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Professional Development

Workforce development, APRN’s on congressional agenda

Funding for nursing workforce development
ANA has been following the fiscal year (FY) 2008 appropriations process in reference to nursing workforce development programs. Here is a brief update.
The House and Senate Labor, Health and Human Services, and Education (Labor, HHS) Appropriations Subcommittees have both produced bills that would increase funding for the Federal Title VIII Nursing Workforce Development Programs. The House bill would increase funding by $16 million, the Senate by $20 million. ANA is grateful that both chambers rejected President Bush’s proposal to cut funding for nursing programs by $44 million. ANA is now working to convince congressional negotiators to support the greater funding amount proposed by the Senate.
The House Labor, HHS bill would bring total FY 2008 nursing education funding to $165.6 million, an increase of 10.6%. Of this increase, $13 million would be invested in Loan Repayments and Scholarships, with an additional $3 million going to the Nursing Faculty Loan Program. The Senate Labor, HHS bill would bring FY 2008 funding to $169.7 million, a 13.4% increase. Of this increase, $11.8 million dollars would be invested in Advanced Education Nursing, $5 million in Loan Repayments and Scholarships, and $3.2 million in the Nursing Faculty Loan Program. You can read summaries of these programs at the ANA Government Affairs website, www.anapoliticalpower.org.
ANA is now focusing efforts on maintaining the full $20-million increase contained in the Senate bill. The continued nursing shortage and the lack of recent investment in nursing education necessitate the full $20 million. It is traditional for conference negotiators to split the difference between House and Senate funding levels. If this were to occur, the Title VIII programs would receive an $18-million increase. These Title VIII programs have not received a funding increase for the past 3 years, but the shortage has grown unabated.

Medicaid coverage of APRNs and SCHIP
The Medicaid Advanced Practice Nurse (APN) and Physician Assistant (PA) Access Act (H.R. 2066/S. 59) has been introduced in both the House and Senate. This legislation, a top ANA priority, would remove the following legal barriers that prevent Advanced Practice Registered Nurses (APRNs) from fully participating in the Medicaid program.
• Current law requires fee-for-service Medicaid to recognize pediatric and family nurse practitioners (NPs), and certified nurse-midwives. The Medicaid APN and PA Access Act would change this law to require Medicaid fee-for-service plans to recognize all NPs, clinical nurse specialists, certified nurse-midwives, and PAs.
• Current law also gives states the option to recognize family and pediatric NPs, certified nurse-midwives, and PAs as primary care case managers in their fee-for-service program. These targeted case management services are designed to meet the needs of the medical complex. H.R. 2066/S. 59 would change the law by removing the state option—therefore requiring states that offer case management services to recognize nonphysician providers. It would also expand the definition of nurse practitioner to include all NPs.
• Many states have moved their Medicaid population into managed care. Current law only requires that these managed care plans enroll “a sufficient number, mix, and geographic distribution of providers.” In reality, many plans do not enroll APRNs. The Medicaid APN and PA Access Act would change the law to require Medicaid managed care plans to include the services of NPs, clinical nurse specialists, certified nurse-midwives, certified registered nurse anesthetists, and PAs.
ANA maintains that this legislation is vital to increasing access to care for low-income Americans. We are working to educate Congress about the fact that APRNs provide cost-effective, high-quality care. APRNs are also often willing to provide services in rural and inner-city areas where access to physicians is limited. Increased access to APRN services can preserve Medicaid resources by decreasing preventable acute-care admissions and emergency department visits. We are working to convince congressional negotiators to include the Medicaid APN and PA Access Act in legislation re-authorizing the State Children’s Health Insurance Program (SCHIP). Congress is expected to act on SCHIP by the end of September.
You can help both of the above efforts. Contact your congressional delegation. Tell them now is the time to invest in nursing. Urge them to support APRNs. Advocacy materials are available at www.anapoliticalpower.org.

Erin McKeon is Associate Director of ANA’s Government Affairs Department.

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