Health Policy/GOVA - C/SNA Conference Call Summary Wednesday, April 11, 2018 C/SNAs represented on the call included 38 representing 24 states: AZ, CT, IN, KS, LA, MD, MA, MI, MN, MO, NE, NH, NJ, NM, NY, ND, OK, SD, TN, TX, UT, VA, VT, WY. Call Leader: Matthew Fitting, Advocacy and Engagement Specialist, Government Affairs Health Policy / GOVA staff updates [Michelle Artz] Michelle.Artz@ana.org Welcomed Samuel Hewitt, new federal lobbyist, to ANA Government Affairs team. Position statement: The Ethical Responsibility to Manage Pain and the Suffering It Causes [Liz Stokes] Liz.Stokes@ana.org The ANA Board of Directors has approved a position statement on The Ethical Responsibility to Manage Pain and the Suffering It Causes. The purpose of this position statement is to provide ethical guidance and support to nurses as they fulfill their responsibility to provide optimal care to persons experiencing pain. Read the full position statement here. Presidential endorsement dialogue forum [Michelle Artz and Erik Koeppen] Michelle.Artz@ana.org; Erik.Koeppen@ana.org For those attending Membership Assembly and for those who know someone who is, the Presidential Endorsement Process will be one of three dialogue forums this year. In 2016, the ANA-PAC board voted that the current Presidential endorsement process be brought forth to the Professional Policy Committee to have it brought before our membership at Membership Assembly. Being two years out from the 2016 election and before the 2020 presidential election campaign the time is ripe for our members to weigh-in on the current policy through the dialogue forum. Materials will be sent out in advance of Membership Assembly giving those attending a background of the 1984 HOD decision, the current political environment and changes to campaign finance regulations that have transformed the impact and return on investment of presidential endorsements today.
Federal Legislative Update [Matthew Fitting and Samuel Hewitt] Matthew.Fitting@ana.org; Samuel.Hewitt@ana.org Last month s omnibus spending bill included a commendable level of funding for Title VIII nursing workforce development programs, as well as resources for states to help fight the ongoing opioid epidemic. It also removed antiquated language that had previously restricted the Centers for Disease Control and Prevention to research methods to reduce gun violence, in part due to the advocacy initiatives undertaken after the Parkland school shooting in Florida this February. While ANA is encouraged by this development, we will continue to advocate for dedicated funding to undertake this critical research. In the past few months, multiple committees of jurisdiction have held hearings on dozens of pieces of legislation to address the opioid crisis. It is expected, at least in the House, that many of these bills will be put into one large package and passed unanimously. It has yet to be seen how the process looks in the Senate and moving forward with any bi-cameral negotiations or conference committees. On April 17, the Opioid Crisis Response Act of 2018 (S. 2680) was introduced in the Senate. Unfortunately, this legislation does not extend the ability of Nurse Practitioners and Physician Assistants to keep providing MAT treatment services to patients with opioid use disorders. Originally, the nursing community was hoping to have this authorization extended to clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists and we are still advocating for that. The legislation in its current form will ultimately cause more patients to end up in emergency rooms or not receive treatment at all. The nursing community is looking into options to avoid this potentially tragic outcome. Environmental Scan of State Policy / Legislative Regulatory Activity; How can ANA help [Janet Haebler] Janet.Haebler@ana.org This summary represents the highlights. Apologies in advance for any omissions. For additional details, please contact the specific C/SNA directly. Registered Veterinary Nurse initiative Veterinary techs efforts to standardize education / practice and change title. They have been unwilling to consider another title. TN and OH had bills this session. In spite of the heavy lobbying in favor, TNA was able to stop the effort from advancing this session. Mars Corp, based in Nashville, which also produces pet food and supports pet clinics, put extensive resources into securing this change. No report from OH. APRN Full Practice Authority SC reported progress, first time in many years thanks to SCNA s leadership and nurses uniting. Voted out of subcommittee and moving to full committee, 3 of 4 roles (CRNAs exempt by choice) would have a transition to practice period to FPA; ratio of collaborating physicians to APRNs increased to 6; and ability to certify death, disabilities etc. OK reports policymakers have been distracted by teacher walk out; APRN FPA bill sits in committee. AZ achieved FPA for 3 of 4 roles last year; plans to pursue for the CNS role next
