Nurse Practitioner Law

Legal Issues Facing Nurse Practitioners

Newly enacted laws have created an unprecedented expansion of the scope of practice for both APRNs and nurse midwives. It allows for qualified APRNs (there is specific criteria) to practice independent of a supervising physician in the following areas of medicine: primary care, family medicine, general pediatrics, and general internal medicine.

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Newly enacted 464.0123 created an unprecedented expansion of the scope of practice for both APRNs and nurse midwives. It allows for qualified APRNs (there is specific criteria) to practice independent of a supervising physician in the following areas of medicine–primary care, family medicine, general pediatrics, and general internal medicine.

Even more, assuming they meet the membership criteria for admission to a healthcare facility medical staff, they may admit patients, manage patient care, and discharge patients. One of the only preserved connections with a physician established by the law is if the APRN practices at a healthcare facility, a transfer agreement including a physician is required. Additionally, the new law establishes a Council On Advanced Practice Registered Nurse Autonomous Practice, two members of which are appointed by the Board of Medicine and an additional two appointed by the Board of Osteopathic Medicine.

While a “game changer” in Florida, the new law also extends to APRNs many of the same restrictions and regulations applicable to physicians for many years, including state self-referral restrictions (the “Florida Patient Self-Referral Act of 1992”), adverse incident reporting, fee splitting prohibitions and professional liability insurance requirements, none of which were directly applicable to APRNs before the new law.

The law distinguishes between APRNs that engage in autonomous practice and those that do not, pinning very particular clinical requirements and responsibilities to those who elect to practice autonomously. They are not all bound by the specific provisions applicable to autonomously practicing APRNs. Finally, the new law is clear that neither commercial insurance, self-insurance nor HMOs may require a patient to treat with an autonomously practicing APRN.

The new law will require APRNs who desire to practice autonomously to come up to speed on things like:

  • The Florida Patient Self-Referral Act of 1992, which (a) prohibits them from owning certain healthcare services (“designated health services” or “DHS”) and referring to them, and (b) imposes supervision requirements on them for the provision of allowed DHS;
  • Professional liability insurance. They will need to understand about concepts like “claims made vs. occurrence coverage and tail insurance;
  • Medicare regulations which, among other things, require (1) patients who will receive non-covered services to first sign an ABN form; and (2) federal supervision requirements;
  • Corporate law, so they make the best choice in terms of legal entity through which to practice (e.g. LLC vs. PA and s corp election with the IRS);
  • Restrictive covenant law, which will help them understand how to best protect their business via non competes, non-solicits and confidentiality provisions;
  • The state Health Care Clinic License Act, in the event they want to open a practice with a non-physician/non-APRN owner; and
  • All issues pertaining to in network and out of network provider arrangements.

In addition, there are serious business pressures that have to be carefully navigated to ensure success. This is especially the case because the specialties where autonomous practice is open (GP, FP, PCP and internal medicine) happen to involve lower reimbursement by payers and high staffing requirements. From a business perspective, these are not “easy” practices. Issues like HR, billing and collecting, practice administration and regulation are especially challenging and will likely be even more challenging to APRNs who likely will not receive the same level of reimbursement from payers that physicians do. In short, it’s aint easy! Especially when one considers that the primary adaptation in these service areas is to combine and be part of a larger practice group, if only to better bear the overhead expenses. The trend here is NOT more and smaller practices.

The expanded scope of practice for APRNs will likely create tremendous opportunities for those who prepared, well-educated and advised BEFORE they move forward. While not a “one size fits all” business, there are a large handful of complex issues that need to be locked down before proceeding.

By: Jeff Cohen

The issue of scope of practice is front and center in Florida right now with the expansion of what nurse practitioners (and nurse midwives) are legally permitted to do.  The newly enacted 464.0123 allows for qualified APRNs (there is specific criteria) to practice independent of a supervising physician in the following areas of medicine–primary care, family medicine, general pediatrics, and general internal medicine.

Even more, assuming they meet the membership criteria for admission to a healthcare facility medical staff, they may admit patients, manage patient care, and discharge patients.  One of the only preserved connections with a physician established by the law is if the APRN practices at a healthcare facility, a transfer agreement including a physician is required.  Additionally, the new law establishes a Council On Advanced Practice Registered Nurse Autonomous Practice, two members of which are appointed by the Board of Medicine and an additional two appointed by the Board of Osteopathic Medicine.

Read on.

By: Chase Howard

In March, the Florida Legislature passed multiple bills that would allow advanced practice registered nurses (APRN) to practice independently of physicians in the delivery of primary care practice. The law, however, went into full effect on July 1. Still, the law did not automatically grant autonomous practice to all nurse practitioners. Rather, an application process is still needed, as well as final regulations governing the new law.

In June, the Florida Board of Nursing voted to move forward with the drafting of rules and the application process to be designated as an independent practice Nurse Practitioner. This process usually takes three months to complete before it is open for practitioners to apply. The Board also voted to define “primary care practice” to include “health promotion, disease prevention, health maintenance, counseling, patient education, and diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings.”

Until final rules are decided, a nurse practitioner will at least need to meet the following requirements:

Read on.

By: Chase Howard

Florida is the latest state to expand the practice of Advanced Practice Registered Nurses. In March 2020, autonomous practice was passed and signed into law, with the law going into effect in July. In October, the Board of Nursing promulgated rules and provided the application for NP’s seeking to practice autonomously.

Before qualifying for autonomous practice, however, an NP must meet the following requirements:

Read on.

By: Chase Howard

In another article, we provided an update to the autonomous practice law for Nurse Practitioners in Florida. For NP’s that qualify, that means they can open a primary care practice without a supervising physician. For most, that means learning about opening and operating a company. Here’s what that entails:

  1. Corporate Structure A company is a legal entity and recognized by both the IRS and the State of Florida. Many different options are available based on the type of business, number of partners, and type of risk involved. In Florida, many primary care practices are either a “professional association” or a “limited liability company”. As it relates to taxes, there are many options, included a common option called an “s-corp”.

Read on.

By: Chase Howard

With the passage of autonomous practice ability for nurse practitioners in Florida this year, many are wondering how this will affect the healthcare industry in Florida. In a traditional sense, rural and underserved areas should have the opportunity for growth in healthcare providers. The autonomous practice law removes restrictions on certain nurse practitioners, granting them the ability to practice in primary care practice settings without worrying about supervision restrictions. Outside of that, the application of the new law can expand healthcare business offerings and abilities.

Read on.

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