From which sources does the NP derive authority to bill for services under Medicaid?

The authority for Nurse Practitioners (NPs) to bill for services under Medicaid comes from both state and federal law. Federal law serves as the foundation for Medicaid programs across the United States, providing guidelines on eligibility, reimbursement, and service coverage. However, because Medicaid is administered at the state level, each state has the authority to establish its own regulations and billing practices for healthcare providers, including NPs.

This dual framework means that while federal law sets the minimum standards and guidelines that states must follow, state laws can expand upon or further define how NPs operate within their Medicaid systems. Therefore, to effectively bill for services under Medicaid, NPs must be aware of both the federal Medicaid requirements and their specific state's regulations and scope of practice for billing.

Other options lack the comprehensive nature required for billing authority. State law alone cannot account for the broader federal mandates, and federal law alone would not adequately reflect the state-specific regulations vital for NPs to practice and bill for their services effectively. Furthermore, while third-party payers play a role in reimbursement for services, they do not establish the foundational legal authority under which NPs operate within the Medicaid framework. Thus, the combination of state and federal law is essential for NPs to have the authority to