Wrapping Your Head around Health Reform

1. Wrapping Your Head around Health Reform Kathleen A. Ream Director, Government Affairs October 1, 2010

2. SETTING THE STAGE • March 23, 2010 - Patient Protection and Affordable Care Act (PPACA), P.L. 111-148 • September 23, 2010 - Patient’s Bill of Rights

3. IMPLICATIONS OF HEALTH CARE REFORM FOR NURSING • Incentives to Educate More Nurses • Increases Demand for Highly-Skilled Nurses • Quality Incentives • Other Practice Opportunities • Boards, Commissions, Councils, and Panels

4. CAUTION!! PPACA is an authorization bill. Many of its provisions will require appropriated funding.

5. PPACA REAUTHORIZES TITLE VIII - NURSING WORKFORCE DEVELOPMENT PROGRAMEffective dates: FY 2010-2014

6. NURSE FACULTY LOAN PROGRAM • Expands the educational loan repayment amount from $30,000 to $35,500 • Creates “Eligible Individual Student Loan Repayment” program • Increases loan repayment amounts up to $40,000 for master’s & $80,000 for doctoral • Funding priority to doctoral students to impact nurse faculty shortage

7. Medicare Graduate Nursing Education Demonstration Program • Effective January 1, 2012 thru 2015 • $200 Million for Demo Projects • Medicare payments to hospitals for clinical training costs of preparing APRNs – nursing’s equivalent to GME • Partnership created among hospitals, accredited schools of nursing, and non-hospital community-based care settings

8. ADVANCED NURSING EDUCATION GRANTS • Eliminates 10% cap on doctoral programs for AEN grants • Allows funds to go directly to students not only to schools

9. LOAN REPAYMENT AND SCHOLARSHIP PROGRAM • Nurse faculty now included as eligible participants • For repayment must serve as faculty at an accredited nursing school for two years

10. NURSE EDUCATION, PRACTICE, & RETENTION GRANTS • Grant program now titled “Nurse Education and Practice Grants” • Nurse Retention gets own section • Expands career ladder programs, funding for nursing internships and residency programs in collaboration with accredited schools of nursing

11. NURSING STUDENT LOAN PROGRAM • Now includes nursing faculty as eligible participants • Increases aggregate amount of student loan from $13,000 to $17,000 • Increases student loan amounts from $2,500 to $3,500 • Increases student loan amounts for final two years from $4,000 to $5,200

12. COMPREHENSIVE GERIATRIC EDUCATION • PPACA creates a CGE Traineeship that provides funding to students for tuition, books, and stipends • No funding has yet been appropriated for FY 2011

13. WORKFORCE DIVERSITY GRANTS • Provides stipends for diploma or AD nurses to enter bridge programs • Provides scholarship or stipends for accelerated degree programs, pre-entry preparation, advanced education preparation, and retention activities

14. ADDITIONS TO TITLE VIII • Two other types of nursing programs are now eligible for Title VIII funding: • “Accelerated” BSN or MSN programs • “Bridge” BSN or MSN programs

15. NATIONAL HEALTH SERVICE CORPS • Scholarship & Loan Repayment Programs for students in accredited health professions education program in exchange for 2-4 years of service in a health professional shortage area • Aimed at FNPs and CNMs

16. PRIMARY CARE "EXTENSION" PROGRAM • Program will educate providers in primary care, prevention, chronic care management, mental and behavioral health, and evidence-based practice • Provision uses the IOM definition of primary care which includes nursing

17. FNP RESIDENCY TRAINING PROGRAM • NP Residency program in federally qualified health centers or nurse managed health clinics • Awarded health centers need to have at least 3 NP residents in training program • Preference given to bi-lingual nurse practitioners

18. U.S. PUBLIC HEALTH SERVICE TRACK • Began FY 2010 • Organized to annually graduate at least 250 nursing students • Students receive tuition and stipend for no more than 4 years • Upon degree completion, awardees serve two years for each year they were supported

19. PEDIATRIC HEALTH CARE WORKFORCE • Loan repayment program to drive clinicians to provide pediatric health care in underserved areas for 2 years • Providers include psychiatric nurses for the Child & Adolescent Behavioral Health provision • Up to $35,000 in loans/year will be repaid for a maximum of 3 years

20. MATERNAL, INFANT, & EARLY CHILDHOOD HOME VISITING PROGRAMS • Creates strong expansion opportunity for Nurse-Family Partnership • $1.5 billion mandatory funding over 5 years – FY 2010 thru FY 2014

21. MEDICARE INDEPENDENCE AT HOME DEMONSTRATION PROGRAM • Payment incentive and service delivery model • Utilizes physician and NP directed home-based primary care teams • $30 million mandatory funding over 6 years – FY 2010 thru FY 2015

22. GRANT PROGRAM FOR SCHOOL-BASED HEALTH CENTERS (SBHCS) • NPs can direct SBHCs • Comprehensive primary health services for medically underserved children & adolescents • Available for both building capacity in existing SBHCs and to create new ones • $200 Million mandatory funding over 5 years – FY 2010 thru FY 2014

23. IMPROVED MEDICARE PAYMENTS • Increases payment for CNMs from 65% to 100% • Increases payments to NPs and CNSs by 10% for primary care & health professional shortage areas services

24. STATE HEALTH CARE WORKFORCE DEVELOPMENT GRANTS • Grant program to create health care workforce development strategies at state & local levels • Planning grants for no more than 1 year with largest award no more than $150,000 • Eligible partnerships must include 2-year & 4-year public institutions of higher education

25. BOARDS, COMMISSIONS, COUNCILS, & PANELS • Independent Medicare Advisory Board • National Health Care Workforce Commission • Patient Centered Outcomes Research Institute • Advisory Board on Elder Abuse, Neglect and Exploitation

26. PATIENT’S BILL OF RIGHTS9/23/10 • No Pre-Existing Condition Exclusions for Children Under Age 19 • No Arbitrary Rescissions of Insurance Coverage • No Lifetime Limits on Coverage

27. PATIENT’S BILL OF RIGHTSCont’d • Restricted Annual Dollar Limits on Coverage • Protecting Your Choice of Doctors by removing insurance barriers • Removing Insurance Company Barriers to accessing ED Services

28. RESOURCE FOR FUTURE INFORMATION NLN’S GOVERNMENT AFFAIRS HOMEPAGE http://www.nln.org/governmentaffairs/index.htm