"Advanced registered nursing practice" is defined as the performance of the acts of a registered nurse and the performance of an expanded role in providing health care services recognized by the medical and nursing professions. Advanced registered nurse practitioners (ARNPs) are authorized to perform all activities registered nurses perform, perform specialized and advanced levels of nursing, and prescribe legend drugs and certain controlled substances. ARNPs scope of practice is defined by the Nursing Care Quality Assurance Commission and includes:

• examining and diagnosing patients;
• admitting, managing, and discharging patients to and from health care facilities;
• ordering, collecting, performing, and interpreting diagnostic tests;
• managing health care by identifying, developing, implementing, and evaluating a plan of care and treatment for patients;
• prescribing therapies and medical equipment;
• prescribing medications when granted prescriptive authority; and
• referring patients to other health care practitioners, services, or facilities.

A physician assistant (PA) is a person who is licensed by the Washington Medical Commission to practice medicine according to a practice agreement signed by one or more participating physicians, with at least one of the physicians working in a supervisory capacity. Physician assistants may provide services they are competent to perform based on their education, training, and experience and that are consistent with their practice agreement.

For health plans, including plans offered the public employees, issued or renewed on or after January 1, 2024, a health carrier may not reimburse a contracted ARNP or PA in an amount less than the allowed amount that the health carrier would reimburse for the same service if provided by a contracted physician or osteopathic physician in the same service area.

A health carrier may not reduce the reimbursement amount paid to physicians and osteopathic physicians to comply with this act.

This act does not apply to ARNPs or PAs who are employees of a health maintenance organization.

By January 1, 2025, the Office of the Insurance Commissioner must report to the Legislature on the number of insurers who have changed their reimbursement policy because of this act, the number of ARNPs or PAs whose reimbursement increased, the number of physicians whose reimbursement decreased, and the cost to insurers to implement this act.

PRO: Reimbursing ARNPs and PAs at the same rate as physicians will strengthen the network of care by allowing practices to stay open. The reimbursement will cover the increased cost of care.  This would be a return to the way reimbursement worked in the past. The overhead, supplies, insurance is the same for these providers, but reimbursement is less.

CON: Physicians have unique training, which justifies a higher reimbursement rate. This bill could impact physician workforce in the future. Increased Medicaid reimbursement would be a better way to address financial difficulties of ARNPs and PAs. Carriers considered a number of factors when negotiating rates and this bill would limit their ability to do that.