Testimony for Legislature on Disability, Capacity, Mental Health Advanced Directives, and Home Health

This testimony will be offered to the House Committee on Finance for their hearing on 2/23/21 in the Hawai'i State Legislature.  Please comment.

Chair Sylvia Luke, Vice Chair Ty J. K. Cullen, and members of the House Committee on Finance, thank you for this opportunity to provide testimony in strong support of HB302HD1.  This measure seeks to enable APRNs to determine total disability under the income tax code, authorizes advanced practice registered nurses to make capacity determinations, and adds advanced practice registered nurses as primary providers in advance mental health care directives. In addition, permanent establishment of authorization for APRNs is sought, to authorize eligibility for home health services: a barrier to healthcare that has too long been suffered by patients of APRNs. 

Hawaiʻi-ANA prefers the original HB302 of this measure, in particular "Advanced practice registered nurse" means a person licensed as an advanced practice registered nurse pursuant to chapter 457." (Section 3, Page 4 lines 3-7).  The section of HB302 HD1 would restrict these authorities to only APRNs with advanced specialization in psychiatric mental health nursing.  We are in agreement with our colleagues that while psychiatric APRNs are likely the larger group of APRNs who would engage in Mental Health Advanced Directives and capacity determination, it should be noted that other specialties including Adult-Geriatric Nurse Practitioners and Family Nurse Practitioners who care for patients with progressive mental health conditions like Dementia who may seek to establish Mental Health Advanced Directives.  The intent is to broaden access to these services by authorizing all primary care providers to provide these services.  Who but the primary care provider (PCP) for that particular patieint is closest to these personal and family matters?  That PCP may well be an APRN who is a Family Nurse Practitioner or an Adult-Geriatric Nurse Practitioner.  The original definition of an APRN in this bill refers to the refers to chapter 457 which clearly defines the scope of practice issues that protect the consumer, making this restriction to one specialty unnecessary, in our view.

Additionally, we are in agreement with our nurse colleagues in seeking to add language into Chapter 457 to adopt provisions passed in section 3708 of the Federal Coronavirus, Aid, Relief and Economic Security Act (CARES Act) which removed the federal barriers preventing select APRNs from documenting Medicare home health care face-to-face assessments as well as certifying and recertifying patient eligibility. Without this provision, patients who are currently benefitting from the federal authorization will only be able to access this care during the State’s emergency declaration period, particularly patients in rural areas and on neighbor islands. Permanent establishment of this authorization in Hawai‘i Revised Statutes is needed to ensure the changes made permanent in federal statute can be applied in our state. The below language is suggested for this proposed amendment:

”§457 -    Advanced practice registered nurses; home health care services.  Notwithstanding any other law to the contrary, an advanced practice registered nurse as authorized by Sec. 1814., 42 U.S.C. 1395f, and who practices within the appropriate nurse’s practice specialty, may order and certify home health care for their Medicare patients and at the time of doing, has a valid, unrevoked, and unsuspended license obtained in accordance with this chapter.”

Hawai’i-ANA recognizes and supports this opportunity to remove barriers from the practice of APRNs within their authorized scope of practice. APRNs have global signature authority pursuant to HRS Chapter 457-8.8.  We agree with the Hawaiʻi Board of Nursing’s on-going support for recognizing the broad scope of practice underpinned by education, clinical training, and experience, afforded to APRNs within each specialty recognized in HRS Chapter 457. 

Hawaiʻi-ANA respectfully requests that this measure be passed through your committee.  Thank you for your continued support for measures that address the need for improving access to safe and effective healthcare provided in communities throughout Hawaiʻi.