ANA Legislative Agenda 9/05

Oppose Medicaid Cuts

ANA urges Congress to halt their plans to cut $10 billion in Medicaid funding. ANA is aware that the tens of thousands of Americans displaced by hurricane Katrina will require ongoing medical and mental services. Now is not the time to further unravel the health care safety net.

Despite the devastation caused by hurricane Katrina, Congressional leaders indicate that they are planning to go ahead with a budget reconciliation plan that would cut funding for Medicaid by $10 billion over five years.

ANA supports a Medicaid Program that provides coverage based on federal standards that ensures access for poor and special needs populations. ANA maintains that any saving realized from the restructuring of Medicaid must be reinvested in expansion of coverage and benefits.

Medicaid provides essential health care coverage for an estimated 51 million Americans. Medicaid covers the elderly, blind and persons with disabilities, pregnant women, children, and the parents of many covered children. Medicaid now covers more than 25 million children including one out of every three births and one out of every four children - and finances care for 70 percent of nursing home residents.

Due to the rising number of uninsured, and increases in the costs of prescription drugs and other health care, Medicaid rolls have increased dramatically in the last five years. The increasing number of people covered by Medicaid has helped to keep the number of uninsured Americans relatively stable.

ANA is appalled that Congressional leaders would consider cutting $10 billion in funding for this essential program at a time when so many Americans are in desperate need. Now is not the time to reduce access to needed health care services

Medicaid Coverage of Advanced Practice Registered Nurses

Advanced Practice RNs in Medicaid

Ask your Members of Congress to cosponsor the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (H.R. 2716 / S 1515). H.R. 2716 / S. 1515 changes federal Medicaid law to improve the recognition of health care services provided by advanced practice registered nurses (APRNs). This bill will increase access to essential health care services and increase state flexibility while helping to control Medicaid spending.

Background

Current federal law requires fee-for-service Medicaid to cover health care services provided by some APRNs (pediatric nurse practitioners, family nurse practitioners and certified nurse midwives). Some states have opted to also cover the services of certified registered nurse anesthetists and clinical nurse specialists - mainly because these practitioners are willing to provide needed services in physician shortage areas.

The Balanced Budget Act of 1997 (BBA, P.L. 105-33) encouraged states to use primary care case managers as gatekeepers to care in the fee for service program. The BBA granted the states the option to recognize pediatric nurse practitioners, family nurse practitioners and certified nurse midwives as primary care case managers; while also allowing them the option to refuse these providers. It precluded the states from recognizing any other type of APRN as a primary care case manager.

In addition, the BBA urged the states to move their Medicaid population into managed care. This law provided only a very vague reference to the types of providers that must be included in managed care panels. Plans must only show that they provide access to a sufficient number, mix, and geographic distributions of providers. In effect, the BBA permitted APRNs to be excluded as Medicaid providers in primary care case management and managed care

The Medicaid Advanced Practice Nurses and Physician Assistants Access Act (H.R. 2716 / S. 1515) would remove these barriers to practice. H.R. 2716 / S. 1515 would alter Medicaid law in the following three respects:

Fee-for-service Medicaid would be expanded to include direct payment for services provided by all nurse practitioners (NPs) and clinical nurse specialists (CNSs).
All NPs and CNMs would be recognized as primary care case managers.
Medicaid managed care panels would be required to include NPs, CNSs, CRNAs, and CNMs.

Many studies have shown that APRNs provide cost-effective, high quality care. Many Medicaid plans reimburse APRNs at a fraction of the physician fee schedule. In addition, APRNs are often willing to provide services in rural and inner-city areas where access to physicians is limited. APRNs increase access to health care and decrease preventable acute care admissions and emergency room visits. By supporting H.R. 2716/S. 1515, your Members of Congress would help ensure that Medicaid patients receive care in a timely and cost-efficient manner.

Funding for Nursing Workforce Development
Contact your Senators and urge them encourage them to increase funding for nursing workforce development.

ISSUE UPDATE (8/3/05): The Senate Appropriations Committee approved the fiscal year (FY) 2006 Labor, Health and Human Services, and Education Appropriations bill on July 21.

