Category: White House

Courts Block Rules That Would Restrict Women’s Access to Reproductive Health Care Services

  

Federal courts this week blocked two Interim Final Rules (IFRs) from the U.S. Department of Health and Human Services (HHS) that would have significantly expanded the ability of employers to deny coverage of contraceptives for female employees on the basis of religious or moral objections.

On January 14th, the U.S. District Court for the Eastern District of Pennsylvania issued an order granting the motion for a preliminary nationwide injunction blocking the implementation of the two IFRs from HHS that would have expanded the ability of employers to cite moral and religious objections in seeking exemptions from the Affordable Care Act’s (ACA) contraceptive mandate. That mandate requires all employers that provide employer-sponsored insurance for their employees to cover contraceptives, with narrow exemptions (e.g., religious entities and closely held for-profit corporations).

The Pennsylvania ruling followed a January 13th ruling from the U.S. District Court for the Northern District of California also blocking the implementation of these two IFRs in the 13 plaintiff states in that lawsuit (California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington), plus the District of Columbia; the judge in the Northern District of California prominently cited ANA’s amicus curiae brief in his order granting the motion for a preliminary injunction.

These IFRs would be particularly damaging given the administration’s proposed regulatory changes to Title X funding, which provides grants for critical family planning services for millions of Americans, particularly low-income women. HHS itself notes in its analysis of the blocked IFRs that they would result in over 125,000 more women relying on Title X programs for reproductive health care services, even as the administration has taken steps that would restrict the ability of Title X programs to provide those services.

These injunctions block HHS from implementing the two IFRs, which were supposed to go into effect on January 14th; the narrower Obama-era exemption policy remains in place during the injunction. It is worth noting that two nearly identical IFRs were also blocked in the same district courts in December 2017. Experts widely expect the defendants in these cases to appeal to the U.S. Courts of Appeals in the Third Circuit and the Ninth Circuit, respectively.

ANA firmly believes in universal access to comprehensive and affordable health care services for all Americans. Access to basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams is critical to the overall well-being of women of all ages and is an essential health benefit. ANA will continue to advocate for universal access to quality, affordable, and accessible health care services, including basic, preventive reproductive health care services, for all Americans.

White House Report Promotes Full Practice Authority for RNs and APRNs

  

The White House yesterday released a report entitled “Reforming America’s Healthcare System Through Choice and Competition” that describes the influence of state and federal laws, regulations, guidance, and policies on choice and competition in health care markets and identifies actions that states or the federal government could take to develop a better functioning health care market.

This report bears great news for RNs and APRNs. It recognizes and promotes the role that RNs and APRNs play in patient care and recommends that the federal government and state governments should allow RNs and APRNs (and other allied health professionals) to practice to the full extent of their education and training. The report makes the following recommendations regarding scope of practice:

  • States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their licenses, utilizing their full skill sets.
  • The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.
  • States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., APRNs, physician assistants, hygienists) that are not justified by legitimate health and safety concerns.

The report also promotes the use of telehealth services, noting that, “telehealth has great potential to improve access in underserved locations, reduce costs, and generate improved short- and long-term health outcomes.” The report makes several recommendations regarding telehealth:

  • States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice.
  • States and the federal government should explore legislative and administrative proposals modifying reimbursement policies that prohibit or impede alternatives to in-person services, including covering telehealth services when they are an appropriate form of care delivery.
  • States generally should consider allowing individual healthcare providers and payers to mutually determine whether and when it is safe and appropriate to provide telehealth services, including when there has not been a prior in-person visit.
  • Congress and other policymakers should increase opportunities for license portability through policies that maintain accountability and disciplinary mechanisms, including permitting licensed professionals to provide telehealth service to out-of-state patients.

ANA’s comments to the Medicare Payment Advisory Commission (MedPAC) expressed our support to expand telehealth services to Medicare beneficiaries, especially in areas in which RNs and APRNs provide care, and ANA encourages the administration to continue to consider the role that RNs and APRNs – able to practice to the full extent of their education and training – play in providing primary care, telehealth, and other health care services to increase access to beneficiaries, also recognizing that reimbursement is necessary to not only provide the services, but to also fill the void in certain specialties and geographies.

ANA applauds the White House for recognizing through this report the crucial role that RNs and APRNs play in the U.S. health care system and for promoting innovative telehealth strategies that will better allow them to practice to the full extent of their education and training. ANA also commends the administration’s recent expansion – through the CY 2019 Medicare Part B Physician Fee Schedule final rule – of telehealth services for prolonged preventive health services and for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. These common-sense strategies will allow RNs and APRNs to maximize their significant contributions to quality patient care and outcomes.

Congressional Action in December

  

Lame Duck Watch

Now that the midterm elections have passed, the 115th Congress has entered its biannual period referred to as a “lame-duck” session. Some lawmakers who return for the lame-duck session will not be in the next Congress because they are retiring or lost their reelection. For that reason, they are referred to as lame-duck members. Lame-duck sessions are never predictable and can occasionally lead to high stakes drama. Here are a few issues we’re taking note of as the lame-duck gets underway.

Government Funding

Yesterday, President Trump threated to shut down the federal government if Congress does not give him $5 billion to build a wall on the U.S.–Mexican border that he campaigned on. Democrats have only agreed to $1.6 billion in funding. If Congress doesn’t pass seven appropriations bills by December 7, nonessential operations at multiple federal agencies will come to a halt due to a lack of funding.

Senate Appropriations Committee Chairman Richard Shelby has stated that a one-year continuing resolution (CR) is likely unless negotiators make significant progress on an agreement on border wall funding by next week, but did not rule out another short-term CR if there is some progress.

A continuing resolution funds the government at the same levels as the previous fiscal year for a set amount of time. Many Republicans would prefer a one-year CR be completed before Democrats take control of the House next year, rather than risk a shutdown which could give Democrats leverage in appropriations negotiations.

Title VIII

Senate Health Education Labor & Pensions Committee Chairman Lamar Alexander announced that there would not be another markup for the Committee this year. This means that Title VIII reauthorization will not happen in 2018. It’s a very unfortunate development after the House passed reauthorization unanimously on a voice vote in July. ANA and the Nursing Community Coalition will continue to fight for this long overdue reauthorization.