Introduction of your new Health Policy Chair

NAPNAP has had an excellent advocacy agenda and program during the last 4 years with the leadership of Karen Duderstadt as Health Policy Chair with the help of Arent Fox (our federal representatives and lobbyists) and the incredible national office staff. I have big shoes to fill in taking over as Health Policy Chair. I am excited about this new challenge and look forward to helping all NAPNAP members continue to be strong advocates for children, children's health, and the continued recognition of the PNP role in our health care system.

One issue that each of you should pay particular attention to in the coming months is Medicaid Reform. This reform has put control of Medicaid benefits into the hands of the states. Our lobbyists are asking that each state monitor Medicaid legislation and contact the national office with all pertinent legislation in your state. This issue bears close watching as some states may impose enough cuts to close or severely restrict the services that can be offered. This is a concern as some PNPs may begin to lose jobs. We need your help to monitor this issue. I look forward to the next 2 years as your new Health Policy Chairperson.

Together we can continue to be strong advocates for children and children's health care.

Ann Sheehan
NAPNAP Health Policy Chair

Medicaid Federal Funding for
Nursing Workforce Grants Medicaid

Unlike last year when Congress was debating significant cuts to the Medicaid program, this year NAPNAP finds itself monitoring Centers for Medicare and Medicaid Services (CMS) rulemaking and state implementation of newfound flexibility on cost-sharing and benefit changes.

In addition, the House has passed appropriations legislation and a Senate committee is set to follow later this month that will provide funding for health and education programs for fiscal year 2007. Medicaid The Deficit Reduction Act of 2005 (DRA), Public Law 109-171, signed into law in December 2005 allows states to make significant changes to benefit levels for children and their families on Medicaid, alter how those services are delivered; and increase how much beneficiaries will pay for them. Some of the most serious changes could affect medically necessary services provided through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) programs. The State of West Virginia received approval from CMS in May to make changes to what EPSDT services are provided to children and to whom they are provided to.

Starting July 1, the state began to phase in a requirement that patients sign a member agreement promising that they will keep doctors appointments, take prescribed medication and not overuse hospital emergency room facilities. Patients who do not sign this agreement and/or do not follow the rules will only be eligible for scaled-back benefits. This two-tiered benefit plan is of serious concern to NAPNAP and we will continue to monitor the implementation of this program. We ask our chapter representatives and members to email any news about changes in Medicaid benefits and cost-sharing for children to the National Office at: info@napnap.org On June 9, CMS issued citizenship guidelines for Medicaid eligibility as part of the Deficit Reduction Act legislation which requires that beneficiaries provide actual citizenship itself monitoring Centers for Medicare and Medicaid Services (CMS) rulemaking and state implementation of newfound flexibility on cost-sharing and benefit changes.

In addition, the House has passed appropriations legislation – and a Senate committee is set to follow later this month that will provide funding for health and education programs for fiscal year 2007. Medicaid The Deficit Reduction Act of 2005 (DRA), Public Law 109-171, signed into law in December 2005 allows states to make significant changes to benefit levels for children and their families on Medicaid, alter how those services are delivered; and increase how much beneficiaries will pay for them. Some of the most serious changes could affect medically necessary services provided through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) programs. The State of West Virginia received approval from CMS in May to make changes to what EPSDT services are provided to children and to whom they are provided to.

Since these changes just went into effect July 1, it is unclear what the impact will be. Federal regulations are being published July 12. Further information on these changes, can be found on the CMS - State Medicaid Directors Letters website There is an effort being led by a number of advocacy groups of which NAPNAP is participating to encourage Congress to pass a technical corrections bill to the DRA which will clarify provisions relating to EPSDT and the citizenship guidelines that will make it more difficult for states to deny benefit to beneficiaries. It is unclear whether Congress will allow such a bill to occur this year. NAPNAP supports efforts to preserve the federal EPSDT benefit. Federal Funding for Nursing Workforce Grants NAPNAP is advocating forincreased funding for HRSA Title VIII –Nursing Education funding – including Advanced Education Nursing Grants, Nurse Education, Practice and Retention Grants, Nurse Loan Repayment and Scholarship Programs, Nurse Faculty Loan Program, and Workforce Diversity Grants – through the House and Senate Labor, HHS, and Education Appropriations subcommittees documentation before Medicaid eligibility is granted.

Title VIII programs received $149.7 million in federal funding for Fiscal Year (FY) 2006 – down $982,000 from FY 2005. It should be noted however that Title VIII fared relatively well considering Title VII physician training programs were zeroed out of the budget. (The President requested $150 million as part of his FY 2007 budget request.) As part of the larger nursing community, NAPNAP is advocating for $175 million in federal funding for Title VIII programs for FY 2007.