This bill includes contains a total of $155.7 million in FY 2006 funding for nursing workforce development; which is $5 million more than the FY 2005 appropriation and $6 million more than the FY 2006 funding level approved by the House of Representatives on June 24.

The full Senate will take up the FY 2006 Appropriations bill after Congress reconvenes in September.

ANA urges the Senate to increase funding for Title VIII by $24 million, to bring FY 2006 funding to $175 million. Thanks to your help, earlier this year, 51 Senators signed a letter in support of this increase (Click here to see if your Senator signed on). If enacted, this increase would help to improve funding for the loan repayment program, scholarships, faculty development, workplace improvements, and many more important programs.

WHAT YOU CAN DO: Contact your Senators

Reach them by phone using the U.S Capitol Switchboard at 202/224-3121

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MORE INFORMATION ON NURSING WORKFORCE DEVELOPMENT FUNDING

Position
ANA urges the Senate to increase funding for the nursing workforce development programs administered by the Health Resources and Services Administration (HRSA) to $175 million in FY 2006.

Rationale
In order to meet the growing demand for nursing services, Congress must invest in nursing workforce development programs. An increase in funding would allow HRSA to implement programs designed to attract more students into nursing programs; improve the workplace for nursing; support schools of nursing to provide faculty and updated curricula; recruit a more diverse student population; provide assistance to students to enable them to complete nursing studies, and; ensure the collection and analysis of current nursing workforce data to guide the appropriate implementation of these programs. ANA applauds Congress for taking the visionary step of passing the Nurse Reinvestment Act. However, the important programs contained in this law will never become a reality without adequate funding.

Background
The nursing workforce development programs administered by the Health Resources and Services Administration (HRSA) through Title VIII provide federal support for nurse workforce development. This title includes the newly authorized programs of the Nurse Reinvestment Act (P.L. 107-205).Title VIII is the primary source of funding for nursing education and recruitment.

Title VIII supports nursing programs through the educational continuum - from entry-level preparation through graduate study. It contains the following major grant programs:

Advanced Education Nursing: Provides grants to nursing schools, academic health centers, and other entities to enhance education and practice for nurses in master's and post-master's programs. These programs prepare nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators and public health nurses. The HRSA website contains additional information on Advanced Education Nursing Traineeships, Advanced Education Nursing Grants and Nurse Anesthetist Traineeships.
Workforce Diversity Grants: Provides grants to increase opportunities for individuals who are from disadvantaged backgrounds, including students from economically disadvantaged families as well as racial and ethnic minorities underrepresented in the nursing profession. This authorizes HRSA to provide student scholarships or stipends, pre-entry preparation and retention activities. Click here for additional information.
Nurse Education, Practice, and Retention Grants: This section supports schools and nurses at the associate and baccalaureate degree level. Grants are provided to schools of nursing, academic health centers, nursing centers, state and local governments and other public or private nonprofit entities. Some grants (such as grants promoting the Magnet best practices for nursing administration) are also available to health care facilities. Click here for additional information.
Nurse Loan Repayments: Deadline extended to March 18, 2005. This section contains the Nurse Education Loan Repayment Program (NELRP) and the new Nursing Scholarship Program. The NELRP repays 60 to 85 percent of outstanding student loans in return for an RN working full time for at least two years in a facility designated to have a critical shortage of nurses. HRSA is currently focusing on nurses who work in disproportionate share hospitals, departments of public health, and nursing facilities. Individual nurses apply directly to HRSA to receive these loan repayments. Click here for additional information.
The Nursing Scholarship Program: Provides financial assistance to nursing students. Upon graduation these scholars are required to work for at least two years in a facility designated to have a critical shortage of nurses. Nursing students work with their school of nursing to apply for these scholarships. Click here for additional information.
Nursing Faculty Loan Program: These grants establish student loan funds within schools of nursing. These funds are used to cancel up to 85 percent of the student loans (plus interest, over 4 years) of Masters or Doctoral students who agree to serve as full-time nursing faculty in the school after completion of their degree. Students should work with their schools to apply for these loans. Click here for additional information.

