CNS Advocacy Issues

NACNS is committed to highlighting the unique contributions clinical nurse specialists bring to addressing key issues in health care.


APRNs at VA Facilities

NACNS has been urging the Department of Veterans Affairs (VA) to amend its restrictions on APRNs in VA facilities and allow them to provide health care services to the full extent of their education.  After years of advocacy by NACNS and other nursing groups, the VA issued a final rule that recognizes the full practice authority of three of the APRN roles – clinical nurse specialists, nurse practitioners, and certified nurse-midwives in December, 2016.

In response to the final rule, NACNS is requesting that the VA also include certified registered nurse anesthetists, the fourth APRN role, as one of the APRNS allowed to practice to the full extent of their education and certification.

NACNS Statements and Media Coverage

NACNS Public Comments


MACRA Final Rule

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) shifts the health care payment system towards value and repeals the Medicare Sustainable Growth Rate methodology for updates to the Physician Fee Schedule and replaces it with a new approach to payment called the Quality Payment Program.  The major provisions of MACRA, the Quality Payment Program and their implications for NACNS members is included in this summary.


2018 Standard Occupational Classification

In recommendations to the Office of Management and Budget for the 2018 Standard Occupational Classification, the Standard Occupational Classification Policy Committee (SOCPC) declined to include clinical nurse specialists in a separate broad occupation and detailed occupation category stating:

Multiple dockets requested a new detailed occupation for Clinical Nurse Specialists.  The SOCPC did not accept this recommendation based on Classification Principle 2 which states that occupations are classified based on work performed and on Classification Principle 9 on collectability.

This is the second time that the SOCPC did not accept NACNS’ request to make the CNS a new detailed occupation in the Standard Occupational Classification.

Read the extensive 2014 filing on why the clinical nurse specialist should be included in the Standard Occupational Classification as a “broad category.” NACNS commented in September 2016, responding directly to the committee, and publicly, regarding the latest SOCPC announcement.

Additional Resources


Cardiac Care Bundled-Payment Model

The Centers for Medicare & Medicaid Services proposed a new bundled-payment model in July 2016, for Medicare patients admitted for heart attack and cardiac bypass surgery. The models continue CMS’ commitment to migrating Medicare away from fee‐for‐service payments and toward a value‐based environment. To improve care coordination and increase program flexibility, the models are proposing waivers that redefine physicians to include non-physicians like clinical nurse specialists, nurse practitioners or physician assistants.

This cardiovascular bundled-payment model will be tested in a five-year demonstration beginning in July, 2017.

More information is included in the summary.


APRN Consensus Model

NACNS calls for careful implementation of the APRN Consensus Model in order to preserve patient and health care system access to clinical nurse specialist services, particularly given the significant influence the CNS role has on cost and quality of health care outcomes.

Additional Resources