Category: Home Health

Opioid Bill Contains Victories for Medicaid – as the Administration Undermines Medicaid Access

  

This week the Senate passed a landmark piece of legislation, the SUPPORT for Patients and Communities Act, that aims to curb the nation’s ongoing opioid-use disorder crisis. The legislation includes a critical provision that enables nurse practitioners and physician assistants to prescribe buprenorphine permanently – once they obtain a waiver required by any provider to prescribe medication-assisted treatment (MAT) – and expands MAT prescribing authority for five years to other advanced practice registered nurse (APRN) specialties: certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists.

Medicaid Provisions in the SUPPORT for Patients and Communities Act

The bill also includes several critical Medicaid provisions aimed at treating individuals who suffer from an opioid-use disorder and preventing others from developing an opioid-use disorder. Taken together, these provisions will significantly increase access to opioid-use disorder treatment and counseling services for some of the nation’s most vulnerable populations and will decrease the rate of new opioid-use disorders.

These provisions include:

  • A temporary suspension (from Fiscal Year 2020 through FY 2023) of the Medicaid institution for mental disease (IMD) exclusion for short-term stays (less than 30 days per year) and the codification of regulations that allow managed care organizations to receive federal funding for patients who are in an IMD for 15 days or less per month (current law does not allow federal payment for patient stays in IMD facilities with greater than 16 beds);
  • A requirement for states to cover MAT, including methadone and counseling services, for opioid-use disorders from FY 2021 through FY 2025;
  • A provision that allows states to cover care for infants with neonatal abstinence syndrome at a residential pediatric recovery center and an extension of enhanced federal match provided under Medicaid for health home services to treat individuals with substance use disorders;
  • A requirement for state Medicaid programs to not terminate coverage for juvenile inmates under the age of 21 while they are incarcerated and an extension of Medicaid coverage for former foster youths ages 18 to 26 who move states, and;
  • A requirement for states to comply with drug review and use requirements as a condition of receiving federal Medicaid funding and a provision that allows state Medicaid programs access to state prescription drug monitoring programs.

Trump Administration Approval of Medicaid Work Requirements

It is ironic, then, that as the SUPPORT for Patients and Communities Act heads to President Trump’s desk, his administration is actively taking steps that will create barriers for Medicaid beneficiaries to remain covered under the program. CMS Administrator Seema Verma recently defended the administration’s policy of approving Medicaid waivers for demonstration projects that impose work requirements on certain Medicaid populations (i.e., the Medicaid expansion population of low-income, childless adults).

CMS recently faced criticism after 4,300 Arkansans lost Medicaid coverage in September as a result of not meeting the state’s new work requirements; this is the first time in the Medicaid program’s 53-year history that beneficiaries have lost coverage for not meeting work requirements. The administration has approved work requirements for Indiana and New Hampshire, and waivers to impose work requirements are pending in South Dakota, Kansas, Mississippi, Ohio, Maine, Utah and Arizona. Kentucky’s work requirements waiver was struck down in federal court in July, though the administration is currently working with Kentucky to revise implement those requirements nonetheless.

Studies show that work requirements for Medicaid beneficiaries have little to no impact on employment and, as demonstrated in Arkansas, result in coverage losses. According to a December 2017 Kaiser Family Foundation issue brief, roughly 6 in 10 of the 22 million non-disabled adults receiving Medicaid benefits are employed either full- or part-time, while 8 in 10 of these adults live in a working family. Most of these individuals work either for small firms or in low-paying industries which do not offer healthcare coverage and thus rely on Medicaid for such. Further, among those adults who are not working, most report a major barrier to employment such as illness, disability, or care-giving duties. According to the same Kaiser issue brief, Medicaid expansion has not negatively impacted labor market participation; in fact, some research demonstrates that Medicaid coverage supports work.

ANA Commends Congress and Urges Its Members to Vote in the Midterms

ANA applauds Congress for its hard work and dedication in passing the SUPPORT for Patients and Communities Act and for recognizing the role that RNs and APRNs play in patient care for those with an opioid-use disorder.

However, ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. The recent moves by both the Trump administration and state governments fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services. These moves also undermine the progress made in Congress with the SUPPORT for Patients and Communities Act.

Healthcare stands to be a major issue in the upcoming 2018 midterm elections – 22 percent of respondents to a June 2018 NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. These elections are right around the corner and are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. When nurses vote, lawmakers in Washington, DC, and in statehouses across the country listen. Visit ANA’s #NursesVote Action Center today and help us make this the most meaningful election for nurses yet.

Protect Your Practice: Healthcare Bill will have Profound Impact on Nursing, Nurses, Patient Care

  

To many nurses around the country, the talk about healthcare reform in the nation’s capital is just that: a whole lot of talk. But if the current healthcare bill being considered by the Senate passes, are you ready for how it will impact your practice and the nursing profession as a whole?

Take hospital funding, for example. Love it or hate it, it’s a fact that “Obamacare” (or the  Affordable Care Act, “ACA”) drastically reduced the amount of money hospitals spend annually on uncompensated, or “charitable,” care.

In one state alone, Minnesota, hospitals have seen their uncompensated care costs decline by 17% since the implementation of the ACA, saving hospitals in the state about $53 million annually.

