Chapter Legislative Chair Webinar

1. Chapter Legislative Chair Webinar April 5, 2013 Raji Koppolu, CPNP and Mary Chesney, CPNP NAPNAP Chapter Chair and Health Policy Chair

2. Objectives • Discuss roles and responsibilities of chapter legislative chairs • Resources for legislative chairs • NAPNAP Health Policy Agenda • Action items at the state level • Current issues: Medicaid expansion, insurance exchanges, executive branch operations at the state level

5. Roles and Responsibilities of the Chapter Legislative Chair • Serves as an advisor to the Board for decisions regarding state legislative activities and child health policy • Receives and responds to activities from the National Office for national/state legislative issues. • Provides up-to-date health policy/legislative information to the Chapter Executive Board for review and/or action. • Receives up-to-date health policy/legislative information to bring to the NAPNAP Chapter Presidents, designated and the general membership. • Participates on the standing committees and other committees or task forces as appointed by the president.

6. Roles and Responsibilities of the Chapter Legislative Chair • Uses educational programs, materials, or other means of communication to educate and keep the membership informed about legislative and health policy issues. • Update Chapter Legislative Chairs on child health policy issues and to advocate for key public policy and professional practice issues. • Attends the Legislative Session at the NAPNAP Annual Conference. • Receives information needing immediate or sustained attention. Maintains communication to inform and educate chapter members on the status of bills and child health policy issues.

7. As a chapter board member… • Annual Activities/Goals and Time Table for the Strategic Plan • Written or verbal report on activities for the Executive Board Meetings • Provides input to the Annual Budget or New Budget Proposals. • Includes input in CH-12 Report for indentifying legislative issues chapter is following/supporting/opposes

8. Chapter 12 Report • Chapter 12: Annual Chapter Report (activities, projects) Due 8/1 • In the past 12 months, what were the two (2) most important professional practice issues your chapter dealt with (i.e., prescriptive authority, third party reimbursement, managed care, state nurse practice act, etc.)?

9. National Health Policy Team • Mary Chesney, Health Policy Chair • Dave Mason, Washington Representative** **Dave Mason works in collaboration with the American Association of Nurse Practitioners (AANP) and the National Organization of Nurse Practitioner Faculties (NONPF) to raise the profile of PNP’s and advocate for federal policy that benefits our clinical practices and the patients we care for.

10. National NAPNAP Efforts • Maintaining a Legislative Tracking sheet, providing current information about key legislation important to PNPs. This information is available on the NAPNAP website, through the Advocacy Section. • Providing regular E-Legislative Alerts to Chapter Presidents and Legislative Liaisons to disseminate timely information about pending legislation. • Hosting annual Capitol Hill Days for members who want to learn more about the legislative process and experience the opportunity to meet with their own legislative leaders in Washington • Sharing information through keynotes, workshops and networking activities at the NAPNAP annual meeting.

11. Resources • NAPNAP Health Policy Committee • Child Health Learning Collaborative • Inside the Beltway • Citizen's Handbook to Influencing Elected Officials: Citizen Advocacy in State Legislatures and Congress: A Guide for Citizen Lobbyists and Grassroots Advocates by Bradley Fitch

12. NAPNAP Health Policy Agenda • http://www.napnap.org/NAPNAPAdvocacy/HealthPolicyAgenda.aspx • Goal #1: Improve child and adolescent health through support and advocacy on a wide range of health issues with emphasis on the following strategic priorities: • Prevention of childhood overweight and obesity through policies to promote breastfeeding, healthy nutrition and physical activity levels; • Advocacy for increased access to comprehensive and integrated services to address childhood developmental, behavioral, and mental health problems; • Development of comprehensive quality health indicators focused on the care of children and families

13. NAPNAP Health Policy Agenda • Goal #2: Improve access to comprehensive primary, chronic, and acute care services for all children and adolescents through support and advocacy for: • Removal of insurance industry barriers that prevent families from obtaining affordable and comprehensive child health insurance coverage; • Optimal funding of Medicaid and CHIP programs.

14. NAPNAP Health Policy Agenda • Goal #3: Promote access to pediatric Nurse Practitioners and Clinical Nurse Specialists through support and direct advocacy on the following issues: • Recognition of nurse practitioners and other pediatric health care providers as primary care providers and leaders in new models of care such as Accountable Care Organizations (ACOs) and primary health care homes; • Comprehensive and fiscally responsible reimbursement by governmental and commercial payers for services provided by advanced practice nurses; • Participation of advanced practice nurses caring for pediatric patients in any federal grant programs aimed at piloting new models of care or increasing the use of health information technology, and electronic medical records. • Increased funding for advanced practice registered nurse education and development of faculty.

