The term "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.
An ARNP's scope of practice is defined by the Washington State Board of Nursing and includes:
In 2024, the title for ARNPs was changed to advanced practice registered nurses (APRNs), but the title change is not in effect until June 30, 2027.
A physician assistant (PA) is a person who is licensed by the Washington Medical Commission to practice medicine under the terms of one or more collaboration agreements. A collaboration agreement is a written agreement that describes the manner in which a PA is supervised by or collaborates with at least one physician, which must be signed by the PA and one or more physicians or the PA's employer. PAs may practice in any area of medicine or surgery as long as the practice is not beyond the scope of expertise and clinical practice of the participating physician or physicians within the department or specialty areas in which the PA practices. The participating physician or the PA's employer and the PA must determine which procedures may be performed and the degree of autonomy under which the procedure is performed.
For health plans, other than health plans offered to public employees, issued or renewed on or after January 1, 2026, a health carrier may not reimburse a contracted APRN or PA in an amount less than the 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 when an APRN or PA is providing primary care services or behavioral health care services, including medication management and therapy.
A carrier may not pay a contracted physician more by making nonclaims-based payments to physicians that are not also made available to APRNs or PAs for the same service in the same service area. A health carrier may not reduce the reimbursement amount paid to physicians and osteopathic physicians to comply with this requirement.
The Office of the Insurance Commissioner (OIC) must collect data from on the implementation of this requirement beginning January 1, 2026, from health carriers or from other available sources including the all-payer claims database. By July 1, 2027, the OIC must report to the relevant committees of the Legislature on the number of insurers that have changed their reimbursement policy because of these requirements, the number of APRNs or PAs whose reimbursement increased, the number of physicians whose reimbursement decreased, and the cost to insurers to implement these requirements. These requirements do not apply to APRNs or PAs who are employees of a health maintenance organization.
Service area means the geographic location area or areas where a specific product is issued and rated, accepts members and enrollees, and covers provided services. A service area must be defined by the county or counties included, unless the commissioner permits limitation of a service area by zip code in rule or an applicable payment methodology uses an alternative service area designation.
PRO: Beginning in 2013 most health plans reduced the reimbursement rates for APRNs to 85 percent of what physicians were paid, despite lots of evidence showing APRNs practice safely. This bill restores reimbursement to prior levels. These reductions make it difficult for practices to remain financially solvent . Decreased reimbursement limits ability to accept new patients.
CON: Due to physicians' training and education, they are able to provide more advanced services. These professionals have chosen a different profession than a physician, which comes with different education levels and costs. If this bill passes there is no financial incentive to pursue the additional training to become a physician. This change will increase health insurance premiums.
OTHER: Labor and Industries completed a three-year pilot project that allowed APRNs to fill the role of attending provider in the Worker's Compensation System. When comparing APRNs to physicians, the pilot found that they did not differ on cost or disability measures after one year and that APRNs provided more care in rural areas.
PRO: Andrea Phillips; Madison Hultquist; Gabriella Romero; Melissa Mossar; Paul Surette; Natalie Paul, Lavender Spectrum Health; Kathleen King; Linda van Hoff, ARNP, ARNPs United of Washington State (AUWS); Maddy Wiley, MSN, ARNP, FAANP, ARNPs United of Washington State (AUWS); Shannon Fitzgerald, ARNP, ARNPs United of Washington State (AUWS); Dan Richer; Karen Rogers.
PRO: This bill addresses critical health care shortages by redirecting funds from large insurance companies to small and independent practices, helping with operational costs like rent, utilities, and staffing. They emphasize the need for reimbursement parity, particularly in primary care and behavioral health, to ensure that APRNs and PAs are adequately reimbursed for their services, enabling these practices to stay open and continue serving vulnerable populations. Reducing disparities in reimbursement will help increase access to care in underserved areas, including for chronic conditions, HIV prevention, and mental health services. This bill supports independent practices, will improve care, and reduce long-term health care costs.
CON: This bill could have negative consequences for workforce recruitment and patient care, particularly in specialties like psychiatry. This disincentivizes medical students from entering the field by offering equal reimbursement for providers with differing levels of training, which could exacerbate existing shortages and limit access to physician-led specialty care. The bill’s cost will ultimately increase patient expenses, reduce quality of care, and create an unsustainable financial burden on the health care system.
PRO: Natalie Paul, Lavender Spectrum Health; Devon Connor-Green, ARNPs United of Washington State / AAPPN; Justin Gill - DNP, RN, ARNP, Washington State Nurses Association (WSNA); Shannon Fitzgerald, ARNP, ARNPs United of Washington State (AUWS); Joshua Lumsden, WAPA President, Washington Academy of Physician Assistants (WAPA).