The Assembly amended and approved a bill Thursday that would allow advanced practice nurses to practice independently, while also taking up two bills passed on party lines that would bar automatic Medicaid renewals and stop some from turning down work to stay in the program.
Under an amendment to the nursing bill, advanced practice nurses who have completed 3,840 clinical hours of practice while working with a physician or a dentist would be allowed to work independently.
They could only provide pain management services while working in a collaborative relationship with a doctor, except if providing the services in a hospital or clinic associated with a hospital.
“Ultimately, this bill, when passed, will lower healthcare costs as well as increase access,” bill co-author Rep. Rachael Cabral-Guevara, R-Appleton, said on the floor before passage of the plan.
Cabral-Guevara said “not only the nurses, but the physicians” worked “to come to a bill that is passable.”
But Mark Grapentine, Wisconsin Medical Society chief policy and advocacy officer, said that the coalition of physician groups that were working on the bill did not reach a deal with lawmakers. They’ll ask Gov. Tony Evers to veto the plan.
“While the amendment that passed today took some smaller steps in the direction physicians felt were necessary to protect our state’s patients, it left other concerns unaddressed,” he said. “So what the Assembly passed fails to include what we felt were bare minimum guardrails.”
Grapentine said it was disappointing to hear comments on the Assembly floor that made it seem like doctors signed off on the bill as amended.
Doctor groups pushed for an amendment requiring 4,000 hours of experience of professional nursing practice and an additional 4,000 hours of physician-supervised experience after obtaining an advanced practice registered nursing certification before the nurses could practice independently.
They also asked that physician-specific terms like medical doctor and anesthesiologist only be used by those with physician-specific degrees.
And they wanted to see nurses outside a hospital setting practice pain management under the supervision of, or in collaboration, with a doctor trained in pain medicine.
The amendment doesn’t include specific training for the doctor the nurse would work with, “which doesn’t provide the level of safety we think is necessary for this area of medicine,” Grapentine said.
Wisconsin Nurses Association CEO Gina Dennik-Champion said the bill would allow advanced practice nurses to practice at the full scope of their license. They’ll be asking Evers to support the bill, which she says provides “access to quality, safe, affordable” care.
“Our state desperately needs these providers to be practicing in these places where there are no physicians,” she said.
Dennik-Champion said the “guardrails are there” with what the bill requires nurses to do to be licensed as advanced practice nurses.
The amendment includes a “transition to practice” provision similar to other states that requires nurses to practice for two years with a doctor before working independently, she noted.
Dennik-Champion said that title protections for physicians can be “addressed at another time” and including it “didn’t make sense at this time” since the bill focuses on advanced practice nurses. If physicians want the protections, they could look at including it in their own practice act, she said.
Certified registered nurse anesthetists delivering pain management services in clinics have to complete a fellowship before they can provide the service, she added, in response to doctors' concerns about that provision in the amendment.
“We think we have a bill that is clean and should be supported and enacted,” Dennik-Champion said.
Besides acting on the bill, the chamber also took up a series of workforce plans that, among other things, would make changes to the state’s Medicaid program.
One of the measures approved by lawmakers would bar the Department of Health Services from automatically renewing a Medicaid recipient’s eligibility. DHS would have to determine eligibility every six months, rather than annually. Any enrollee failing to report changes that affect their eligibility would be ineligible for benefits for six months from the date DHS discovers the change.
Wisconsin’s Medicaid program is under a continuous enrollment policy to qualify for more federal dollars during the COVID-19 national public health emergency. Under the bill, DHS would have to “promptly” remove people deemed ineligible for Medicaid once the funding ends. Until then, it would have to report the number of ineligible enrollees still receiving benefits.
A separate measure, from Rep. Calvin Callahan, R-Tomahawk, would bar some BadgerCare adults from turning down work or accepting a raise in order to maintain eligibility for the program.
“We are not kicking people off healthcare,” he said. “This bill would only affect those who are able-bodied and actually refuse work in an attempt to maintain their eligibility status.”
Advocates for those with disabilities and lower-income people oppose the measures. William Parke-Sutherland, health policy analyst for Kids Forward, said Callahan’s measure doesn’t take into account whether jobs provide affordable health insurance, offer hours recipients can’t meet or offer work that is unsuitable for their circumstances.
The Medicaid enrollment bill would pose hurdles for people to renew their coverage, requiring them to submit twice as much paperwork to keep it. The plan would also bar the state from using one of its best tools to ensure people have continuous health insurance coverage, Parke-Sutherland said.
“These changes would weaken the workforce by making our state sicker and would worsen stark racial inequities in who has access to care and coverage,” he said in a statement.
The Assembly passed the Republican-backed measures on party lines, advancing them to the Senate for further consideration.
The chamber also passed a measure along party lines that would bar the governor from declaring certain businesses essential or nonessential during a public health emergency. Any actions applied during such an emergency to businesses would have to be applied to all uniformly.
They also signed off on legislation requiring additional reporting on public benefits and the work of the Wisconsin Department of Health Services’ Office of the Inspector General.
Lawmakers signed off on a bill that would regulate and license genetic counselors, amending the plan so that it bars those in the profession from encouraging an expectant parent to obtain an elective abortion.The Assembly also advanced the biennial agreed-upon bill recommended by the Worker’s Compensation Advisory Council.