Reimbursement of Care Provided by Advanced Registered Nurses

FORMS AND RATES BULLETIN NO. 7 REIMBURSEMENTS FOR CARE PROVIDED BY ADVANCED REGISTERED NURSES Original NO. 90-12 Adopted November 30, 1990 Amended April 15, 1992 The purpose of this bulletin is to provide a definition for “advanced registered nurse” as that term is used in a new Section 2318 of the Delaware Unfair Practices Act. This definition is provided pursuant to the Commissioner’s rule making authority under 18 Del. C., Section 314. Section 2318 becomes effective on January 1, 1991. The statute prohibits discrimination in providing reimbursement for services provided by advanced registered nurses. To comply with Section 2318 insurers shall use the definition of “advanced registered nurse” as follows: “Advanced registered nurse” or “advanced registered nurse practitioner” means a currently licensed registered nurse who has gained added knowledge and skills through an organized post-basic program of study and clinical experience and who has met national certification requirements as approved by the Delaware Board of Nursing and is designated to perform advanced or specialized nursing practice. Advanced registered nurse or nurse practitioner shall include, but not be limited to, pediatric nurse practitioner, family nurse practitioner, maternal-gynecological nurse practitioner, clinical specialist in psychiatric-mental health nursing, nurse anesthetist and gynecological nurse practitioner.” Section 2318 requires all health insurers and health service corporations licensed in Delaware to provide reimbursements to advanced registered nurses/nurse practitioners who act within the scope of their practice and/or definitions pursuant to professional licensing laws. Health insurers and health service corporations are prohibited from discriminating against advanced registered nurses/nurse practitioners as providers of covered services. The statute does not expand coverage, but requires only that reimbursement be afforded to registered nurse practitioners who provide services or treatment for already established coverage benefits.