Governmental Affairs Update

Jan-Apr 2007

Title VIII Funding

        President Bush released his fiscal year (FY) 2008 Budget on Monday, February 5, 2007. This $2.9 trillion spending plan details the budget priorities for the Bush Administration. Unfortunately, the President proposes to cut many health care programs important to nursing. While this Budget does not carry the weight of law or change current funding, it does indicate that new funding for nursing education and health care will be hard to come by in 2008.
        The budget contains proposed cuts to domestic healthcare programs. For the first time since this Administration took office, nursing has been targeted in these cuts. The President proposes to cut funding for the Health Resources and Services Administration (HRSA) by $343 million (5.6 percent). Within HRSA, the Administration would cut funding for the Title VIII Nursing Workforce Development programs by $44 million (30 percent). This cut would be achieved by eliminating all funding for Advanced Education Nursing programs for a savings of $57 million, $13 million of which would be re-invested in the Nurse Education Loan Repayment Program. These Advanced Nurse Education programs support schools of nursing and academic health centers that prepare clinical nurse specialists, nurse practitioners, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, and public health nurses. These programs also fund traineeships awarded to individual nursing students.
     The Department of Labor (DOL) reported in the 2006-07 edition of the Occupational Outlook Handbook that registered nurses are projected to create the second largest number of new jobs among all U.S. occupations in the decade between 2004 and 2014. During this time, America's demand for RNs will grow 29 percent, and domestic schools of nursing will need to produce 1.2 million new RNs to accommodate growing patient needs and to replace retirees.
      Representative Lois Capps, RN (D-CA) expressed her dismay to Health and Human Services Secretary Mike Leavitt when he came to testify before the House Energy and Commerce Committee. She pointed out the fact that it is not wise to reduce funding for a program that prepares nursing faculty at a time when schools of nursing are being forced to turn away tens of thousands of qualified applicants per year due to faculty shortages.  (www.capitolupdate.org)

       In early March, Reps. Lois Capps, RN (D-CA) and Steven LaTourette (R-OH), the Co-Chairs of the Congressional Nursing Caucus, circulated a letter in the U.S. House of Representatives supporting $200 million in FY 2008 appropriations for the Title VIII Nursing Workforce Development programs. The final letter, which was delivered to the House Appropriations Committee on March 20, was signed by a bipartisan group of 96 Members of the House of Representatives. Senators Barbara Mikulski (D-MD) and Susan Collins (R-ME) then circulated a similar letter in the U.S. Senate. This letter is open for Senators to sign through April 3. (Please see the letter on the face page of the ASPAN GA website) Due to the financial demands of the war in Iraq, discretionary spending, such as funding for the Nurse Reinvestment Act, may be jeopardized.   (www.capitolupdate.org)

Medicaid Funding

     As above, President Bush released his budget in Feb, 2007. This budget included cuts to Medicare and Medicaid funding by $100 billion over five years, and $300 billion over ten years. Most of these cuts would be enacted through reduced Medicare payments to inpatient, inpatient rehabilitation, and outpatient hospital payments and a phase-out of bad debt payments. Skilled nursing facility and home health agency payments would also be cut. In addition, the President proposes to set future Medicare payment updates at a rate lower than inflation for all of these providers. The budget also assumes that the Medicare physician fee schedule (which determines reimbursements for advanced practice registered nurses who bill Medicare directly) would be cut by 8 percent in FY 2008.

If enacted, the Medicaid administrative matching rates and targeted case management would be capped at 50 percent, which would cut federal funding by $6.5 billion over five years. In addition, Medicaid funding for graduate medical education would be completely eliminated. The President also proposes to fund the State Children’s Health Insurance Program (S-CHIP) at $10 billion less than what would be needed to cover everyone who currently receives benefits.

