Nurse-practitioners push bill to align insurer coverage rules with full practice authority

BOSTON — The Massachusetts Coalition of Nurse Practitioners urged the Joint Committee on Financial Services and Insurance to report H.1140 favorably to ensure insurers recognize nurse practitioners as independently authorized providers for coverage determinations now that Massachusetts grants full practice authority to eligible NPs.

Katharine MacKinnon, executive director of the coalition and a licensed nurse practitioner, said licensed NPs in Massachusetts can independently evaluate patients, diagnose, order and manage treatment and prescribe medications in accordance with state licensure and Board of Registration in Nursing regulations. "Despite this legal authority, many state insurance statutes have not been updated and continue to require physician involvement as a condition of coverage for certain services," she said, citing denials where insurers required physician confirmation even though NPs were legally qualified to provide the service.

MacKinnon gave examples she said arise when insurers refuse to recognize NPs as the provider of record: delayed coverage for diagnostic evaluations for autism for a child diagnosed by a pediatric NP and denied coverage of supplemental nutrition ordered by a primary-care NP for a patient with chronic gastrointestinal disease. She said the bill does not expand scope of practice but ensures insurers allow NPs to satisfy coverage requirements consistent with their licensure.

She urged the committee to update statutes so coverage rules reflect practice realities and to protect access in rural and underserved areas where NPs often serve as primary providers. The committee did not vote; MacKinnon requested a favorable report.