Insurers' Contracting Policies on Nurse Practitioners as Primary Care Providers

The Current Landscape and What Needs to Change

Hansen-Turton, Tine BA, MGA
Ritter, Ann BA, JD
Begun, Heather BA
Berkowitz, Sandra L. RN, JD
Rothman, Nancy EdD, RN
Valdez, Brian BA, JD

Tine Hansen-Turton, BA, MGA, is executive director of National Nursing Centers Consortium in Philadelphia, Pennsylvania.
Ann Ritter, BA, JD, is a policy analyst at the National Nursing Centers Consortium in Philadelphia, Pennsylvania.
Heather Begun, BA, is a BSN/MSN candidate at the University of Pennsylvania, School of Nursing, in Philadelphia, Pennsylvania.
Sandra L. Berkowitz, RN, JD, is a health care consultant at the National Nursing Centers Consortium in Philadelphia, Pennsylvania.
Nancy Rothman, EdD, RN, is Independence Foundation Professor of Urban Community Nursing and director of community-based practices, Department of Nursing, College of Health Professions, Temple University, in Philadelphia, Pennsylvania.
Brian Valdez, BA, JD, is a health policy manager at the National Nursing Centers Consortium in Philadelphia, Pennsylvania.

Policy, Politics & Nursing Practice 7(3):p 216-226, August 2006.

A national survey showed that most insurance companies refuse to credential nurse practitioners as primary care providers in nurse-managed health centers. These prohibitive policies, along with weak federal and state laws, threaten the long-term sustainability of nurse-managed health centers as safety-net health care providers and limit the ability for nurse practitioners to become an accepted primary health care source in the United States. Interviews with national managed care organizations revealed that these companies' current business practice and policies are unlikely to change without regulatory change at state and/or federal levels.