Antitrust Law Daily Wrap Up, ANTITRUST NEWS: FTC staff comments on VA proposal for advanced practice registered nurses, (Jul 25, 2016)

By Linda O’Brien, J.D., LL.M.

In response to the U.S. Department of Veterans Affairs (VA) request for public comments on a proposed rule granting full practice authority to advanced practice registered nurses (APRNs), the staff of the FTC’s Office of Policy Planning, Bureau of Economics, and Bureau of Competition stated in a comment today that removing the remaining state law based supervision restrictions for APRNs working within the VA system could benefit VA patients nationwide "by improving access to care, containing costs, and expanding innovation in health care delivery."

The proposed rule would permit the VA to grant "full practice authority" to the four main categories of APRNs—Certified Nurse Practitioners ("CNPs"), Clinical Nurse Specialists ("CNSs"), Certified Nurse Midwives ("CNMs"), and Certified Registered Nurse Anesthetists ("CRNAs")—provided certain background conditions are met. Those background conditions are verification of an APRN’s credentials, including licensure under the laws of at least one state, and determination that the APRN has demonstrated the knowledge and skills necessary to providing the health care services that the VA requires.

As defined by the proposed rule, "full practice authority" means that APRNs employed by the VA would be able to provide certain services "without the clinical oversight of a physician, regardless of State or local law restrictions." APRNs generally would be able to evaluate VA patients, order diagnostic tests for them, and manage their treatments without physician involvement or approval as long as they do so within the limits of their professional education and training. In its announcement of the proposed rule, the VA recognizes that CNPs – the main category of primary care APRNs – already have full practice authority under the laws of over 20 states and the District of Columbia.

The FTC staff comment supports the effort to maximize VA staff capabilities. The FTC’s prior examination of the impact of nursing regulations on health care competition reinforces the VA’s view that the proposed rule would increase the Veterans Health Administration’s (VHA) ability to provide timely, efficient, and effective primary care services and increase veteran access to needed health care, particularly in medically underserved areas, as well as decrease the amount of time veterans spend waiting for patient appointments. These changes in VA policy may also benefit health care consumers in private markets. Accordingly, the FTC staff encouraged "the VA to continue its efforts, as embodied in the proposed rule, to improve access to care for VHA patients, and to provide that care effectively and efficiently."

News: Antitrust FederalTradeCommissionNews