The War in Iraq

         The Senate has voted, similar to the House of Representatives, to link funding for the war in Iraq to a timeline for troop withdrawal and have submitted the measure to the White House for approval.  The President had indicated that he will veto any measure that links funding with a timetable for continued military intervention in Iraq. The Senate bill funds the wars in Iraq and Afghanistan through September 30^th with a stipulation that troop withdrawal begin Oct 1^st. (earlier if the Iraqi government does not meet benchmarks in reducing sectarian violence) The measure approves the spending of $124 billion, $20 billion of which is directed to areas not associated with the war effort. These areas include veterans’ care, ongoing aid for Hurricane Katrina victims, and farm disaster relief. An increase in the minimum wage has also been included in the bill. On Tuesday, May 1^st, the President vetoed this measure, stating that he will not sign any bill that links funding for the ongoing war effort to a timetable for troop withdrawal. Both the Senate and the House of Representatives are considering compromise measures at this time.  

Breast Cancer Patient Protection Act of 2007

    Both the Senate and the House have similar bills related to the hospitalization of mastectomy patients. S. 459 and H.R. 119 are titled ‘Breast Cancer Patient Protection Act of 2007’. These bills, if enacted would require health insurance carriers and group health plans to offer benefits for both inpatient and outpatient care related to breast cancer surgery and breast cancer treatment. It further stipulates that inpatient coverage for a patient who has had a mastectomy or lumpectomy should not be limited to less than 48 hours and that coverage for procedures for lymph node dissection should not be less than 24 hours. However, if both the attending physician and the patient determine that a shorter hospital stay is medically appropriate, then that decision will supercede the 48 hour and 24 hour mandate. These bills are in committee at the present time.  

CMS Modifies Policy on Infant Medicaid Eligibility

       The Centers for Medicare and Medicaid (CMS) has announced that it will modify its policy related to access to Medicaid for infants born in the United States to undocumented immigrants. The current policy, which took effect in July 2006, states that individuals seeking care through Medicaid must show proof of US citizenship before receiving care. Critics felt that this policy would hamper care delivery to any newborn of illegal immigrants. These infants are US citizens by birth. However, the process of obtaining documentation of citizenship may be lengthy and the infant may require health care and be eligible for coverage by Medicaid. Critics of the current rule felt that the infants may have gone without necessary health care while the paperwork was being processed.

     Under the proposed modified rule, any newborn, whose mother files an application and is determined eligible for emergency Medicaid for the delivery, will automatically be eligible for Medicaid for the first year of their life if certain conditions are met. This policy change is in response to criticisms from lawmakers, state governors, consumer and patient advocates who said that the CMS existing rule went too far when it implemented Medicaid eligibility documentation requirements as required by the Deficit Reduction Act of 2005. CMS says they have heard the concerns raised and are taking action to modify the documentation requirements to put all babies born in the United States whose deliveries are covered by Medicaid on an equal footing.  (www.capitolupdate.org)

Uniform Emergency Volunteer Healthcare Practitioners Act

 Many qualified nurses, physicians and other healthcare professionals faced confusing administrative hurdles in obtaining permission to practice in the affected areas of the Gulf Coast states during Hurricanes Katrina and Rita, often resulting in the delay of timely delivery of essential health care services. To reduce the likelihood of a repeat of this problem, the National Conference of Commissioners on Uniform State Laws (NCCUSL) convened meetings to craft what has since become known as the Uniform Emergency Volunteer Healthcare Practitioners Act (UEVHPA). UEVHPA establishes a system whereby healthcare practitioners may register to provide volunteer services either before or during an emergency. It further authorizes healthcare facilities and disaster relief organizations in affected states or territories to use registered professionals and to rely on the registration systems to confirm that these professionals are appropriately licensed.

