Current laws regarding Medicaid reimbursement for nurse practitioners and clinical nurse specialists are extremely complicated in terms of which categories of these advanced practice registered nurses may be reimbursed. In fact, these laws are so confusing for carriers, providers and consumers that they have become a barrier to access to health care services in and of themselves. Under current law, state Medicaid programs are required to provide direct reimbursement to pediatric nurse practitioners, family nurse practitioners and certified nurse midwives. Some states have opted to cover the services of other advanced practice registered nurses, while other states have chosen not to include services of advanced practice registered nurses beyond the current Federal mandate. Although states set their own reimbursement rates for Medicaid providers, payment levels must be adequate to ensure that Medicaid beneficiaries have access to services comparable to those enjoyed by the general population. Millions of Americans each year go without the health care services they need because physicians simply are not available to care for them. This problem plagues rural and urban areas alike. Medicaid beneficiaries are particularly vulnerable, since in recent years an increasing number of health professionals have chosen not to care for them or have been unwilling to locate in the inner-city and rural communities where many of the beneficiaries live. Nurse practitioners and clinical nurse specialists are an exception to this trend; they frequently accept patients whom others will not treat and serve in areas where others refuse to work.
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