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.

ANA-PAC’s Success in the 2018 Mid-Term Elections


It’s clear that the November 6th midterm elections were a successful day for the nursing profession and health care more broadly. The American Nurses Association Political Action Committee (ANA-PAC) paid dividends for its members and the profession by spending more than $422,000 to help elect longstanding champions of nursing like Reps. David Joyce (R-OH-14) and Frank Pallone (D-NJ-6), as well as Sens. John Barrasso (R-WY) and Tom Carper (D-DE) while helping usher in fresh faces for the 116th Congress like Rep. Elects Joe Morelle (D-NY-25) and Dusty Johnson (R-SD-At-Large).

Rep. Elect Morelle has collaborated with the American Nurses Association-New York during his time in the state assembly and consistently helped secure legislative victories to advance the nursing profession, including passage of a bill that strengthens education requirements for future nurses and establishing a commission to evaluate and report on barriers to entry into the nursing profession in New York while Rep. Elect Johnson was responsible for overseeing the South Dakota State Employee Health Care Plan in his capacity as chief of staff to Governor Dennis Daugaard, where he heard and implemented input from health care professionals across the state, including nurses. He is dedicated to bringing stability to a health care market that has experienced a great deal of uncertainty in the past year and a half.

On a particularly great note, registered nurse Lauren Underwood achieved victory as the next Member of Congress representing the Illinois 14th congressional district. Besides being a fellow nurse, she also earned the distinct honor of being elected the first congresswoman from her district. Lauren will join registered nurses Reps. Karen Bass (D-CA-37) and Eddie Bernice Johnson (D-TX-30) in the 116th Congress.

If there was ever any proof ANA knows how to support the correct candidates it’s this: of the more than 120 candidates for federal office supported by ANA-PAC, an impressive 94% have won their election. A total of 96% of incumbents, 91% of those running in open seats and 90% of candidates running against a sitting federal lawmaker won their elections while 93% of those candidates the PAC endorsed were elected. This showcases ANA staff’s ability to identify candidates who are both invested in moving nurses forward and are likely to run successful campaigns that are responsive to their voters’ broader interests, including the need for increased access to affordable health care.

Not surprisingly, ANA staff are already evaluating the political landscape on Capitol Hill and strategizing for the 116th Congress. A Republican-controlled Senate and a Democratic-controlled House is just one of the many factors being considered in terms of how best to advance ANA’s legislative and regulatory agendas. Whether the issue is safe staffing, nursing scope of practice or safe patient handling, staff are determined to find new ways to build and enhance bipartisan support of our issues.

This cycle, ANA’s members helped the ANA-PAC achieve and exceed its fundraising goal by raising more than $500,000 since January 1, 2017 (remember: no ANA dues money is ever used to support political candidates). Staff, along with the ANA-PAC Board of Trustees, will be utilizing these contributions to continue cultivating relationships on both sides of the  political aisle, and maintaining our non-partisan presence on Capitol Hill. Stay tuned to Capitol Beat for more updates as the legislative agenda for the 116th Congress develops.

To learn more about ANA-PAC, check out of FAQs and see who the PAC supported in your state please check out the ANA-PAC website.