W.O.C.N.S Pacific Coast Region		ANA Legislative Agenda 9/05

		Oppose Medicaid Cuts ANA urges Congress to halt their plans to cut $10 billion in Medicaid funding. ANA is aware that the tens of thousands of Americans displaced by hurricane Katrina will require ongoing medical and mental services. Now is not the time to further unravel the health care safety net. Despite the devastation caused by hurricane Katrina, Congressional leaders indicate that they are planning to go ahead with a budget reconciliation plan that would cut funding for Medicaid by $10 billion over five years. ANA supports a Medicaid Program that provides coverage based on federal standards that ensures access for poor and special needs populations. ANA maintains that any saving realized from the restructuring of Medicaid must be reinvested in expansion of coverage and benefits. Medicaid provides essential health care coverage for an estimated 51 million Americans. Medicaid covers the elderly, blind and persons with disabilities, pregnant women, children, and the parents of many covered children. Medicaid now covers more than 25 million children including one out of every three births and one out of every four children - and finances care for 70 percent of nursing home residents. Due to the rising number of uninsured, and increases in the costs of prescription drugs and other health care, Medicaid rolls have increased dramatically in the last five years. The increasing number of people covered by Medicaid has helped to keep the number of uninsured Americans relatively stable. ANA is appalled that Congressional leaders would consider cutting $10 billion in funding for this essential program at a time when so many Americans are in desperate need. Now is not the time to reduce access to needed health care services Medicaid Coverage of Advanced Practice Registered Nurses Advanced Practice RNs in Medicaid Ask your Members of Congress to cosponsor the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (H.R. 2716 / S 1515). H.R. 2716 / S. 1515 changes federal Medicaid law to improve the recognition of health care services provided by advanced practice registered nurses (APRNs). This bill will increase access to essential health care services and increase state flexibility while helping to control Medicaid spending. Background Current federal law requires fee-for-service Medicaid to cover health care services provided by some APRNs (pediatric nurse practitioners, family nurse practitioners and certified nurse midwives). Some states have opted to also cover the services of certified registered nurse anesthetists and clinical nurse specialists - mainly because these practitioners are willing to provide needed services in physician shortage areas. The Balanced Budget Act of 1997 (BBA, P.L. 105-33) encouraged states to use primary care case managers as gatekeepers to care in the fee for service program. The BBA granted the states the option to recognize pediatric nurse practitioners, family nurse practitioners and certified nurse midwives as primary care case managers; while also allowing them the option to refuse these providers. It precluded the states from recognizing any other type of APRN as a primary care case manager. In addition, the BBA urged the states to move their Medicaid population into managed care. This law provided only a very vague reference to the types of providers that must be included in managed care panels. Plans must only show that they provide access to a sufficient number, mix, and geographic distributions of providers. In effect, the BBA permitted APRNs to be excluded as Medicaid providers in primary care case management and managed care The Medicaid Advanced Practice Nurses and Physician Assistants Access Act (H.R. 2716 / S. 1515) would remove these barriers to practice. H.R. 2716 / S. 1515 would alter Medicaid law in the following three respects: Fee-for-service Medicaid would be expanded to include direct payment for services provided by all nurse practitioners (NPs) and clinical nurse specialists (CNSs). All NPs and CNMs would be recognized as primary care case managers. Medicaid managed care panels would be required to include NPs, CNSs, CRNAs, and CNMs. Many studies have shown that APRNs provide cost-effective, high quality care. Many Medicaid plans reimburse APRNs at a fraction of the physician fee schedule. In addition, APRNs are often willing to provide services in rural and inner-city areas where access to physicians is limited. APRNs increase access to health care and decrease preventable acute care admissions and emergency room visits. By supporting H.R. 2716/S. 1515, your Members of Congress would help ensure that Medicaid patients receive care in a timely and cost-efficient manner. Funding for Nursing Workforce Development Contact your Senators and urge them encourage them to increase funding for nursing workforce development. ISSUE UPDATE (8/3/05): The Senate Appropriations Committee approved the fiscal year (FY) 2006 Labor, Health and Human Services, and Education Appropriations bill on July 21. This bill includes contains a total of $155.7 million in FY 2006 funding for nursing workforce development; which is $5 million more than