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

 Alabama  Sen. (R)  Rep Terri Sewell (D)  Rep (R)  Rep Martha Roby (R)  Rep (D)  Rep Bobby Bright (D)  Rep Steve Southerland (R)  Mississippi  Rep Daniel Webster (R)  Rep Alan Nunnellee (R)  Rep (R)  Rep Steven Palazzo (R)  Rep (R)  Rep Gene Taylor (D)  Rep (R)  Rep Travis Childers (D)  Rep Richard Nugent (R)  Rep (D)  Georgia  Rep (D)  Rep Austin Scott (R)  Rep (D)  Rep Rob Woodall (R)  Rep (D)  Rep Jim Marshall (D)

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Patient Protection Affordable Care Act

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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

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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

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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

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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)

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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

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2013 Appropriations

 Presidents Proposal  Budget Committee  Appropriations Committee

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Nurse Managed Clinics

 CMMI Challenge Grant  HRSA – Division of Nursing  Appropriations

2/4/2012

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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

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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

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Legislative Priorities

 ACO Participation  Order Home Health (Co-Sponsorship)  Appropriations: Save Title VIII & Nurse Managed Clinic Funding

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Regulatory Issues

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What’s Happening with the Medical Home

 Inclusion in Bills  Increased Statewide Activity  Increased discussion of “Health Care” Home  CMMI Program  Accreditation

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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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Medicare Regulations Conditions of Participation

Physician Oversite Hospital Privileges

 Ordering Portable X-Rays

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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

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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

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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

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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

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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]

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