Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQ, Executive Director, Mississippi State Board of Nursing & Phyllis Johnson, MSN, FNP-BC, Director of Advanced

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1 Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQ, Executive Director, Mississippi State Board of Nursing & Phyllis Johnson, MSN, FNP-BC, Director of Advanced Practice, Mississippi State Board of Nursing

2 ! Changes " ONE! New Licensing Software (ThoughtSpan)! Collaboration! Telehealth! Mississippi Division of Medicaid! Monitored Practice! Controlled Substances! Practice Site Definition! MACM Medical Assurance Company of Mississippi! NCSBN APRN Compact Update! Full Practice Authority

3 ! ONE is the new vision for MSBN! One! Nurse! Empowered " Can do many things 58,000 Nurses in Mississippi Of these 3,700 APRNs! Reactive to Proactive " Education (Key)! Office of Nursing Workforce (ONW) " Collecting Demand and Supply Data " Management back under MSBN! NCSBN survey forthcoming! Survey Monkey on satisfaction, telephone service, etc.! Two new nursing positions added to MSBN staff.

4 ! Thoughtspan, implementation date October 2015! Interactive! Discussion & Questions

5 ! Opportunity for improvement, reduce confusion and paperwork for collaboration.! Discussion & Questions! Pilot project, Baptist " Identification of primary care physician.

6 ! NCSBN Telehealth Position Paper! University of Mississippi Center for Telehealth! Mississippi Telehealth Association! TelehealthOne Mississippi! Center for Connected Health Policy (February 2015)! Recent Findings, As of February 2015: " 46 state Medicaid programs reimburse for some form of live video. " 9 state Medicaid programs offer some reimbursement for storeand-forward, not counting states that only reimbursed for tele-radiology. " 14 state Medicaid programs offer reimbursement for remote patient monitoring. " 3 state Medicaid programs (Alaska, Minnesota and Mississippi) reimburse for all three. " 26 states will reimburse either a transmission, facility fee, or both.

7 ! 70 nurse reviewers.! APRNs billing and reimbursement.! Denials reapply!! Review website, changes every quarter.! medicaid.ms.gov! APRN in same like practice.! 800,000 covered lives.! Discussion & Questions

8 ! 720 hours " Licensed as APRN " Either collaboration with Physician or APRN! Why was the monitored practice of 720 hours implemented?! Discussion & Questions

9 ! Prescription Monitoring Program (PMP)! Discussion & Questions! DEA Investigations! National Association of Drug and Diversion Investigation (NADDI) September 24, 2015 annual conference in Raymond, MS

10 ! Physical Location in Mississippi! Site of NPI number! Site of DEA number! Discussion & Questions

11 ! Malpractice for Physicians, which can include APRNs who do group practice.! Questions that are required of physicians by MACM regarding APRNs. " APRN not employee of physician group! Discussion & Questions

12 ! Mississippi is now a compact state, one of 24 states.! RNs included! APRNs not included! Proposed rules that will allow states to be in compact with APRNs.! Discussion: " Proposed changes will include opening of the nurse practice act. " If Mississippi legislatures do not agree, then in 2018, Mississippi will no longer be compact state. If approved will be compact for RNs and APRNs.

13 ! Where we need to go and how to get there.! Appropriate, reliable and succinct data. Patient Centered Care! Demonstrate APRNs can promote healthcare as an economy driver, improve access and put the patient at the center of healthcare.

14 ! The Mississippi State Board of Nursing supports the Advanced Practice Registered Nurse (APRN) to practice to full scope of their education and training. " Motion 7/26/2013

15 ! 1. Discuss APRN s dispensing medications.! 2. Delegation to medical assistants in a clinic without a physician on site.! 3. What are the guidelines or limitations on APRN s who go outside the US on medical trips?! 4. What lobbying efforts have or is the board participating in related to full practice authority?! 5. Protocols Is it to be an additional written document or does our collaborative agreement paper that is signed by the physician suffice?

16 ! 6. If you work at more than one practice site, does the APRN have to have QA/QI at each site or just their primary site?! 7. How do we do away with the limiting regulations concerning NPs writing prescriptions for home equipment, home health, diabetic shoes, compression hose, etc.?! 8. If your collaborating physician does procedures that may not be clearly defined by your scope, how do you get approval from the board to do those procedures or see those patients?! 9. How many hospitals in MS allow APRNs to admit and discharge patients to and from hospitals compared to other states?