the FY 2005 appropriation and $6 million more than the FY 2006 funding level approved by the House of Representatives on June 24. The full Senate will take up the FY 2006 Appropriations bill after Congress reconvenes in September. ANA urges the Senate to increase funding for Title VIII by $24 million, to bring FY 2006 funding to $175 million. Thanks to your help, earlier this year, 51 Senators signed a letter in support of this increase (Click here to see if your Senator signed on). If enacted, this increase would help to improve funding for the loan repayment program, scholarships, faculty development, workplace improvements, and many more important programs. WHAT YOU CAN DO: Contact your Senators Reach them by phone using the U.S Capitol Switchboard at 202/224-3121 ----------------------------------------------------------------------------------- MORE INFORMATION ON NURSING WORKFORCE DEVELOPMENT FUNDING Position ANA urges the Senate to increase funding for the nursing workforce development programs administered by the Health Resources and Services Administration (HRSA) to $175 million in FY 2006. Rationale In order to meet the growing demand for nursing services, Congress must invest in nursing workforce development programs. An increase in funding would allow HRSA to implement programs designed to attract more students into nursing programs; improve the workplace for nursing; support schools of nursing to provide faculty and updated curricula; recruit a more diverse student population; provide assistance to students to enable them to complete nursing studies, and; ensure the collection and analysis of current nursing workforce data to guide the appropriate implementation of these programs. ANA applauds Congress for taking the visionary step of passing the Nurse Reinvestment Act. However, the important programs contained in this law will never become a reality without adequate funding. Background The nursing workforce development programs administered by the Health Resources and Services Administration (HRSA) through Title VIII provide federal support for nurse workforce development. This title includes the newly authorized programs of the Nurse Reinvestment Act (P.L. 107-205).Title VIII is the primary source of funding for nursing education and recruitment. Title VIII supports nursing programs through the educational continuum - from entry-level preparation through graduate study. It contains the following major grant programs: Advanced Education Nursing: Provides grants to nursing schools, academic health centers, and other entities to enhance education and practice for nurses in master's and post-master's programs. These programs prepare nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators and public health nurses. The HRSA website contains additional information on Advanced Education Nursing Traineeships, Advanced Education Nursing Grants and Nurse Anesthetist Traineeships. Workforce Diversity Grants: Provides grants to increase opportunities for individuals who are from disadvantaged backgrounds, including students from economically disadvantaged families as well as racial and ethnic minorities underrepresented in the nursing profession. This authorizes HRSA to provide student scholarships or stipends, pre-entry preparation and retention activities. Click here for additional information. Nurse Education, Practice, and Retention Grants: This section supports schools and nurses at the associate and baccalaureate degree level. Grants are provided to schools of nursing, academic health centers, nursing centers, state and local governments and other public or private nonprofit entities. Some grants (such as grants promoting the Magnet best practices for nursing administration) are also available to health care facilities. Click here for additional information. Nurse Loan Repayments: *Deadline extended to March 18, 2005.* This section contains the Nurse Education Loan Repayment Program (NELRP) and the new Nursing Scholarship Program. The NELRP repays 60 to 85 percent of outstanding student loans in return for an RN working full time for at least two years in a facility designated to have a critical shortage of nurses. HRSA is currently focusing on nurses who work in disproportionate share hospitals, departments of public health, and nursing facilities. Individual nurses apply directly to HRSA to receive these loan repayments. Click here for additional information. The Nursing Scholarship Program: Provides financial assistance to nursing students. Upon graduation these scholars are required to work for at least two years in a facility designated to have a critical shortage of nurses. Nursing students work with their school of nursing to apply for these scholarships. Click here for additional information. Nursing Faculty Loan Program: These grants establish student loan funds within schools of nursing. These funds are used to cancel up to 85 percent of the student loans (plus interest, over 4 years) of Masters or Doctoral students who agree to serve as full-time nursing faculty in the school after completion of their degree. Students should work with their schools to apply for these loans. Click here for additional information.