Panel OKs rule on patient care despite opposition from nurses

A state legislative panel on Monday officially reviewed a proposed rule requiring insurance companies that offer plans through the Health Insurance Marketplace to participate in the state’s patient-centered medical home program.

Some members of the Administrative Rules and Regulations Subcommittee of the Legislative Council objected to the rule because the program does not allow advanced-practice nurses to lead the so-called homes, or teams of health care professionals who provide care under the program.

The rule proposed by the state Insurance Department would require insurance companies participating in the Health Insurance Marketplace to pay health care providers an average of $5 per month for each customer who is assigned to a patient-centered medical home.

The medical homes are part of the state’s Payment Improvement Initiative, which seeks to replace a fee-for-services payment system with a system in which teams of health care professionals are paid for episodes of care and rewarded for healthy outcomes. More than 170 practices are participating in the initiative, state Surgeon General Joe Thompson testified Monday.

Darlene Byrd of Cabot, an advanced-practice nurse and member of the Arkansas Nursing Association, told the panel the association opposes the proposed rule, which she said would conflict with state and federal laws by barring anyone but a doctor from being a team leader.

“At at time of primary physician care shortage and the coverage of 250,000 newly insured Arkansas citizens, we believe we need to remove the barriers to ensure access to all health care providers and not put up new barriers that would further restrict access to health care for this at-risk population,” Byrd said.

Thompson told the panel that to be consistent with Medicaid rules, the Insurance Department is seeking to define a team leader as a physician. He said a patient’s primary care provider, or the provider who sees the patient the most, would not have to be a physician.