year. IN is working to secure HRSA grants. LA NPs are exempt from a collaborative agreement if employed by an acute or long term care facility. Assistant Physician - is a new level of provider, employed for medical school graduates unable to secure a residency. Through laws passed in 3 states to date, this new title permits this group to practice primary care, initially through a collaborative agreement with a physician. Though it was intended to address gaps in access in rural settings, there is nothing to stop them from practicing in other geographic areas. There is a slight variation between the 3 states in which they are recognized MO, AL, & KS. NH reports a current bill that would recognize them as graduate physicians. Question posed about ANA C/SNA opposition of assistant physicians. Response Opposition rests with the fact that in these states, APRNs have not been able to attain full practice authority to improve access. Yet medical graduates without a residency are able to assume the primary care role. But it falls back to where the C/SNA wishes to place their political capital and variations in bill language between states, so C/SNAs may decide to remain neutral. Nurse Licensure Compacts: APRN and Enhanced ANA representatives reaffirmed opposition to the Compacts at the 2015 Membership Assembly. Several C/SNAs have used ANA talking points to educate their members enabling them to evaluate how they wished to navigate this in their individual state, given the extensive resources NCSBN has invested in lobbying. MN reports the APRN Compact was pulled- CRNAs feeling vulnerable. There is a split with regards to the E-Compact. LA members have debated the E-Compact and are leaning toward support. Nurse Staffing MA is in coalition with the nurse leaders and hospital association traveling the state to educate about the MNA ballot initiative that would prescribe ratios and includes provisions for steep penalties. If passed in November, implementation is immediate Janaury 2019. ANA-MA invites anyone else who is engaged in a similar struggle to contact them. (Diane O Toole, Executive Director) VT - RN circulator bill passed. Question posed - Would ANA reconsider its position to include legislating prescribed ratios? Response - Not at this time. ANA continues to believe that ratios in statute or regulation are not a good measure of appropriate staffing levels, given the many other variables which influence safety and patient outcomes. (nurse experience, skill mix, patient acuity, workflow on the unit admissions, discharges and transfers, and available support / resources.) ANA supports empowering direct care nurses to create staffing
plans that are unique for each individual unit. With prescribed ratios, there is also the risk that: facilities will staff to the ratio in the law which may be higher than what is deemed safe and effective. there will be a delay in revising / amending the law / regulation as the future dictates needed change. facilities will choose to reduce the numbers of ancillary / support staff to finance increased RN staff, still resulting in inadequate nursing time to provide quality care, needed supervision of support staff and / or care coordination. And of course, the biggest limitation of any law is a lack of or weak enforcement provisions. Nursing Workforce IN will pursue again next session a faculty loan repayment program modeled after NY following efforts to suspend faculty requirements. Additionally, undocumented immigrants are not eligible for licensure / re-licensure. MN - considering reciprocity for mental health providers with at least 5 years-experience moving in from another state. NM uses a minimum data set across all health professions; data is collected by UNM and NMNA has a seat on the Committee that reviews the supply data. Supply data can be useful for a number of policy issues creation of maps in SC for availability of primary care to advance APRN FPA. Since it is an unfunded mandate in NM (or anywhere), there is no analysis. VT mentioned the same with the repository in the Department of Health. Additionally, NCSBN collects data through the BONs, so the question is - who owns the data: NCSBN or the state? Follow up - Requested this topic be added to the annual lobbyist meeting agenda in September. Opioid States continue to address this complex issue in a variety of ways. Adding APRNs for treating - VT; Statewide task force to address CT has a nursing presence. Other issues NH - Medicaid expansion reauthorization fund using money from tax of alcohol and put in a trust fund. VT toxic substance protection law passed; secure insurance coverage for connected health telemedicine; acupuncture study planned to evaluate access / cost effectiveness for Medicaid beneficiaries; sexual assault examiners increase access to evidence tool kit; considering public funding option for health coverage - would be available to all Vermont residents and
employers. It would remove health insurance benefits from the bargainable subjects for public employees who are subject to a collective bargaining agreement and instead specify that employees who wish to have health insurance coverage would be covered under the public option. Announcements AZ shared they have 5 nurses running for elected office: 4 for state legislature and 1 for Congress. ND also has a nurse running for the state legislature. 2 of the nurses campaigning are graduates of the American Nurses Advocacy Institute (ANAI). 2018 Remaining Call Dates ********* June 13th August 8th October 10th December 12th All calls held between: 11 AM to 12:30 PM Eastern Call-in-Number: 1-800-311-9401 / Passcode: 67009