Title VIII Legislation Passes House, Advances to Senate Floor


At the end of October, there were 7,679 bills introduced in the U.S. House of Representatives and the U.S. Senate.

With so many pieces of important legislation constantly in front of lawmakers and staff, it makes the fact that H.R. 728, the Nursing Workforce Reauthorization Act, was passed unanimously in the House that much more exciting.

As you may recall, nurses lobbied their members of Congress during ANA’s Hill Day in June to urge their lawmakers to cosponsor this legislation. With your tireless advocacy, you can now say your work on Title VIII is completed in the House.

Additionally, on the other side of the Capitol, the Senate has been working just as hard on Title VIII. During the same week of House passage, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on S. 1399, the Nursing Workforce Reauthorization Act. We are pleased to report the legislation successfully went through the committee process and the next step is for a vote on the Senate floor.

With all eyes on the Senate, we ask you to reach out to your Senators and ask them to consider cosponsoring S. 1399. If they are already a cosponsor, ask them to talk to Senate Leadership to bring Title VIII for a vote this year.

While this week has been focused on Title VIII reauthorization, we are continuing to advocate for additional priorities such as the Home Health Planning Improvement Act (S. 296/H.R. 2150) and the Workplace Violence Prevention for Health Care and Social Service Workers Act (S. 851/ H.R. 1309), and additional important pieces of legislation.

Executive Order for Medicare Accelerates APRN Reforms and CMS Delivers


Last week’s Capitol Beat offered a 10,000-foot review of the Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors. This week, we take a deeper dive and connect the dots with ANA advocacy and a new success story expanding scope for advance practice registered nurses (APRNs) in Medicare.

Among other provisions, the Executive Order directs the federal Medicare agency to remove certain billing rules that can get in the way of providers caring for their patients. The initiative specifically targets Medicare practice rules that are more stringent than state laws. Medicare must propose new rules within a year’s time. This is welcome news for many APRNs participating in Medicare, who are subject to an array of confusing federal rules that keep them from practicing at the top of their profession in caring for Medicare beneficiaries.

ANA has long advocated for administrative reforms to lift separate Medicare practice restrictions on APRNs, who are subject to state licensing authorities where they practice. Most recently, in a letter to Medicare officials on September 24, 2019, ANA emphasized that federal payment rules applied to APRNs should not have the effect of restricting patient access and choice, and that Medicare beneficiaries are increasingly relying on APRNs for primary care. We also cautioned that federal restrictions on APRN practice can have systemic consequences, especially in rural, underserved, and appointment shortage areas, where new approaches are sorely needed to improve access and care experience.  

We are therefore excited to see signs in the Executive Order that nurses’ voices are being heard when it comes to health care reform. ANA and our members look forward to engaging with Medicare in the months ahead to identify some of the most troublesome barriers to APRN practice.

It is also encouraging to see that Medicare is already taking small steps to dismantle barriers to APRN care. The Centers for Medicare and Medicaid (CMS), starting next year, will allow nurse practitioners (NPs) in the state of Maryland to certify when their patients need home health care. This is a significant waiver of current law which requires an NP to bring in a physician, even when they are qualified under state practice authority to make such a decision.

The home health certification waiver in Maryland relates to a larger pilot program, which is testing a new payment system for Medicare in that state. Because of this pilot, CMS is able to authorize changes to existing law that are limited to the Maryland pilot. An act of Congress will be required to change the rules for the rest of the country. ANA supports the bipartisan Home Health Care Planning Improvement Act (H.R. 2150 / S. 296), which will allow NPs, clinical nurse specialists (CNSs), and certified nurse midwives (CNMs) to order home health care services without physician approval.

There is much work to be done to craft appropriate policies that expand access to APRN care and reward APRNs for the high-quality care they provide. ANA acknowledges and applauds the commitment of federal partners who are working with nurses to bring about the best possible results for our members and their patients.

Nurses are speaking and Congress is listening as August recess wraps up


After a very busy spring and summer, Congress has left Washington, D.C. for a few weeks and all eyes now look ahead to what is gearing up to be an active fall.

It is clear that lawmakers and staff are listening to the nurses. Many key priorities of ANA have progressed during the last few months.

It was met with great news when the House Education and Labor Committee passed the Workplace Violence and Prevention for Health Care and Social Service Workers Act (H.R. 1309) with a bipartisan vote during the week of Hill Day and Membership Assembly. This bill directs the Occupational Safety and Health Administration to issue a standard requiring health care and social service employers to develop and implement a comprehensive violence prevention plan tailored to the facility and services with the intention to protect employees from violence incidents in the workplace.

In July, the House Energy and Commerce Committee unanimously passed the Title VIII Nursing Workforce Reauthorization Act (H.R. 728). This legislation would reauthorize nursing workforce development programs through Fiscal Year 2024. That means two of ANA’s key bills are ready for a vote on the floor of the House of Representatives.

Additionally, it is appropriations season in the House of Representatives and the nurses received two wins in the House-passed Labor-HHS appropriations legislation. It included a $30 million increase in Title VIII funding and language to direct CMS to provide information for evaluating appropriate nurse staffing. ANA staff is working with the Senate to ensure they are aware of the provisions in the House-passed text.

Lastly, ANA has been working closely with the Nursing Community Coalition and the coalition was able to include an amendment to the House passed National Defense Authorization Act. This amendment would recognize the nurses who served as members of the United States Cadet Nurse Corps during World War II and provide them with honorable discharges, medal privileges, and burial benefits for cemeteries administered under the Department of Veterans Affairs. We are hopeful this amendment will be in the final legislation!

In order to keep up the great progress that has been made, we urge you to keep calling upon your members of Congress to ensure we can keep moving the ball during the upcoming months!