The process with any attempt to create uniformity in statute across states begins with the NCCUSL providing its' seal of approval. At this point, a uniform act is officially promulgated for consideration by the states, and legislatures are urged to adopt it. Kentucky is the first state to adopt UEVHPA, which Governor Fletcher signed in to law on March 23. To date, 6 other states plus the US Virgin Islands which have introduced legislation to codify the act within their respective jurisdictions: California: AB 64/Sponsor Assemblywoman Berg; Colorado: HB 1199/ Sponsor Rep. McGihon; Maine: LD1637/ Sponsor Rep. Simpson; Oregon: HB3091/ sponsored by the Committee on Health Care; Tennessee: SB 692/ Sponsor Sen. Bunch; and U.S. Virgin Islands: Bill 26-0339. A hearing was held last fall in the U.S. Virgin Islands, but there has been no movement so far this session.

A Mississippi bill: HB 1101/Sponsor Rep. Hollan was never brought up for discussion or a vote and is subsequently dead for this legislative session. There is a possibility that we will see introductions later this year in the District of Columbia, Florida, Maine and Pennsylvania. Although the intent is to create uniformity and adopt the model legislation, states may elect to make changes. (www.capitolupdate.org)

110^th Congressional House Nursing Caucus

     Congresswoman Lois Capps (D-CA) and Congressman Steven LaTourette (R-OH) have come together to chair the House Nursing Caucus for the 110th Congress.  The Caucus provides an excellent, non-partisan forum for the discussion of issues that impact the nursing profession, and helps members of Congress who care about these issues to come together to address them.  Additionally, the Nursing Caucus will allow members of Congress an open forum to address issues affecting the nursing community.  It will also serve as a clearinghouse for information and a sounding board for ideas brought forth by the nursing community. The Caucus holds regular briefings on matters such as the nursing shortage, barriers to practice for Advanced Practice Registered Nurses, bioterrorism preparedness, health care reform, and patient safety issues.
     Every Member of Congress who belongs to the House Nursing Caucus identifies a staff person dedicated to the Caucus and its issues. This increases the number of staff on Capitol Hill knowledgeable of nursing issues. Not every member of the House of Representatives is even aware of this opportunity, especially our newly elected members. As constituents and nurses, we should encourage them to join the Caucus- being a registered nurse is not a requirement for membership. 

Members of the 110^th Congressional House Nursing Caucus:

Republican Representatives in Italics

(www.capitolupdate.org)

Literacy Among Patients

     The Joint Commission issued a call to action to health care providers to acknowledge low health literacy among their patients and work to bridge the communication gap that threatens patient safety. Releasing a new public policy white paper, “‘what did the Doctor Say?’ Improving Health Literacy to Protect Patient Safety,” the accrediting organization emphasized that a number of variables, including language and culture, impede patients’ health literacy and understanding of information or instructions offered by their physicians and other health care providers.

     “There is a low-health-literacy epidemic,” said Dennis S. O’Leary, M.D., president of the Joint Commission. “If the patient doesn’t understand his or her illness, we have lost the treatment battle at the beginning and may have unwittingly placed them in danger.” O’Leary added that research has shown that only half of Americans understand their medical information and only half understand numbers, including medication dosages, and most providers are unaware of this communication barrier.

      “When I went to medical school, no one warned me that my patients wouldn’t understand me,” he said, stressing that it is the responsibility of health care practitioners to work to make effective communication a priority in their treatment of all patients.

    The Joint Commission identified 35 strategies that health care practitioners and facilities can employ to address health literacy and protect patient safety, including: the sensitization, education and training of clinicians and health care organization leaders and staff regarding health literacy issues and patient-centered communication; the development of patient-friendly navigational aids in facilities; the enhanced training and use of interpreters; the expanded adaptation and use of adult learning centers to meet patient health literacy needs; and the assessment by health care organizations of the literacy levels and language needs of the communities they serve.

Both O’Leary and J. James Rohack, M.D., a member of the Board of Trustees of the American Medical Association and Board of Commissioners of the Joint Commission, emphasized the importance of “teaching back” patients to ensure their understanding of what was discussed with or instructed of them.  (www.amnhealthcare.com)

Pandemic Flu Preparedness

       The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) unveiled two new efforts to improve state, local, and community preparedness for an influenza pandemic. The first part consists of community

planning guidance from CDC that incorporates a new tool,

the Pandemic Severity Index (PSI). The second effort consists of a

number of new radio and television public service announcements

(PSAs) designed to raise awareness and educate the public about

pandemic influenza and the need to prepare in advance.

