Category: Nurse Advocacy

2022 Congressional Spending Bill Included Several ANA-Supported Nursing Provisions to Cap off the Year

  

As 2022 was winding down, Congress finalized negotiations on an end of year package to keep the government open. This bill would fund government agencies through Sept. 30, 2023. It includes $773 billion in domestic spending and $858 billion in defense funding. In addition, there is $45 billion in aid for Ukraine and $40 billion for disaster aid for communities impacted by recent storms and wildfires.  

ANA staff went through the bill and pulled out provisions of interest to the nursing community that we have outlined below:  

Nursing Workforce Programs 

ANA has actively advocated for increases for the Nursing Workforce Development Programs and the National Institute of Nursing Research (NINR) for decades. In this package, Title VIII Nursing Workforce Development Programs received $300.472 million. This is a $20 million increase over Fiscal Year (FY) 2022 enacted levels.  

The NINR received $197.693 million. This is a $16.831 million increase over FY 2022 enacted levels. In the report language, it highlights that $10 million of this is to support research “related to identifying and reducing health disparities.”  

Opioids 

ANA Chief Nursing Officer, Debbie Hatmaker, sent a letter to Congressional Leadership highlighting the need for certain bills and/or provisions to be included in this omnibus package. We are pleased to report that H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2021 was included. Specifically, ANA supported the inclusion of H.R. 1384, the Mainstreaming Addiction Treatment (MAT) Act. This legislation would eliminate the duplicative and burdensome requirement that providers, including APRNs, apply for a Drug Enforcement Administration waiver in order to dispense lifesaving buprenorphine to treat those suffering from opioid use disorder.  

ANA successfully led the charge in 2018 for permanent prescribing authority of medication assisted treatment by nurse practitioners. A compromise was reached to give five years prescribing authority for Certified Nurse-Midwives, Clinical Nurse Specialists, and Nurse Anesthetists who take additional continuing education in the SUPPORT for Patients and Communities Act of 2018. The inclusion of H.R. 1384 will further ensure Certified Nurse-Midwives, Clinical Nurse Specialists, and Nurse Anesthetists will not lose prescribing authority for medication assisted treatment when the provision sunsets in October 2023.  

Telehealth 

The omnibus continues Medicare’s expanded access to telehealth by extending COVID-19 telehealth flexibilities for an additional two years, through Dec. 31, 2024.  

Pandemic Preparedness 

The omnibus provides language to improve the Strategic National Stockpile to ensure critical pandemic supplies are operational, resilient, and ready to deploy. This includes the replenishing sale/transfer mechanism that will provide useful predictability for domestic manufacturing of personal protective equipment. The bill also provides support to the public health workforce by encouraging investments in the next generation of health care workers through grants and public health loan forgiveness.  

The bill includes $350 million in flexible funding for public health infrastructure and capacity, a 75 percent increase for the program that was established in fiscal year 2022 for the Centers for Disease Control to bolster public health infrastructure and rebuild the workforce at the state and local level to strengthen our capacity to be ready to respond to emerging public health threats. 

Annual Medicare Payment Changes 

Medicare providers were faced with 8.5% payment cuts slated to go into effect on January 1, 2023. The legislation prevents the 4% PAYGO cut as well as a portion of the 4.5 reimbursement cut resulting from expiration of previous congressional mitigation measures. Specifically, the cuts will be reduced by 2.5% in 2023 and 1.25% in 2024.  

If you have any questions about these provisions, or anything else, please leave a comment or contact someone on ANA’s Policy and Government Affairs staff.  

2022: The Year of the Value of the Nurse

  

This year was a busy and turbulent time for all of us as we continued to navigate life under the COVID-19 pandemic—and nobody knows this more than nurses and healthcare workers. While nurses across the country continued to provide valuable care to their patients, the Policy and Government Affairs team at American Nurses Association focused 2022 on highlighting the value of the nurse in our health care delivery system.

So, what do we mean when we talk about the value of the nurse? This takes a multitude of forms under our legislative and regulatory advocacy. We urged lawmakers to look at workplace challenges faced by nurses such as safety and staffing, advocated for the removal of barriers to practice, and the need to increase reimbursements for nursing services—all to strengthen and bolster the future of the profession. In a tumultuous year, we advocated for nurses and made important progress that will carry us into the new legislative session in 2023.

Legislative Recap

A Successful Spring

In March, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. This law will identify and disseminate best practices to reduce and prevent mental and behavioral health conditions, suicide, and burnout, as well as increase access to evidence-based treatment for nurses and other health care professionals. Over 7,500 nurses like yourself sent a letter to Congress urging them to pass this bill, and we want to thank you for your help getting this bill signed into law.

March proved to be a successful month for ANA, as there were some key pieces of legislation for nurses passed in the omnibus appropriations bill.

