Benefit: Advanced Registered Nurse Practitioner (ARNP)

Definition: An ARNP is a registered nurse who has completed specific advanced nursing education (generally a master's degree) and training in the diagnosis and management of common as well as complex medical conditions. ARNPs treat both general and chronic conditions through comprehensive history taking, physical exams, prescribing medications, physical therapy, ordering tests and therapies for patients, within their scope of practice. Many ARNPs can write prescriptions. ARNPs must work in collaboration with a doctor.

Limits:  Medicaid reimbursement for ARNP services is limited to:

• One ARNP-recipient contact per day (except for emergencies);
• One long-term care facility service, per ARNP, per month, per recipient (except for emergencies);
• Ten prenatal visits per recipient per pregnancy. Two postpartum visits per recipient per pregnancy; and
• One new patient evaluation and management service per physician assistant, per recipient every three years, if no services were rendered by the physician assistant to the recipient during the three years. Subsequent encounters must be reimbursed as established patient evaluation and management services. An additional new patient visit cannot be done by the supervising doctor of the ARNP for a patient already seen as a new patient by an ARNP.

Exceptions: The ARNP may request authorization for reimbursement for services in excess of the service limitations.

Co-pays: $2 for ANRP services, per provider, per day, unless exempt.

Reform items that can vary: Co-pays