On June 7, the House Labor, HHS and Education Appropriation subcommittee recommended level funding for Title VIII programs. The Senate Appropriations Committee is expected to pass its own legislation by July20. NAPNAP supports efforts to provide federal funding for a number of critical programs affecting children, including: emergency funding for children's health care and mental health services, Centers for Disease Control funding to establish a network of regional consortia dedicated to the medical aspects of child maltreatment; Title V- Maternal and Child Health block grants; and the National Institutes for Health - National Children’s Study - among others.

Medicaid Advanced Practice Nurses
and Physician Assistants Access Act

Legislation by:

Representative John Olver (D-MA) and Senator Dan Inouye –
H.R. 2716 and S. 1515 respectively

Support for this act has received a number of new co-sponsors, thanks to efforts of a number of groups – including NAPNAP – who are advocating for greater support on the Hill.    

The legislation would provide access to advanced practice nurses (APRNs) and physician assistants (PAs) under the Medicaid program. Current law requires fee-for-service Medicaid to cover health care services provided by some APRNs. The Balanced Budget Act of 1997 encouraged states to move Medicaid recipients into managed care and to use primary care case managers Title VIII programs received $149.7 million in federal funding for Fiscal Year (FY) 2006 – down $982,000 from FY 2005. It should be noted however that Title VIII fared relatively well considering Title VII physician training programs were zeroed out of the budget. (The President requested $150 million as part of his FY 2007 budget request.) As part of the larger nursing community, NAPNAP is advocating for $175 million in federal funding for Title VIII programs for FY 2007.  On June 7, the House Labor, HHS and Education Appropriation subcommittee recommended level funding for Title VIII programs. The Senate Appropriations Committee is expected to pass its own legislation by July 20.  

NAPNAP supports efforts to provide federal funding for a number of critical programs affecting children, including: emergency funding for children’s health care and mental health services, Centers for Disease Control funding to establish a network of regional consortia dedicated to the medical aspects of child maltreatment; Title V- Maternal and Child Health block grants; and the National Institutes for Health - National Children’s Study - among others.      

If you do not see your Representative and/or Senators listed as co-sponsors of this legislation, please call the Capitol Switchboard at: (202) 224-3121 and ask to be connected to their office(s). Once connected, please ask to talk with the Representative or Senator’s health aide and ask them to support this legislation.

 

The Health Care Truth and Transparency Act of 2006  

Legislation filed June 27 would make it illegal for any licensed health care provider who is not a medical doctor (MD), doctor of osteopathic medicine (DO), doctor of dental surgery (DDS), or doctor of dental medicine (DDM) to make any statement or engage in any act that would lead patients or the public to believe that they have the same or equivalent education, skills, or training. If this bill were enacted, nurse practitioners (NPs) and other licensed health care providers could be found by the Federal Trade Commission to have engaged in unfair trade practices, and could lead to a $10,000 per violation fine.    

The legislation includes a number of exaggerated and otherwise incorrect findings about which health care professionals are best trained to prescribe medication and perform certain health care procedures. The legislation also makes a number of statements about the confusion consumers face with regard to seeking health care services – and who should be providing that care.   The legislation appears to be an extension of the medical community’s attempt to tighten Scope of Practice Acts to limit the scope of practice for nurse practitioners and other health care professionals.

While NAPNAP would support consumer-friendly legislation that promotes patient access to the highest quality care, we are working with sponsors to educate them about the flaws that exist in this legislation. For example, if disclosure of one’s education and training is required, NAPNAP believes all health care professional should comply – including MDs, DOs, DDSs, and DDMs.

The legislation can be found at: http://thomas.loc.gov Members in the following states are encouraged to contact their legislators who are sponsors of this legislation and explain that Nurse Practice Acts in all U.S. States and Territories provide adequate remedies for Nurse Practitioners found to be engaging in unscrupulous behavior; describe the value that NPs in their communities; and request that the Member withdraw his name from this legislation.

• Rep. John Sullivan (R-OK) (202) 225-2211 - Wendy Taylor  
• Rep. Charles Bass (R- NH) (202) 225-5206 - John Billings  
• Rep. Joe Schwarz (R-MI) (202) 225-6276 - Mark Ratner  
• Rep. Bilirakis (R-FL) (202) 225-5755 - Jerry White  
• Rep. Pete Sessions (R-TX) (202) 225-2231 - Robert Hillart  
• Rep. Michael Burgess (R-TX) (202) 225-7772 - Josh Martin
• Rep. Gene Green (D-TX) – removed himself from legislation
  after meeting with representatives of NAPNAP and other groups.