The CDC guidance focuses primarily on community-level measures

that could be used during an influenza pandemic in an effort to reduce

the spread of infection using the PSI. Modeled after the approach

used to characterize hurricanes, the PSI has five different

categories of pandemics, with a category 1 representing moderate

severity and a category 5 representing the most severe. Based on

the projected severity of the pandemic, government and health officials may recommend different actions communities can take to try

to limit the spread of disease. Such actions may include:

·        Asking ill persons to remain at home or not go to work until they are no longer contagious (seven to 10 days). Ill persons will be treated with antiviral medication if drugs are available and effective against the pandemic strain.

·        Asking household members of ill persons to stay at

         home for seven days.

·        Dismissing students from schools and closing child

         care programs for up to three months for the most

         severe pandemics, and reducing contact between

         children and adolescents in the community.

·        Recommending social distancing of adults in the community

          and at work, which may include closing large

          public gatherings, changing workplace environments,

           and shifting work schedules without disrupting essential   

           services. (www.ena.org)

HRSA Releases Report on RN Survey

     The Department of Health Resources and Services Administration’s (HRSA) Bureau of Health Professions

Has released its report on its periodic survey of RNs. The latest

of these reports is called The Registered Nurse

Population: Findings from the March 2004 National

Sample Survey of Registered Nurses. The report includes

data from seven recurring surveys, 1980 through

2004. Finding are as follows:

·        The number of licensed RNs in the United States grew by

almost 8% between 2000 and 2004 to a new high of 2.9

million

·        Real earnings for RNs grew significantly.

·        Average age of the RN work force 46.8 years in 2004 This represents the highest average age since the first comparable report was published in 1980

·        Just over 41% of RNs were 50 years of age or older in 2004, a dramatic increase from 33% in 2000 and 25% in 1980.

·        Only 8% of RNs were under the age of 30 in 2004, compared to 25% in 1980.

·        More than 83% of RNs with active licenses were employed in nursing in 2004, the highest employment rate since1980

·        Average annual earnings for RNs in 2004 were $57,785, a nearly 14% increase in salaries since 2000 and the first significant increase since 1992

·         The number of RNs with master’s or doctorate degrees rose to 376,901 in 2004, an increase of 37% from 2000 and up from 85,860 in 1980.

In her comments, HRSA Administrator Betty Duke said,

“While we are encouraged by the growth in the number

of RNs, we are concerned about the aging of the nursing

work force and how this will impact the future supply of

nurses.”  (www.ena.org) a copy of this survey is available at www.hrsa.org)

Stem Cell Legislation

    The Senate April 12 passed (63-34) the "Stem Cell Research Enhancement Act of 2007" (S. 5), which would allow federal funding for research on new human embryonic stem cell lines, overturning President Bush's 2001 ban. Senators Christopher Dodd (D-Conn.), Tim Johnson (D-S.D.), and Mary Landrieu (D-La.) were not present for the vote, but are expected to support the measure. President Bush has already expressed his intention to veto S. 5 should Congress approve it.  S. 5 also authorizes appropriations for research "to develop techniques for the isolation, derivation, production, or testing" of pluripotent stem cells that "are not derived from a human embryo." This language was not included in the House version of the "Stem Cell Research Enhancement Act of 2007" (H.R. 3), passed Jan. 11.

        The Senate also passed (70-28) an alternative measure, the "Hope Offered through Principled and Ethical Stem Cell Research (HOPE) Act" (S. 30), that would fund human embryonic stem cell research that does not involve "the destruction or discarding of, or risk of injury to, a human embryo or embryos other than those that are naturally dead."     (www.aamc.org/advocacy)