Washington Elder Law Practice Report (#6)/ Washington State expands reimbursement for advanced registered nurse practitioners

December 9, 2013

Washington Elder LawThis is installment #6 in a continuing series of Washington Elder Law Practice Reports.

Implementation of the Affordable Care Act (ACA) in Washington State is proceeding rapidly, with growth of new Medicaid enrollees and insurance coverage purchased through the State Exchange www.wahealthplanfinder.org.

As many additional individuals obtain governmental or private insurance coverage for health care services, it may be expected that new pressures will be placed on the provider community, to arrange for cost-effective access to care for more potential patients.

Against this backdrop, the State is increasing reimbursement for independent Advanced Registered Nurse Practitioners (ARNPs), which will likely expand the supply of primary care services.

In an announcement dated November 20, 2013, the Health Care Authority (HCA) has indicated that it is in the process of establishing a new section of the Washington Administrative Code (WAC)—at WAC 182-531-2010—to define how such reimbursement will be “set up”.

This step is being taken in response to a new state statute included in the 2013-2014 budget for the HCA (Third Engrossed Substitute Senate Bill 5034, Chapter 4, Laws of 2013, section 213, subsection 26).

The new statute provides that:

“Within the amounts appropriated in this section, the authority (HCA) shall increase reimbursement rates for primary care services provided by independent nurse practitioners to medicare levels for the period from July 1, 2013, to December 31, 2014.”

This change is consistent with legislative changes that have been advocated by the ARNP community. The ARNPs United organization proposed a 2013 legislative agenda that included working toward legislation that “promotes transparency of health plans and insurers reimbursement practices” and “contains provider neutral language”.

Implementation of the new reimbursement regulations falls under the general authority of the HCA (RCW 41.05.021).

ARNPs are listed as professional providers who are eligible to enroll with the Washington State Department of Social and Health Services (DSHS) to “provide covered health care services to eligible clients….” (WAC 182-502-0002).

A rapid expansion of ARNP roles in the health care system may have many attractive features, in terms of improving access to care and creating a more flexible Health Care System. But such changes may also have unexpected side effects.

Various reactions to a more-rapid deployment of independent ARNPs in Washington may be expected, and plans should be developed for dealing with any issues that arise.

Pressures may increase to further expand and reimburse ARNP services. And hospitals and organized delivery systems may need to modify their practice strategies to accommodate larger community roles by ARNPs.


Employers and insurance companies may have to change the ways in which they deal with ARNPs as essential providers. And it is also yet to be determined how ARNPs  will choose to promote their roles within the Health Care System.

All major changes in the Health Care System tend to lead to reactions by affected organizations. Improved responses to such reactions may be made by looking ahead, and developing plans to minimize any expected impact.

Elder law practice in Washington is discussed by Cheryl and Ferd Mitchell in volumes 26 and 26A of Washington Practice (Washington Elder Law and Practice and the associated Elder Law Handbook). Probate practice is covered in volume 26B.