3/7/2012
Jan Towers, PhD, NP-C CRNP, FAANP, FAAN Presents Region 11 Legislative and Regulatory Update February 4, 2012
2/4/2012
Freshman By State
Florida Alabama Sen. Marco Rubio (R) Rep Terri Sewell (D) Rep Sandy Adams (R) Rep Martha Roby (R) Rep Frederica Wilson (D) Rep Bobby Bright (D) Rep Steve Southerland (R) Mississippi Rep Daniel Webster (R) Rep Alan Nunnellee (R) Rep Dennis Ross (R) Rep Steven Palazzo (R) Rep David Rivera (R) Rep Gene Taylor (D) Rep Allen West (R) Rep Travis Childers (D) Rep Richard Nugent (R) Rep Alan Grayson (D) Georgia Rep Suzanne Kosmas (D) Rep Austin Scott (R) Rep Ron Klein (D) Rep Rob Woodall (R) Rep Allen Boyd (D) Rep Jim Marshall (D)
2/4/2012
Patient Protection Affordable Care Act
2/4/2012
1 3/7/2012
Proposed Legal Action
Major issue: Constitutionality of Universal Coverage Requirements
Car owner permit concept (14 states challenging constitutionality) Others states examining opt out options and state constitution changes
Law Experts: Law is not unconstitutional State law can’t nullify federal law Not likely to get through the court system
14 Judges Dismissed 3 Rule Provision is Constitutional 2 Rules Universal Health Coverage is Unconstitutional* 1 Rules Totally Unconstitutional*
Supreme Court Rejects Bypass Appeal *Appeals to Supreme Court Hear Oral Arguments: March 26-28, 2012 Decision Expected: June/July 2/4/2012
HR 2 Repeal PPACA HR 1 Attempted Amendments
2/4/2012
Bill Content
Protects choice (2010-15) Protects individuals with preexisting conditions (2010) Protects against caps and out of pocket requirements (2010 (6 mos.)) Universal coverage (2014) Protects small business (2010-14) Expands Medicaid (2014) Closes doughnut hole in Medicare (2010-20) Quality/health system performance (2010 (6 mos.)) Funding for workforce training (2011) 2/4/2012
2 3/7/2012
Nurse Practitioner Issue Status
Provider neutral language Primary Care Provider Medical Home: Pilot (2011-19) Independence at Home (2010-14) Nurse-managed centers; school based clinics (2010-14) Accountable Care Organizations (ACOs) (2013) GNE Legislation (2012-15) Advanced Practice Education Authorization (2011) Non Discrimination Language (Immediate) 2/4/2012
GNE Legislation
Clinical Education for APRNs $10 Million to Five Hospitals Required: 50% for Community Based Clinical Education
2/4/2012
Other NP Areas of Concern
Accountable Care Organization (2014) Insurance Exchanges (2014) Ordering Home Health Durable Medical Equipment HIT Medicaid IPAB (Independent Payment Advisory Board) (2012)
2/4/2012
3 3/7/2012
Appropriations
Title VIII Title VII National Health Service Corp, Community Health Centers, Ryan White (HIV), Maternal Child Health Nurse Managed Health Centers
Fund Health Care Reform Provisions
2/4/2012
2013 Appropriations
Presidents Proposal Budget Committee Appropriations Committee
2/4/2012
Nurse Managed Clinics
CMMI Challenge Grant HRSA – Division of Nursing Appropriations
2/4/2012
4 3/7/2012
Home Health Care Planning Improvement Act of 2011 S 227
Sen Collins, Susan [ME] Sen Reed, Jack [RI] Sen Wyden, Ron [OR] Sen Akaka, Daniel K. [HI] Sen Chris Coons [DE] Sen Conrad, Kent [ND] Sen Scott Brown [MA] Sen Inouye, Daniel K. [HI] Sen Jeff Merkley [OR] Sen Johnson, Tim [SD] Sen Shaheen, Jeanne [NH] Sen. Casey, Bob [PA] Sen Whitehouse, Sheldon [RI]
