Category: Nurse Advocacy

Rebuilding America’s Nursing  Workforce—Title VIII Programs

  

America continues to face a geographic nursing workforce shortage, particularly in rural and medically underserved communities.

Inadequate staffing tends to have an adverse, ripple effect on the nursing workforce and the ability of healthcare facilities to provide timely, high-quality healthcare services. One solution to this staffing crisis is for policymakers to continue to invest in nursing education by supporting the Title VIII Nursing Workforce Development Programs. 

There will be about 194,500 openings for registered nurses (RNs) annually through 2033 due to nurse retirements and other workforce exits.

U.S. Bureau of Labor Statistics

What are the Title VIII Nursing Workforce Development Programs? 

The Title VIII Nursing Workforce Development Programs represent the only dedicated federal programs addressing all aspects of nursing workforce development, including education, practice, and retention. These programs are administered by the Health Resources and Services Administration within the U.S. Department of Health and Human Services. Here is an overview of the Title VIII Programs: 

  • ADVANCED NURSING EDUCATION PROGRAM – The Advanced Nursing Education Program helps support advanced practice registered nursing (APRN) students so they may practice in rural and underserved settings. This program also focuses on increasing nurses in primary care through traineeships opportunities.  
  • NURSING WORKFORCE DIVERSITY PROGRAM – The Nursing Workforce Diversity Program increases nursing education opportunities for students underrepresented in the profession by supporting career advancement for nurses with diplomas to become baccalaureate prepared registered nurses (RNs) or graduate-prepared advanced practice registered nurses (APRNs).  
  • NURSE EDUCATION, PRACTICE, QUALITY AND RETENTION PROGRAM – The Nursing Education, Practice, Quality and Retention Program focuses on national nursing needs and strengthens nursing workforce capacity.  
  • NURSE FACULTY LOAN PROGRAM – The Nurse Faculty Loan Program works to increase the number of qualified nurse educators by awarding funds to institutions that provide student loans to graduate students willing to serve as faculty upon graduation.  
  • NURSE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS – The Nurse Corps Scholarship Program awards scholarships to individuals who are enrolled or accepted in a school of nursing, in exchange for service of at least two years in a Critical Shortage Facility (CSF) after graduation. The Nurse Corps Loan Repayment Program assists in the recruitment and retention of RNs and APRNs to work in CSFs or as faculty in nursing schools by providing these nurses with loan repayment benefits. 

Importance of Reauthorizing the Title VIII Nursing Programs 

The Title VIII Programs were last reauthorized in 2020 as part of the Coronavirus, Aid, Relief, and Economic Security (CARES) Act for a period of five years. Anticipating the need to reauthorize these critical programs, the American Nurses Association (ANA) and its allies in the nursing community worked with a bipartisan group of congressional champions to introduce the Title VIII Nursing Workforce Reauthorization Act (H.R. 3593 / S. 1874). Both bills have garnered bipartisan support on Capitol Hill.

In fact, the House Energy and Commerce Committee held a hearing earlier this year to examine H.R. 3593. Unfortunately, the federal government shutdown slowed down momentum for moving this bill and authorization for the programs expired on October 1st. Without the passage of this bill, the Title VIII Programs are at risk for losing congressional funding and being eliminated altogether. Our team continues to advocate for reauthorization during ongoing conversations with key Leadership and committee staff on both sides of the aisle.  

Congressional Funding is Critical to Expand Nursing Workforce 

Despite making up the largest sector of the healthcare workforce at over 5 million nurses, congressional support for nursing workforce development currently stands at $305.472 million in discretionary spending under the current continuing resolution which is in effect until January 30, 2026. This amount pales in comparison to the $17.8 billion in mandatory funding that Congress provides to graduate medical education. Unfortunately, the Senate Appropriations Committee approved a healthcare spending bill that would provide $303.472 million for the Title VIII Programs in Fiscal Year 2026. The measure proposes a $2 million haircut to the Nursing Workforce Diversity Program. 

Even worse, the House Appropriations Committee took a machete to the Title VIII Programs by proposing to cut these programs by $47 million. Specifically, the bill would eliminate funding for the Nursing Workforce Diversity Program and the Nurse Faculty Loan Program. The adoption of the House bill would make it harder for our nation to attract talented nurse faculty to educate the next generation of nurses. It would also make it more difficult for our nation to attract a nursing workforce that meets the needs of all Americans. Consequently, ANA and its nursing allies are now requesting that Congress provide at least $303.472 million for the Title VIII Programs in FY 2026 by adopting the Senate’s healthcare spending bill. 

How You Can Help Protect Nursing Education 

There are plenty of ways that nursing advocates can help ANA protect the Title VIII Programs and nursing education. The easiest way is to reach out to your members of Congress to ask for their support for reauthorization and funding for these vital programs by visiting RNAction.org. Nursing advocates can also schedule meetings with their lawmakers and their staff in their district offices during constituent work periods. Visit ANA’s In-District webpage that share tips for scheduling and executing these meetings. Finally, ANA members can join the Nurses Action Society if they would like to leverage their existing relationships with federal lawmakers or would like to develop relationships with lawmakers on Capitol Hill. 

Regulatory Roundup

  

The American Nurses Association (ANA) plays a vital role in shaping federal healthcare policy through regulatory advocacy, particularly by engaging with the Centers for Medicare & Medicaid Services (CMS) during its annual rulemaking cycle. Each year, CMS proposes payment rules  to update the Medicare payment program, influencing quality reporting, practitioner reimbursement, and emerging healthcare priorities.  