15. Action Items at the State Level • Your role is KEY to identifying, monitoring, and advocating for important policy issues in your state. • Tracking of legislative activities & regulatory activities (rules coming from the state health department or department of human services) • Seeking guidance from the national health policy team when determining whether or not to support or oppose various state initiatives.

16. Examples of State Action Issues • NP/APRN scope-of-practice legislation & rules • State-based Medicaid and CHIP decisions (legislation & rules) • Child health-related state laws (E.g. fluoridation of water, required immunizations for school entry, required school health services, etc.) • ACA implementation of Medicaid expansion and state insurance exchanges

17. Current Medicaid Funding • Entitlement program • Funded through state & federal partnership • Administered by state • States required to cover children under 6 years of age with family incomes at or below 133% FPL; children 6-18 years of age at or below 100%; CHIP covers those between 100-200% FPL • FMAP – Federal MA percentage formula determines how much feds pay; based on average per capita income;

18. ACA Medicaid Expansion Funding • ACA’s Medicaid Expansion – 3 program changes • Inclusion of non-disabled adults without children • National eligibility expansion to 138% of FPL • Streamlined, web-based enrollment • Allocates 100% federal funding to those added to MA through expansion from 2014-2016; phases down to 90% by 2020) (Go to KFF State Health Facts for Medicaid info related to your state.)

19. States’ MA Expansion Decisions • Support: AZ, AS, CA, CO, CT, DE, DC, FL, HI, IL, MD, MA, MI, MN, MO, MT, NV, NH, NJ, NM, NY, ND, OH, OR, RI, VT, WA • Oppose: AL, AK, GA, ID, IN, IA, LA, ME, MS, NE, NC, OK, PA, SC, TX, VA, WI • Undecided: KS, KY, SD, TN, UT, WV, WY (KFF, State Health Facts 3-5-13)

20. Opt-In or Out Implications • If your state is opting in – watch for possible changes to CHIP program (E.g. California and New Hampshire) • If your state is opting out – concern for adults and adults with children who are below 100% of FPL; Persons must be at or above 100% to qualify for state or federal insurance exchange. Those caught in the gap will add to uncompensated care costs.

21. State Insurance Exchanges • States have 3 options • Create a state insurance exchange • Partner with federal government in a shared state/fed exchange • Allow state citizens to use federal exchange • If your state is creating its own exchange or a fed/state partnership exchange, you will want to carefully monitor or participate in developing policy • Children’s benefit packages • Affordability of plans for families with children • Ability of NPs to provide primary care & be listed on insurance plans list of providers

22. Effective State Advocacy Strategies • Be aware of the regulatory side of state government. Executive branch members promulgate the rules regarding how laws will be implemented • Advocate for NP representation on MA or Exchange Boards or Advisory Panels • Get to know key regulators • State insurance commissioner • State insurance exchange director • State DHS Medicaid director • State Board of Nursing executive director or APRN representative

23. Questions? Contact: Raji Koppolu, CPNPChapter Chair chapter@napnap.org Mary Chesney Health Policy Chair healthpolicy@napnap.org National Office Staff Felicia Taylor Director of Membership, Chapters, and Communication Daniela Weitzman Chapter Services Manager

24. References • Chesney, M. L., & Duderstadt, K. (submitted fo review). Affordable Care Act: Medicaidexpansion key to increasing access to care. • Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured (2013b). Medicaid: A primer. Retrieved from http://www.kff.org/medicaid/upload/7334-05.pdf • Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured (2012). Medicaid financing: An overview of the Federal Medicaid Matching Rate (FMAP). Retrieved from http://www.kff.org/medicaid/upload/8352.pdf • Kaiser Family Foundation, Kaiser Commission on Medicaid and the Uninsured. (2013c). Medicaid: Three key issues to watch in 2013. Retrieved from http://www.kff.org/medicaid/quicktake_medicaid_in_2013.cfm • Kaiser Family Foundation, State Health Facts (March 5, 2013). Health reform: State activity around expanding Medicaid under the Affordable Care Act. Retrieved from http://www.statehealthfacts.org/comparereport.jsp?rep=158&cat=17