Virginia would be immediately eligible for the attestation process, as they have already completed the equivalent of five or more years of practice. Once an NP completed the attestation process, they would be permitted to practice independently, without an agreement with a physician.
The MSV amendment would change the nature of the Transition to Practice period and severely decrease the percentage of eligible NPs, undermining the very intent of the bill. Our aim is to expand access to care by allowing NPs to practice to the full extent of their education and training. HB 793, without further amendment, would significantly bolster the workforce of individuals ready and able to provide quality care to patients across the Commonwealth.
By Monday, April 9th at the latest, the Governor must decide whether to sign, amend, or veto HB 793. There is no time to lose. We need you to MOBILIZE your colleagues, peers, and clients in support of HB 793, unamended.
Here’s what you can do:
Request that your PATIENTS send a letter using our VoterVoice campaign or call the gubernatorial office at 804-786-2211. See “How to Call the Governor’s Office” below for a sample phone script.
Ask your collaborating PHYSICIAN to contact the Governor, if they are supportive of our cause.
Lead by example! Continue to write and call the Governor’s office, while engaging your fellow NPs and encouraging them to do the same.
Share the videos from the VCNP Facebook page! New testimonies about the importance of HB 793 are being posted regularly. Sharing the videos on your personal profile raises awareness for our cause by tapping into your network of friends.
How to WRITE the Governor
Writing the Governor’s office is simple using our Voter Voice software! Visit the TAKE ACTION page of CareforVA.com to get started – it takes just a few minutes of your time.
How to CALL the Governor
A representative of the Governor’s office will answer the phone. You may wish to incorporate elements of your practice or personal story into this suggested phone script:
“Hello. My name is _____, and I am a [NP/physician/patient] calling in support of HB 793, a bill which would allow Nurse Practitioners to practice independent of a collaborative agreement, after completing a Transition to Practice period of five years and an attestation process.
HB 793, as it stands, would increase access to healthcare by expanding the workforce of healthcare professionals ready and willing to provide quality care throughout the Commonwealth, including underserved regions. The bill in its current form is widely supported by legislators, having passed the House 97-2 and the Senate 40-0.
Amendments to the bill are not necessary, as such alterations would make regulations unduly cumbersome and hinder access to care in Virginia. I respectfully request that the Governor sign HB 793, without further amendments.
Thank you for your time. Please let me know if you have any questions.”
VCNP respectfully requests that Governor Northam sign HB 793 without further amendment, as it passed the Virginia Senate 40-0 and the House of Delegates 97-2. To voice your support for HB 793 unamended, please send a letter to the Governor by utilizing our VoterVoice platform.
HB 793 passed in the General Assembly and was signed by Governor Northam!
We have composed a Frequently Asked Questions document to address inquiries we have received from both members and non-members. The document explains how the legislation will take effect, clarifies what attestation entails, and describes how experienced NPs can be “grandfathered” in. The document may be found below:
The next steps involve the Department of Health Professions (including the Boards of Nursing and Medicine) promulgating the regulations for how this bill will be implemented. As this process unfolds, you may have questions about what this bill might mean for you and your practice. Let us know your questions! Click Here to ask a question about HB793.
We have reviewed the letter distributed today by AANP and appreciate their acknowledgment of the difficult legislative landscape of the Commonwealth of Virginia. We wanted to take an opportunity to clarify for our members a few points that were addressed.
First, it is important to note that a lot of states would value the opportunity to transition to practice without requirement for a practice agreement. Once the bill is passed and the attestation process is completed, more than 50 percent of our members will have the ability to practice without a collaborative agreement.
Regarding AANP’s mention of our current bill: it’s important to note that we are working from a new substitute bill that reduces the restrictive language that was initially introduced during the first House sub-committee meeting.
While the legislation does retain physician-led team language during the collaborative period and the joint regulatory oversight of the Boards of Medicine and Nursing, this was a trade-off we needed to make in order to achieve transition to practice language.
Please note that we are working on a question and answer document (FAQ) to clarify any and all potential questions and hope to have it completed within the next few days. We will follow up with an email when that is finished. This document will also be housed on CareforVA.com.
We appreciate all the questions and encouragement that we have received. As AANP noted, this is a difficult process and we are doing everything we can to ensure that legislation is in the best interest of all NPs in Virginia. This is why the VCNP executive committee, all regional presidents, and the regional government relations chairs held an emergency conference call last Wednesday to discuss our new substitute bill and to vote on if they wanted Del. Roxann Robinson to move forward. Nine members of the executive committee and 12 regional presidents all voted unanimously to move forward with the substitute.