Cosponsors Needed
2/4/2012
Home Health Care Planning Improvement Act of 2011 HR 2267 Lead sponsor: Greg Walden (R-OR)
Rep Altmire, Jason [PA-4] Rep McIntyre, Mike [NC-7] Rep Baldwin, Tammy [WI-2] Rep Meehan, Patrick [PA-7] Rep Barletta, Lou [PA-11] Rep Michaud, Michael H. [ME-2] Rep Bass, Charles F. [NH-2] Rep Napolitano, Grace F. [CA-38] Rep Bilbray, Brian P. [CA-50] Rep Neal, Richard E. [MA-2] Rep Blumenauer, Earl [OR-3] Rep Neugebauer, Randy [TX-19] Rep Bordallo, Madeleine Z. [GU] Rep Owens, William L. [NY-23] Rep Boswell, Leonard L. [IA-3] Rep Paul, Ron [TX-14] Rep Brady, Robert A. [PA-1] Rep Pingree, Chellie [ME-1] Rep Butterfield, G. K. [NC-1] Rep Platts, Todd Russell [PA-19] Rep Capps, Lois [CA-23] Rep Rahall, Nick J., II [WV-3] Rep Chandler, Ben [KY-6] Rep Rothman, Steven R. [NJ-9] Rep Cicilline, David N. [RI-1] Rep Schakowsky, Janice D. [IL-9] Rep Coble, Howard [NC-6] Rep Schrader, Kurt [OR-5] Rep Coffman, Mike [CO-6] Rep Schwartz, Allyson Y. [PA-13] Rep Connolly, Gerald E. "Gerry" [VA-11] Rep Slaughter, Louise McIntosh [NY-28] Rep Courtney, Joe [CT-2] Rep Smith, Christopher H. [NJ-4] Rep DeFazio, Peter A. [OR-4] Rep Terry, Lee [NE-2] Rep Dent, Charles W. [PA-15] Rep Thompson, Mike [CA-1] Rep Ellison, Keith [MN-5] Rep Tiberi, Patrick J. [OH-12] Rep Grijalva, Raul M. [AZ-7] Rep Towns, Edolphus [NY-10] Rep Hanabusa, Colleen W. [HI-1] Rep Tsongas, Niki [MA-5] Rep Hanna, Richard L. [NY-24] Rep Woolsey, Lynn C. [CA-6] Rep Holt, Rush D. [NJ-12] Rep Wu, David [OR-1] Rep Jones, Walter B., Jr. [NC-3] Rep Yarmuth, John A. [KY-3] Rep Lance, Leonard [NJ-7] Rep Martin Heinrich (D-NM) Rep Langevin, James R. [RI-2] Rep Frank LoBiondo (R-NJ) Rep Latham, Tom [IA-4] Rep Mark Critz (D-PA) Rep LaTourette, Steven C. [OH-14] Rep Robert Wittman (R-VA) Rep Lee, Barbara [CA-9] Rep Eddie Bernice Johnson (D-TX) Rep Loebsack, David [IA-2] Rep Sean Duffy (R-WI) Rep Lujan, Ben Ray [NM-3] Rep Tierney, John (MA) Rep McGovern, James P. [MA-3] Rep Tipton, Scott (CO) Rep Tonko, Paul (NY) Rep Walz, Timothy (MN)
2/4/2012 Co-sponsors Needed
Accountable Care Organizations (Shared Savings)
NPs Recognized as ACO Providers Requirements – 5000 Medicare Patients in ACO – Accountable for quality, cost and overall management of Medicare patients – Appropriate business structure – 3 Year Commitment – Patient Centered Problem: – Assigned Beneficiaries
Needed – Reinclusion in Statute
2/4/2012 – Revision of Proposed Regulation
5 3/7/2012
Federal Employee Compensation Act
2/4/2012
Nurse Practitioner Authority to Sign Workers Compensation Claims
States Where Nurse Practitioner Can Sign Workers Compensation Forms
States Where Nurse Practitioner Can Not Sign Workers Compensation
Can sign if Delegated by Physician
2/4/2012 ©American Academy of Nurse Practitioners, 2011
NP Action: Contact Legislators
Discuss Role of NP Discuss Contribution we Make Discuss Cost Effectiveness Discuss Need for Removal of Barriers
2/4/2012
6 3/7/2012
Legislative Priorities
ACO Participation Order Home Health (Co-Sponsorship) Appropriations: Save Title VIII & Nurse Managed Clinic Funding