These proposed rules typically have a 60-day comment period—allowing stakeholders to review the proposals and submit comments through regulations.gov. After the 60-day comment period closes, CMS reads and counts every comment to determine which proposals should be finalized or changed from the proposed rule and implement the policy in the next fiscal year.  

2026 Payment Rules 

In the 2026 cycle, ANA reviewed the proposed rules and determined which proposals impact nursing practice the most and submitted detailed comments to ensure the nursing profession’s voice is represented, including the role of Advanced Practice Registered Nurses (APRNs) and their scope of practice. 

A consistent theme across the proposed 2026 rules was the removal of quality metrics related to Social Determinants of Health (SDOH) and equity, replaced by new measures focused on well-being, nutrition, and related categories. Additionally, the role of AI, digital health and telehealth were also seen throughout the proposed 2026 rules. Finally, another widespread suggested change was the elimination of COVID-19 vaccination reporting requirements for healthcare personnel, reflecting the end of the public health emergency. ANA responded to the shift in quality metric reporting by advocating for the retention of SDOH metrics and emphasizing the importance of nurses in delivering person-centered care across all healthcare settings. ANA, across its comments, stressed the importance of evidence-based quality measures, workforce metrics like nursing turnover, and regulatory flexibility to support telehealth, safe staffing, and nurse-led care planning. 

ANA also submitted comments to the Administration’s Requests for Information (RFIs) on deregulation in healthcare and across the department of Health and Human Services as well as in the context of digital health. These comments reinforced the need to eliminate regulatory barriers that prevent APRNs from practicing to the full extent of their training and licensure.  

Across specific payment systems, ANA’s comments were tailored to the unique challenges and opportunities in each care setting: 

  • Physician Fee Schedule: ANA’s  comments focused on telehealth and AI flexibilities, reimbursement, the removal and addition of quality measures, and ensuring nurses are included in the implementation of new metrics. 
  • Hospital Outpatient Prospective Payment System:  ANA’s comments emphasized the role of nurses in coordinated care and urged CMS to support rural access, innovation, and transparency. Key issues included telehealth reimbursement, hospital price transparency, practitioner terminology, and supervision authority. 
  • Home Health  PPS: ANA’s comments opposed the removal of SDOH metrics and called for greater nurse involvement in developing quality measures. ANA also stressed the need to maintain nursing visibility in patient surveys and electronic health records, balance functional and outcome-based measures, and eliminate outdated COVID-19 vaccination metrics. 
  • Hospice Prospective Payment System: ANA’s comments supported allowing APRNs to conduct and sign hospice recertification attestations, called for immediate implementation of the Hospice Outcomes and Patient Evaluation assessment tool, and highlighted nurses’ role in applying quality metrics for patient-centered care. 
  • Inpatient Psychiatric Facility Prospective Payment System: ANA’s comments backed the removal of COVID-19 vaccination reporting given the end of the public health emergency but opposed eliminating SDOH measures. ANA emphasized nurses’ contributions to developing new quality metrics and advocated appropriate staffing to improve outcomes and retention. 
  • Inpatient Prospective Payment System: ANA’s comments urged CMS to remove regulatory barriers for APRNs, retain equity-focused quality measures, and engage nurses in shaping hospital quality programs. ANA also supported ending COVID-19 vaccination reporting mandates. 

Overall, ANA’s regulatory advocacy in the 2026 CMS rulemaking cycle focused on preserving and enhancing the visibility, authority, and impact of nurses in all healthcare settings and the preservation of SDOH data metrics.  

ANA consistently emphasized the need for evidence-based quality measures, the removal of administrative burdens like outdated COVID-19 vaccine reporting, and regulatory flexibility to empower nurses and improve patient outcomes. The ANA Policy and Government Affairs team continue to track all the payment rules as they are finalized.  

Removing Regulations, Removing Barriers to Nursing Practice

  

Since President Trump took office, we have seen an Administration-wide push to eliminate unnecessary regulations. Back in January, President Trump issued an Executive Order (EO), Unleashing Prosperity Through Deregulation, requiring agencies to get rid of ten existing regulations for every new regulation introduced. This builds on deregulatory efforts from President Trump’s first term, where agencies were asked to get rid of two regulations for every new regulation introduced—now at a 5x larger scale. The goal of this effort is to increase government efficiency and reduce the administrative burden for stakeholders. As part of complying with the EO, the Department of Health and Human Services (HHS) sought public feedback on which regulations to eliminate through a request for information (RFI) on a deregulatory plan to lower healthcare costs and empower healthcare providers.

ANA has long-identified persistent regulatory barriers that nurses face and welcomed the opportunity to provide comment to HHS. In ANA’s official response to the RFI, the association detailed how HHS’ deregulatory efforts can remove barriers to nursing practice and advance our policy priorities by action such as:

  • removing regulatory barriers to allow advanced practice registered nurses (APRNs) to practice at the top of their license,  
  • eliminating overly burdensome collaboration and supervision requirements,
  • removing “incident to” billing from Medicare reimbursement,
  • making COVID-19 telehealth flexibilities permanent,
  • and banning the use of non-compete agreements for nurses in Medicare and Medicaid facilities.

Notably, this RFI from HHS is not the first health-related deregulatory RFI of this Administration—in May, ANA responded to the Centers for Medicare & Medicaid Services’ (CMS’) RFI on deregulation. CMS continues to promote this RFI in its 2026 Medicare Hospital Outpatient Prospective Pay System and Physician Fee Schedule proposed rules. This signals that the deregulation efforts will remain a key priority for the Administration. ANA will continue to respond to opportunities to weigh in on deregulation efforts as we advocate for nurses and advance nursing priorities.