We will continue to work on your behalf and keep you informed of any changes.
Today, the Virginia Council of Nurse Practitioners – along with Del. Roxann Robinson, the patron of HB 793 – generated a huge legislative win that will move nurse practitioners in Virginia closer to obtaining Full Practice Authority.
During the Virginia Senate Education and Health Committee’s reading of HB 793, Del. Robinson introduced a new “substitute” bill that removed many of the overbearing restrictions in the original bill that opponents had wanted to impose on NPs. The substitute was unanimously approved by the committee in a 15-0 vote.
The new substitute bill goes a long way to reduce the restrictions that would have been imposed by the original House subcommittee substitute of HB 793, but it does retain the five-year transition to practice requirement. With this being a top concern for members, VCNP’s Executive Committee, all Regional Presidents, and regional Government Relations chairs, held an emergency conference call Wednesday night to discuss the new substitute bill and to vote on if they wanted Del. Robinson to move forward with it. Nine members of the Executive Committee and 12 Regional Presidents all voted unanimously to move forward with the substitute.
Mark Coles of the Tidewater region noted before the vote: “Virginia is a state where legislative progress is only made incrementally. We might be an outlier with a five-year transition to practice, but there are more than 20 other states around the country that would love to be in the place where we are right now. Full practice authority is within reach.”
It is important for all members to understand that, with the new substitute bill, more than 50 percent of NPs in Virginia have already met the five-year transition to practice requirement. Once the substitute bill is approved by the entire Senate, it will return to the House floor for another vote. Should it pass again and be signed by the Governor, rules will be promulgated by January 1, 2019 and NPs will be eligible to move forward with authority to practice without requirement of a collaborative agreement.
VCNP President Chris Daley noted to everyone on last night’s call that we are pledged to transparency throughout this process. If you have questions or concerns, please contact your Regional President or Government Relations chair. It is the goal of the VCNP Board to ensure that everyone is comfortable with this process.
HB 793 will be voted on by the full Senate in the upcoming days. Please stay tuned for additional details on our progress.
Contact the Senate Education and Health Committee Members now! It is possible that HB 793 could be heard as early as Tuesday, February 20. This is the stage, with the Senate Sub-Committee and full Senate Committee, at which we will be proposing amendments to HB 793. We want you to know and trust that we will not let Virginia be an outlier. We have the commitment of our patron that we will not move forward with the bill if it remains in its current form.
Tell the Committee members that you support HB 793!
We are actively working on changing and adding to the legislation to best fit the needs of Virginia NPs. This includes the following key points:
A reduction in hours requirements for the Transition to Practice program. This is a top priority for VCNP and its membership. We are working to educate our Senators that five full years of clinical experience requirements is excessive and has not been proven as a barometer for safe practice.
Attestation will be a standardized form created by DHP with provisions for exceptions for NPs who may not be able to obtain the physician signature; for example, circumstances due to physician death.
There is no provision for grandfathering NPs; however, existing experience will count towards years of experience qualifying for the transition time period. All eligible NPs will need to submit an attestation form to DHP to be able to practice unencumbered by the practice agreement requirement.
Endorsement of NPs from other states will be considered under regulations with provisions for NPs from out of state to meet equivalent time requirements attested by a physician or other entity if the physician’s signature cannot be obtained.
Removal of APRN titling because the definition excludes those early NPs whose educational programs granted certificates and not a master’s degree.
Removal of redundant language from regulations restating provisions for periodic review of records, including site visits.
Removal of language that NPs must have graduated from an educational program accredited by Commission on Collegiate Education, as this requirement has been met by virtue of licensure.
Collaboration will be defined as to the degree of cooperation necessary to provide treatment and the collaboration is with MDs and other health care providers.
The American Academy of Nursing has announced their official position on Full Practice Authority for Advanced Practiced Registered Nurses (APRNs). The Academy declares, “Lack of full practice authority for APRNs is a barrier to the provision of efficient, cost-effective, high-quality, and comprehensive health care services for some of the nation’s most vulnerable populations”. The statement cites the improvements in care that states with Full Practice Authority have experienced and makes suggestions at the state and federal level for lowering barriers to practice. Read the full statement below.