March 2014

Volume 11, Issue 4

HEADLINES

PRESIDENT'S BUDGET PROPOSAL FLAT FOR TITLE VIII
Title VIII Nursing Workforce Development Programs
FTC RELEASES REPORT ON APRNS AND SCOPE OF PRACTICE
FROM THE STATES . . .

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LINKS

NLN Government Affairs Action Center
NLN Public Policy

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"DEAR COLLEAGUE" LETTER ON TITLE VIII FUNDING CIRCULATING IN HOUSE

SIGNATURES NEEDED BY TUESDAY, APRIL 1, 2014

Representatives Lois Capps, RN (D-CA) and Richard Hanna (R-NY) are circulating a "Dear Colleague" letter among their fellow representatives that requests a strong commitment from them in Fiscal Year 2015 for the Title VIII Nursing Workforce Development Programs at the Health Resources and Services Administration. Representatives Capps and Hanna need to get as many of their colleagues in the House to sign this letter by Tuesday, April 1, 2014.

See a copy of the Capps/Hanna letter >

The Title VIII Nursing Workforce Development Programs are a comprehensive system of evidence-based, capacity-building strategies that provide students and schools of nursing with grants to strengthen education programs, including faculty recruitment and retention efforts, facility and equipment acquisition, clinical lab enhancements, and loans, scholarships, and services that enable students to overcome obstacles to completing their nursing education programs. They fill a clear need in our health care workforce.

ACTION REQUIRED:

Call, fax, or email your representative NOW – this Email Alert is ONLY directed towards the House of Representatives – and urge him/her to sign onto the Capps/Hanna letter to support the Title VIII Nursing Workforce Development Programs in the FY 2015 appropriations process.

Talking points >

Find the telephone or fax number for your representative. Include your representative’s Health LA (legislative assistant) in any message that you send. That person is listed under the "Staff" tab that appears on your representative’s homepage. Let them know that they should contact Adriane Casalotti in Representative Capps’ office or Emily Lambe in Representative Hanna's office to sign onto the "Dear Colleague" by the deadline of Tuesday, April 1, 2014.

PRESIDENT'S BUDGET PROPOSAL FLAT FOR TITLE VIII

On March 4, the Obama Administration released a proposed flat budget (see table below) for the Title VIII Nursing Workforce Development Programs for FY 2015. This release kicks off the congressional appropriations process for the year which, theoretically, should end with a congressional budget for FY 2015 by the September 30, 2014 deadline.

Title VIII Nursing Workforce Development Programs (in thousands)

Program		FY 2012	FY 2013	FY 2014 Final Omnibus Bill	FY 2015 President's Request
Advanced Education Nursing		$63.925	$59.943	$61.581	$61.581
Comprehensive Geriatric Education		$4.485	$4.248	$4.361	$4.361
NURSE Corps Scholarship and Loan Repayment Program		$83.135	$77.957	$79.986	$79.986
Nurse Education, Practice, and Retention		$39.182	$37.113	$38.008	$38.008
Nursing Faculty Loan Program		$24.553	$23.256	$24.562	$24.562
Nursing Workforce Diversity		$15.819	$14.984	$15.343	$15.343
Total, Title VIII Â		$231.099	$217.501	$223.841	$223.841

FTC RELEASES REPORT ON APRNS AND SCOPE OF PRACTICE

The Federal Trade Commission (FTC) issued a policy paper on March 12 stating that state legislators should be cautious when evaluating proposals to limit the scope of practice of APRNs since such proposals may reduce competition that benefits consumers. Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses notes the potential benefits of improved competition in the provision of primary healthcare services. FTC staff cites research suggesting that APRNs provide safe and effective care within the scope of their training, certification and licensure. In addition, health policy experts have warned of significant shortages of primary care practitioners across the United States, and have suggested that APRNs might help to alleviate healthcare access problems if undue regulatory burdens were reduced.

The policy paper recommends principles for evaluating APRN scope-of-practice proposals. It states, "Numerous expert healthcare policy organizations have concluded that expanded APRN scope of practice should be a key component of our nation's strategy to deliver effective healthcare efficiently and, in particular, to fill gaps in primary care access. Based on our extensive knowledge of healthcare markets, economic principles, and competition theory, the FTC staff reached the same conclusion: Expanded APRN scope of practice is good for competition and American consumers."

The policy paper is part of the FTC's ongoing efforts to promote competition in the health care sector, which benefits consumers through lower costs, better care, and more innovation.

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FROM THE STATES . . .

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Connecticut APRN Bill Moves Forward

A controversial proposal that would allow nurse practitioners to practice independent of doctors cleared the Connecticut House's Public Health Committee on March 10. Legislators voted 22 to 4 to advance the bill to the Senate floor.

Some members of the committee indicated that they believed the bill should move forward, but that it would need fine-tuning before becoming law. In particular, they raised concerns about malpractice insurance requirements for nurse practitioners and "truth in advertising" that would make clear to patients whether they are seeing a doctor or a nurse practitioner.

Current Connecticut law requires that APRNs practice in collaboration with a licensed physician. The proposal, which originated with Governor Dannel P. Malloy's (D) administration, would require APRNs to have a collaborative agreement with a physician for the first three years after getting their licenses. After that, they would be allowed to practice independently. The Malloy administration has framed the proposal as a way to improve access to primary care at lower costs. Supporters say that there is no evidence to suggest the change would cause safety concerns. Opponents, however, note that doctors have significantly more training and say lawmakers should not reduce the level of training needed to provide medical care.

Minnesota Bill Would Allow APRNs to Practice Independently

As the health care industry increasingly relies on nurses to perform work that once was exclusively assigned to doctors, bills sponsored by Minnesota state senator Kathy Sheran (DFL-Mankato) and state representative Dan Schoen (DFL-St. Paul Park), would give APRNs the independence they seek by granting full practice authority to nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists. Allowing this work without a requirement for permission from physicians is supported by a former dean of the University of Minnesota medical school, by Governor Mark Dayton's (D) health care reform task force, and by the Institute of Medicine, along with decades of research.

However, the proposed legislation that would remove physician supervision is not popular with doctors' groups. They oppose the legislation, arguing there is not enough evidence that nurses can provide the best patient care without physician oversight. Family physicians say equating the skills of advanced practice nursing with those of primary physicians is like comparing apples to oranges.

New York Bill Directed at NPs' Scope of Practice

A bill currently in the New York legislature would eliminate the need for a written practice agreement with a physician once a nurse practitioner has about three years of full-time experience. At issue is not just the autonomy of the state's nearly 16,000 NPs, but also whether removing the written agreement rule would make it easier to fill the growing shortage of primary care providers, as health reforms and increasing numbers of people with insurance coverage are fueling the demand for those providers.

New York currently requires that an NP's collaborating doctor review at least one medical chart every three months. Doctors' groups argue removing the requirement would erode patient safety.