  • Title VIII Nursing Workforce Development Programs received $280.472 million dollars. This is $16 million more than these programs received in 2021.
  • The National Institute of Nursing Research received $180. 862 million. This is a nearly $6 million increase over the fiscal year enacted levels!
  • The Sexual Assault Nurse Examiners Program received $13 million, which is an increase of $4 million dollars. This funding will directly impact the Advanced Education Nursing program to expand training and certification of RNs, APRNs, and Forensic Nurses to practice as sexual assault nurse examiners.
  • Nursing also received nearly $5 million for Nurse Education, Practice, Quality and Retention efforts to address the RN shortage. The agreement directs Health Resources Service Administration (HRSA) to give priority in new funding announcements to public entities for training of additional RNs, specifically for acute care settings. In addition, it directs HRSA to give priority to applicants in States listed in the HRSA publication “Supply and Demand Projections of the Nursing Workforce 2014-2030” as having the greatest shortages.

An Auspicious Autumn

ANA has made meaningful progress on several vital pieces of legislation that we will continue to advocate for in 2023 and the 118th Congress.

This year, ANA worked with Congress on the Improving Access to Workers’ Compensation for Injured Federal Workers Act. This legislation would improve the Federal Employees Compensation Act and close a loophole negatively impacting Nurse Practitioners (NPs) and their ability to provide care to federal employees who are injured at work. This common-sense legislation passed in bipartisan fashion in the U.S. House, and in 2023 ANA will continue our work on this bill.

In September, ANA worked with several other nursing organizations and Congressional Representatives Lucille Roybal-Allard (D-CA) and Dave Joyce (R-OH) to introduce the Improving Care and Access to Nurses, or #ICAN Act, in the U.S. House. If enacted, this bill will remove practice barriers for advanced practice registered nurses (APRNs), improving access to care for Medicare and Medicaid patients. Read more about the #ICAN Act here.

In December, ANA worked closely with Senator Jeff Merkley (D-OR) to introduce the #ICAN Act in the Senate – a huge step forward to get the bill passed into law. Nearly 3,000 nurse advocates have written to their elected officials in support of this important legislation. You can join them, here.

Also in December, we continued our work with Senator Merkley, and worked with him to introduce the Nurse Overtime and Patient Safety Act in the U.S. Senate. As you know, many nurses have been forced to work overtime to alleviate staffing shortages. Substantial use of mandatory overtime can jeopardize patient safety and nurse well-being. A recent ANA survey found that nearly 60% of nurses reported being required to work beyond their shift on a weekly or even daily basis. This is unacceptably high, and Congress must rectify the issue. The trucking and aviation industries have federal mandatory overtime protections—nursing and health care are long overdue for the same safeguards. Learn more and email your senators, here.

Regulatory Recap:

A Strong Summer

Every year, CMS issues proposed rules related to Medicare reimbursement for services provided to patients. ANA uses this opportunity to comment on provisions that impact the nursing profession, highlight staffing and workforce challenges, and continue the drumbeat of the value of the nurse.

CMS also issued Requests for Information (RFI) throughout the year, allowing additional opportunities for ANA to share the nursing perspective on several topics. We weighed in on the impact of COVID-19, workforce challenges, rural health and health equity—all top priorities for ANA. In our comments, ANA asked CMS to remove barriers to practice, urged the agency to make the COVID-19 waivers permanent, and to continue to focus on workforce challenges and health equity. Read ANA’s comments, here, and learn more about our response to the Make Your Voice Heard RFI on the ANA Capitol Beat Blog.

In November, CMS released a memorandum on workplace violence in hospitals, reiterating that they will hold hospitals accountable for workplace safety. ANA is encouraged by this action, which signals that the administration is hearing our concerns around this critical issue.

A Winning Winter

In November, ANA’s Chief Nursing Officer, Debbie Hatmaker, and members of the Policy and Government Affairs team, met with Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to discuss nurse staffing concerns, workplace environment and retention challenges, and the value of the nurse in today’s health care delivery system.

ANA staff also met with Center for Medicaid and CHIP Services Director and Deputy Administrator Daniel Tsai to discuss the Medicaid program once the COVID-19 PHE ends. We also discussed Director Tsai’s greater vision for the program as they work closely with states to expand coverage and access.

Rounding out the year, ANA staff attended a Department of Health and Human Services (HHS) event focused on maternal health and mortality. This event showcased the agency’s plan to tackle this important, pressing issue. ANA staff used this opportunity to articulate to agency staff the important role nurses play in addressing maternal health and the need for nurses to be included in any agency-led approaches.

ANA staff will continue its dialogue with HHS, CMS, and other subagencies in the New Year to ensure the nursing perspective is not only heard but incorporated. We also will continue to seek opportunities for engagement as our regulatory advocacy focuses on advancing the value of the nurse.    

The Policy and Government Affairs Team is excited about the progress made legislatively and implemented through regulation in 2022 but we know our work on behalf of nurses and the nursing profession is never done. We look forward to 2023 and new opportunities to advocate for nurses and advance the nursing profession. ANA knows the value of the nurse, but we will make sure Washington does, too.