Such numbers are far from uncommon, and are probably similar where you live. The reason is simple: when more people have insurance, more people are able to pay their hospital bills. Unfortunately, the healthcare changes being considered by the Senate would leave 49 million people across the US without health insurance, once again increasing the need for hospitals to provide enormous (and enormously expensive) amounts of charitable and otherwise uncompensated care.

These increased costs will need to be accounted for in hospital budgets and will likely impact nurse staffing and care delivery—a critical issue which ANA recently addressed in a widely co-signed letter to the Center for Medicare Services.

But the healthcare bill will also impact nurses outside of the hospital setting. According to a recent survey of school administrators, over seventy percent of school districts turn to Medicaid to pay for the health professionals and school nurses needed to care for special education students. Since the senate healthcare bill would cut Medicaid spending by almost $800 billion and impose a cap on the amount of Medicaid-funded services any child could receive, school nurses and administrators are staunchly opposed to the bill.

Even if you don’t work in a hospital setting, and even if you don’t have children in school, it’s likely you will still be impacted by the healthcare bill being considered by the Senate. For example, we all have a vested interest in the health of our nation’s veterans. But of concern to veterans, VA nurses, and Veterans groups, 1.75 million vets stand to lose their Medicaid coverage under the healthcare bill, which in turn would impact the VA as more veterans seek care in that already overloaded and underfunded system.

Since Medicaid pays for most of the 1.4 million Americans in nursing homes, elderly Americans and nursing home nurses are also gravely concerned by the impact of the healthcare bill. The same goes for rural nurses and citizens, whose safety-net hospitals are projected to lose eighty-three percent of their net income by 2026 under the new bill.

The list goes on: whether or not you realize it, this healthcare bill will impact you and your practice, perhaps in ways that are unforeseen or unintended. That’s why the American Nurses Association is calling for a more thorough, nuanced, and bipartisan process for healthcare reform.

We urge the Senate to step back and approach this herculean task in a way that works for all Americans. For the sake of nurses and their patients, we can’t afford to get this one wrong.

National Nurses Week Recognized on Capitol Hill

  

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In honor of National Nurses Week, ANA has worked with Congress to celebrate nurses for their expertise, compassion, and vital role they play in our nation’s healthcare system.

On May 4th, Representative Eddie Bernice Johnson (D-TX), the first registered nurse elected to Congress, introduced House Resolution 315. This resolution states that the U.S. House of Representatives supports the goals and ideals of National Nurses Week as founded by the American Nurses Association. It notes that as nurse staffing levels increase, the risk of patient complications and length of hospital stays decrease, resulting in cost savings. Further, it acknowledges that nurses consistently deliver high-quality care with positive patient outcomes when they are allowed to work to the full extent of their education and training.

Rep. Johnson called her resolution a small token of gratitude and recognition for all the hard work nurses perform. “As a non-practicing registered nurse and member of the Congressional Nursing Caucus, I am acutely aware of how valuable nurses are to the medical system, patients, and our society,” said Johnson. “Whether in hospitals, nursing homes, community clinics, or any other setting, nurses are integral to patient care. Nurses are our greatest resource in eliminating health disparities and alleviating chronic disease as they exemplify and lead prevention and public health efforts.”

The Co-Chairs of the Senate Nursing Caucus, Sens. Roger Wicker (R-MS) and Jeff Merkley (D-OR), introduced an identical resolution officially honoring May 6-12 as National Nurses Week. Their resolution recognizes nurses as strong allies to Congress, experienced researchers, and the cornerstone of the public health infrastructure.

On May 11th, a bipartisan group of Senators introduced S. 1109, the Nursing Workforce Reauthorization Act. Led by Senators Jeff Merkley (D-OR), Richard Burr (R-NC), Tammy Baldwin (D-WI), and Susan Collins (R-ME), this legislation would reauthorize, update and improve programs that help to grow and support the nursing workforce in the United States.

“As the husband of a nurse, I hear firsthand about the challenges and successes that come with working on the frontlines of our health care system,” said Merkley. “Every day, nurses take on difficult, essential, and often thankless tasks that keep our health care system running and that have a huge impact on the patient experience. Each of us has a story about the nurse who made all the difference at a frightening or difficult time for our families. I’ll keep fighting to improve federal policy to fully recognize and support the essential role of nurses in our health care system, and I invite all Oregonians to join me in recognizing the tremendous work of our Oregon nurses this National Nurses Week.”

Additionally, ANA co-sponsored two Hill briefings with the Nursing Community in collaboration with the House and Senate Nursing Caucuses. The series was entitled “Transforming Health and Health Care: Nursing Workforce and Research.” The first briefing featured nursing experts who made a clear case to Congress for funding nursing education by highlighting ways the nursing profession is meeting healthcare needs of the nation. The second briefing focused on the contributions of nursing science as it relates to care across the continuum, including data science and precision health. The speakers discussed nurses’ leading role in research innovations and how nurse science has helped improve patient outcomes.

As we bring Nurses Week to a close, The Hill published an op-ed by President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, urging Congress to cut through the red tape to help Medicare beneficiaries get the care they need by passing S.444/HR 1825, the Home Health Care Planning Improvement Act. This legislation would authorize nurse practitioners, clinical nurse specialists, and certified nurse midwives as eligible healthcare professionals who can certify patient eligibility for home health care services under Medicare.

Happy Nurses Week and thank you for the meaningful work you do every single day!!