CNPs are authorized to certify patients to receive therapeutic or palliative benefit from medical use of marijuana. APRNs' SOP is addressed in regulation in that “patient services provided by an APRN must be in accord with the educational preparation of that APRN.” The APRN SOP includes the following: certain acts of medical diagnosis or medical prescriptions of a therapeutic or corrective nature; prescribing assessment studies; legend and certain controlled drugs; therapeutic regimens; medical devices and appliances; receiving and distributing a therapeutic regimen of prepackaged drugs prepared and labeled by a pharmacist; and free samples supplied by a drug manufacturer (excluding receipt of samples of controlled substances). CNSs practice in an independent role; however, a CNP who qualifies as an APRN must practice for at least 24 months under the supervision of a licensed physician, NP, or must be employed by a clinic or hospital that has a medical director who is a licensed physician. APRNs must complete 5 pharmacology contact hours annually as part of their CE requirement (all APRNs with a CAPA-CS must include 1.5 of the 5 contact hours related to the use of the prescription monitoring system, pain management, or addiction disorders).
Recent amendment of regulations (Title 46, Part XL VII, §4513) provides for CRNA Rx authority without a collaborative practice agreement when prescribing or writing orders in a hospital or other licensed surgical facility for services related to anesthesia care. The BON has sole authority to develop, adapt, and revise R&R governing SOP, including Rx authority, the receipt and distribution of sample and prepackaged drugs, and prescribing legend and controlled drugs. APRNs may also dispense nonscheduled legend drugs from local, district, and independent health department settings subject to the direction of the appropriate governing board of the individual health department. APRNs are legally authorized to request and receive, as well as dispense, nonscheduled legend pharmaceutical samples. An APRN who is granted limited Rx authority may request approval to prescribe. Admitting privileges are not granted in this authority. APRNs have Rx authority in Louisiana, including Schedules II-V controlled substances. CNPs and CNMs may prescribe Schedule II-V controlled substances and drugs off-label, according to common and established standards of practice. The APRN SOP, as defined in regulation, includes standards of the national certifying body and “consultation with or referral to medical and other healthcare providers when required by client healthcare needs.” Psychiatric and mental health CNPs and certified PCNSs may sign documents for emergency, involuntary commitment through EDs.
Prior legislation prohibits qualified plans from excluding direct reimbursement of healthcare services provided by an APRN. Reimbursement under indemnity plans is mandated for master's-prepared, certified psychiatric/mental health CNSs; no other third-party reimbursement for APRNs is required by law. The 1999 Act to Increase Access to Primary Health Care Services requires reimbursement under an indemnity or managed-care plan for patient visits to an NP or CNM when referred from a PCP; requires insurers to assign separate provider ID numbers to CNPs and CNMs; and allows managed-care enrollees to designate CNPs as their PCP. CNPs and CNMs receive Medicaid reimbursement at 90% of the physician rate. Medicaid reimbursement for services if they are practicing within their legal SOP. APRNs are statutorily defined as “PCPs”. Louisiana State law includes “any willing provider” language, and APRNs are legally authorized to hold hospital privileges. May be credentialed as allied staff for hospital privileges. When a licensed physician, certified physician assistant, or licensed advanced practice registered nurse has previously certified to the Department that an applicant's condition is both permanent and stable, a special registration plate or placard may be renewed by the applicant without submission of a form signed by a licensed physician, certified physician assistant, or licensed advanced practice registered nurse.
Maryland also recognizes nurse psychotherapists as APRNs (APRN/PMH). NP SOP is independent, defined in statute and regulations, and is in accordance with the Standards of Practice of the American Association of Nurse Practitioners or any other national certifying body recognized by the BON. APRNs must be licensed as an RN, possess a master's degree or higher, and be certified by a national certifying body recognized by the BON, or meet “commensurate requirements” if certification is not available. The CNP must submit written evidence to the BON upon completion of the required clinical experience. BON rules require CNPs and CNMs to have a pharmacology course and prescribe from FDA-approved drugs related to the nurse's specialty. Workers' compensation forms recognize CNPs and allow issuance of license plates and cards for the physically disabled. What are parking cards or Parkcards? Certain screening services for children are reimbursed at 100%. All billing must be under the APRN's provider number, essentially eliminating “incident to” billing, though that option is available under certain conditions. If the medical license was issued in a state other than Michigan, the Physician/Physical Therapist must submit a copy of their medical license.
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