2/4/2012
Regulatory Issues
2/4/2012
What’s Happening with the Medical Home
Inclusion in Bills Increased Statewide Activity Increased discussion of “Health Care” Home CMMI Program Accreditation
2/4/2012
7 3/7/2012
Medical Home/Health Care Certification/Accreditation
Joint Commission on Accreditation of Health Organizations (JCAHO) National Committee for Quality Assurance (NCQA) Utilization Review Accreditation Commission (URAC) Accreditation Association for Ambulatory Health Care (AAAHC) 2/4/2012
Private Medical Home Pilots
State Pilot Name Project Contact Expected Demographics of Participating Practices
Florida Metcare of Florida/Humana Chris Corbin Number of Practices: 9 502-580-3820 Number of Participants: 17 Physicians per Practice: 1-3
Alabama Alabama Health Improvement Initiative Daniel Jackson Number of Practices: 14 205-220-7842 Number of Participants: 70 Physicians per Practice: 1-8
Georgia PCMH University Fay Brown Number of Practices: 24 404-321-7445 Number of Participants: Physicians per Practice: -5
Georgia WellStar Health System/Humana Chris Corbin Number of Practices: 2 502-580-3820 Number of Participants: 12 Physicians per Practice: 5-7
2/4/2012
CMMI CMS Innovation Center
Integration of Care for Dual Eligible' s Patient Centered Care Coordination and Federally Qualified Health Centers Multi Payer Advanced Primary Care Practice Demonstration Medicaid Health Homes Comprehensive Primary Care Innovative Medicare and Medicaid Enhanced Payment to Primary Care Providers CMMI Challenge Grants 2/4/2012
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3/7/2012
Medicare Regulations Conditions of Participation
Physician Oversite Hospital Privileges
Ordering Portable X-Rays
2/4/2012
Risk Evaluation and Mitigation Strategies (REMS)
2/4/2012
FDA Program Proposals
Supporting Education for Patients and Health Care Providers Expansion of State-Based Prescription Drug Monitoring Programs Recommending Convenient and Environmentally Responsible ways to Remove Unused Medications from Homes Reducing the Number of “Pill Mills” and Doctor- Shopping Through Law Enforcement
2/4/2012
9 3/7/2012
Joining Forces
Focus on civilian provider screening and treatment of mental health problems in the military Population Focus: Active military, veterans and their families Make NPs aware and knowledgeable- specifically PTSD, TBI, and post combat depression
2/4/2012
Regulatory and Practice Priorities
Accountable Care Organization Insurance Exchange Programs Medical Home
2/4/2012
Truth and Transparency Act HR 451 Introduced by: Representative John Sullivan (R/OK)
Rep Barton, Joe [TX-6] - 5/5/2011 Rep Luetkemeyer, Blaine [MO-9] - 7/25/2011 Rep Berkley, Shelley [NV-1] - 4/1/2011 Rep Maloney, Carolyn B. [NY-14] - 4/8/2011 Rep Bilirakis, Gus M. [FL-9] - 3/3/2011 Rep Marino, Tom [PA-10] - 4/8/2011 Rep Brady, Kevin [TX-8] - 6/16/2011 Rep Matheson, Jim [UT-2] - 6/3/2011 Rep Bucshon, Larry [IN-8] - 5/24/2011 Rep McCarthy, Carolyn [NY-4] - 5/2/2011 Rep Butterfield, G. K. [NC-1] - 5/2/2011 Rep McHenry, Patrick T. [NC-10] - 10/26/2011 Rep Castor, Kathy [FL-11] - 6/16/2011 Rep Moran, James P. [VA-8] - 