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Nurse Practitioner Authority to Prescribe 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 8 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.
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