Florida Tax Watch Report and Recommendations of the Government Cost Savings Task Force for FY2012-13.

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32. Expand the role of Advanced Registered Nurse Practitioners & Physician Assistants Advanced Registered Nurse Practitioners (ARNP) and Physician Assistants (PA) are highly trained graduate-level medical professionals. These professionals work predominately in primary care, however, a percentage comprise specialty fields. ARNPs and PAs are both state and nationally certified. They treat both physical and mental conditions through analyzing patient history, physical exams, and interpreting diagnostic tests results. ARNPs and PAs diagnose disease and suggest appropriate treatment for the patients, including prescribing medication. In the majority of routine medical visits, ARNPs and PAs can serve as the primary health care provider and remain an efficient and effective alternative to primary care physicians. According to Florida law, ARNPs and PAs are permitted to independently manage common medical problems and may initiate, monitor, alter or order drug therapies as a nursing function. Any drug therapy that an ARNP or PA prescribes, initiates, monitors, alters, or orders must be within their scope of practice, knowledge, and training, and must be authorized by the supervising physician.35 Several states have granted ARNPs and PAs the authority to prescribe controlled substances independently with 47 states allowing this authority under a physician’s supervision.36 A number of research reports have revealed that the prescription habits of ARNPs and PAs are identical to their physician colleagues. This is an important factor when addressing the potential dangers of controlled substances and the negative impacts of pain clinics in Florida. Expanding the scope of practice for Advanced Registered Nurse Practitioners (ARNPs) and Physicians Assistants (PAs) can generate potential cost savings of $7 million to $44 million annually for Medicaid, $744,000 to $2.2 million for state employee health insurance, and $339 million across Florida’s entire health care system.37 If the legislature grants ARNPs and PAs the ability to grant prescriptions independently and bill insurance directly, the state would save $339 million annually.

Recommendation: There are two phases of implementation available that will produce varying levels of cost savings. The first recommendation phase requires the Florida Legislature to grant ARNPs and PAs prescription authority for controlled substances with the supervision of a physician and within the scope of their practice. The second phase expands the scope to allow ARNPs and PAs to practice independently of a physician. This includes prescription of controlled substances and direct billing to Medicaid and insurance providers. To achieve this, the Legislature must clarify s.458.347, F.S., and s.459.022, F.S., to define the scope of practice for ARNPs and PAs. In addition, the Legislature must create language to allow ARNPs and PAs to conduct direct billing in the same manner as physicians. The final step would be to amend the administrative rules governing this area of practice under the Florida Department of Health.

35 “Authorization for Advanced Registered Nurse Practitioners to Prescribe Controlled Substances.” Florida Senate. Committeeon Health Regulation. October 2008. Interim Report 2009-117 36 Ibid.

37 OPPAGA, “Expanding Scope of Practice for Advanced Registered Nurse Practitioners.” Research Memorandum, December30, 2010. The $339 million in savings across Florida includes small businesses and individuals who purchase insurance directly through providers.

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