4/8/2011 Rep Coble, Howard [NC-6] - 5/2/2011 Rep Murphy, Tim [PA-18] - 7/7/2011 Rep Cole, Tom [OK-4] - 5/5/2011 Rep Norton, Eleanor Holmes [DC] - 5/26/2011 Rep Connolly, Gerald E. "Gerry" [VA-11] - 7/15/2011 Rep Quayle, Benjamin [AZ-3] - 11/18/2011 Rep Cuellar, Henry [TX-28] - 5/2/2011 Rep Quigley, Mike [IL-5] - 6/3/2011 Rep DeFazio, Peter A. [OR-4] - 6/1/2011 Rep Roe, David P. [TN-1] - 7/15/2011 Rep Farenthold, Blake [TX-27] - 7/28/2011 Rep Rogers, Mike J. [MI-8] - 5/24/2011 Rep Farr, Sam [CA-17] - 5/24/2011 Rep Schiff, Adam B. [CA-29] - 7/7/2011 Rep Fortenberry, Jeff [NE-1] - 5/24/2011 Rep Schweikert, David [AZ-5] - 5/24/2011 Rep Franks, Trent [AZ-2] - 12/2/2011 Rep Scott, David [GA-13] - 2/14/2011 Rep Gingrey, Phil [GA-11] - 4/8/2011 Rep Smith, Adam [WA-9] - 6/1/2011 Rep Graves, Tom [GA-9] - 1/23/2012 Rep Speier, Jackie [CA-12] - 4/1/2011 Rep Harris, Andy [MD-1] - 6/16/2011 Rep Stivers, Steve [OH-15] - 5/2/2011 Rep Heck, Joseph J. [NV-3] - 5/24/2011 Rep Stutzman, Marlin A. [IN-3] - 6/24/2011 Rep Hinchey, Maurice D. [NY-22] - 6/1/2011 Rep Tiberi, Patrick J. [OH-12] - 2/14/2011 Rep Hultgren, Randy [IL-14] - 7/15/2011 Rep West, Allen B. [FL-22] - 4/8/2011 Rep Jackson, Jesse L., Jr. [IL-2] - 9/14/2011 Rep Wilson, Joe [SC-2] - 4/1/2011 Rep2/4/2012 Johnson, Eddie Bernice [TX-30] - 5/4/2011 Rep Young, C.W. Bill [FL-10] - 5/24/2011 Rep Lankford, James [OK-5] - 7/7/2011 Rep Lofgren, Zoe [CA-16] - 5/5/2011
10 3/7/2012
The AMA's Truth in Advertising Campaign
Arizona California Illinois Oklahoma Connecticut Tennessee Utah 2/4/2012
Other Professional Issues
2/4/2012
Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health
2/4/2012
11 3/7/2012
Regional Action Coalitions
Set clearly defined goals Form and mobilize key stakeholders to build a blueprint for action Educate policymakers and other decision-makers Seek financial support for Action Coalition efforts Gain visibility through the media and other outlets Work to advance key recommendations
2/4/2012
Advance Practice Consensus Document
Nurse Practitioner Education Nurse Practitioner Program Accreditation Nurse Practitioner Board Certification Nurse Practitioner Regulation
2/4/2012 2015 Goal
APRN REGULATORY MODEL
APRN SPECIALTIES Focus of practice beyond role and population focus linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care
POPULATION FOCI
Family/Individual Adult- Women’s Psychiatric- Neonatal Pediatrics Across Lifespan Gerontology* Health/Gender Mental Health** - Related
APRN ROLES
Nurse Nurse- Clinical Nurse Nurse
Role & Population Foci Population Role & Anesthetist Midwife Specialist+ Practitioner++ Licensure occurs at Levels of Levels at occurs Licensure
2/4/2012
12 3/7/2012
DNP (Doctor of Nursing Practice)
Degree Transition Curriculum Changes No Change in Certification No DNP Examination Needed Using Title Dr. 2015 Goal
2/4/2012
Jan Towers, PhD, NP-C, CRNP, FAANP, FAAN Director of Health Policy/Federal Government & Professional Affairs American Academy of Nurse Practitioners Office of Health Policy PO Box 40130 Washington, DC 20016 202-966-6414 Fax: 202-966-2856 E-mail: [email protected]
2/4/2012
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