ANA Makes Nurses’ Voices Heard on Equity and Efficiency

  

Recently, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) entitled Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs. Through this RFI, CMS solicited feedback from stakeholders on the impact of the COVID-19 public health emergency (PHE) on the healthcare delivery system, with specific questions related to access, health equity, and workforce challenges. ANA took advantage of the opportunity to provide feedback to the agency on the nurses’ perspectives. We focused on how the COVID-19 pandemic has impacted the nation’s health care system and pointed to important areas of consideration as we all look to the future.

Representing and supporting over 4.3 million registered nurses, ANA understands the importance of elevating the nurse’s voice regarding the challenges in health care because nurses are integral to patient care. In sharing firsthand experiences from members and association priorities, ANA’s comments addressed access to health care, the nurse’s experience in providing care, advancing health equity, and assessing the impact of waivers issued in response to the PHE. A few key ANA recommendations to CMS are:

  • Make permanent the waivers that allow better access to telehealth and that allow Advanced Practice Registered Nurses (APRNs) to practice at the top of their license by removing unnecessary barriers; and
  • Acknowledge and support the role of the nurse in addressing health inequity and other long-standing nursing concerns about patient care.

Accessing Healthcare and the Public Health Emergency Waivers:

CMS asked to understand what challenges health care workers face that impact their wellbeing and present challenges to meet patient needs. In response, ANA shared member stories of patients who experienced barriers to care due to restrictive rules on APRN practice, such as not being able to access needed mental health care or obtain prescriptions for necessary medications.

We know that when APRNs are allowed to practice at the top of their license, more patients overcome barriers to receiving safe and cost-effective care. ANA recommended that current waivers still in place from the PHE, set now to expire in January 2023, be made permanent through CMS action, so that APRNs can continue to practice at the top of their license. These recommendations also support ANA’s legislative advocacy as we encourage lawmakers to support H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act which would allow for changes in Medicare and Medicaid for APRNs to provide necessary care within their scope to better reach and support the needs of more patients.

APRNs at the #ICAN Act Press Event in September, 2022

Allowing APRNs to continue to serve their communities as they have been able to through the PHE waivers offers more timely and accessible care options in underserved areas and specialties where care can be delayed. Additionally, the PHE waivers for telehealth flexibilities have allowed APRNs to better reach patients where they are needed. ANA recommended to CMS that telehealth allowances be continued and made permanent to increase accessibility to care for more patients.

Understanding Provider Experiences:

CMS also sought feedback to better understand the challenges that impact health care workers’ wellbeing and the challenges in their meeting patient needs. ANA responded by highlighting issues that were exacerbated by COVID-19. Limited resources, critical staffing shortages, and increasing levels of burnout during the ongoing pandemic are several key issues that still need to be addressed. ANA called on CMS to take concrete steps to protect nurses and their patients using all available authority and resources to address these concerns.

In sharing provider experiences, ANA made sure to promote nurse and patient wellbeing and safety issues in its comments. These experiences include:

  • encountering the stigma of needing mental health care, affecting patients and providers;
  • lack of meal breaks during shifts;
  • unenforced safe staffing standards;
  • inadequate nurse involvement in leadership decisions where nursing is impacted; and
  • needing to promote nursing education to keep up with the growing need for more nurses.

In addition, ANA recommended that CMS support nurses and providers by promoting retention efforts of healthcare workers through payment and reimbursement system changes which would allow for appropriate compensation of nurses that more accurately reflect the value of nursing to the healthcare system. ANA also suggested that CMS look further into ensuring documentation requirements are appropriate, to allow nurses to spend more time with patients, and less time charting extraneous details which are nonessential to daily care tasks.

Advancing Health Equity and COVID-19 PHEs:

Continuing their work on advancing health equity, CMS asked how to better help eliminate health disparities. The agency also inquired about COVID-19 PHE waivers, asking what was helpful and what needs to be improved upon from these waivers. ANA responded by continuing to emphasize the important role that nurses perform in their daily tasks and the accessibility that APRNs practicing at the top of their license provides to many patients in underserved areas.

An APRN advocating for the #ICAN Act in September, 2022

Nurses have firsthand experience witnessing health disparities and barriers to care that impact their patients’ health and wellbeing. The culturally competent care nurses provide allows them to identify and offer invaluable insight on the individualized needs of patients and more widely, on advancing health equity in their communities. Because of this, ANA encourages nurse involvement in researching, designing, and implementing measures to address health disparities and advance health equity. ANA stresses the importance of recognizing the role of the nurse in any proposed measure to advance health equity.

Allowing APRNs to practice at the top of their license, as well as the emergence of widely used telehealth appointments increases the accessibility of healthcare resources and making these emergency waivers permanent is one way CMS can immediately act to advance health equity before the waivers expire and we are forced to take a step backwards in access to high quality nursing care.

ANA continues to advocate on behalf of its members and the nursing profession with the federal agencies.

This blog was guest-authored by Samantha Karp. She is completing her Master of Science in Nursing with a focus in Nursing Leadership in Healthcare at Gonzaga University and has spent her practicum semester working with the ANA Policy and Government Affairs team, learning how nurses can be active advocates in policy.