1. Nursing and Healthcare Reform AONE’s Perspective

2. Healthcare Reform Legislation and its Impact on Nursing What the Bill Does Expands coverage to 32 million people through a combination of public and private sector insurance expansions. This includes Medicaid coverage to single childless adults for the first time nationwide. It also creates a health care exchange through the states to provide affordable coverage options. Subsides are provided for those with limited means. Puts in place important insurance reforms that will ensure coverage by including no lifetime limits on coverage; no exclusions based on pre- existing conditions; no discrimination on health status; no annual limits; coverage of preventive services without cost-sharing and no cancellation of insurance coverage when someone becomes sick. Also allows dependents up to age of 26 to remain on parent’s health plan.

3. Nursing and Nursing Related Provisions that are Effective upon Enactment: Nursing Student Loan Program. Increases loan amounts and updates the years for nursing schools to establish and maintain student loan funds. Public Health Workforce Recruitment and Retention Program. Establishes the Public Health Workforce Loan Repayment Program to ensure an adequate supply of public health professionals to eliminate shortages in federal, state, local, or tribal public health agencies. Funding for the National Health Service Corp. Increases and extends the authorization of appropriations for the National Health Service Corps scholarship and loan repayment program for 2010-2015.

4. Nurse-Managed Health Clinics. Strengthens the health care safety-net by creating a $50 million grant program administered by HRSA to support-nurse managed clinics. Clinics now qualify for federal funding. Advance Nursing Education Grants. Strengthens language for accredited Nurse Midwifery programs to receive advanced nurse education grants in Title VIII of the Public Health Service Act. Nurse Education, Practice and Retention Grants. Awards grants to nursing schools to strengthen nurse education and training programs and to improve nurse retention. Authorizes such sums as may be necessary for 2010-2012. Nurse Faculty Loan Program. Establishes a Federally-funded student loan program for nurses with outstanding debt who pursue careers in nursing education. Nursing Workforce Diversity Grants. Increases loan amounts Fellowship Training in Public Health. Authorizes the Secretary of HHs to address workforce shortages in State and local health departments in applied public health epidemiology and public health laboratory sciences and informatics. Reporting of Expenditures. Requires the Secretary to modify cost reports for Skilled Nursing Facilities (SNFs) to require reporting of expenditures for wages and benefits for direct care staff, breaking out registered nurses, licensed professional nurses, certified nurse assistants and other medical and therapy staff.

5. Exclusion of Assistance Provided to Participants in State Student Loan Repayment Programs for Certain Health Professionals. Excludes from gross income any amount received under any State Loan repayment or loan forgiveness program that is intended to provide for the increased availability of health care services in underserved or health professional shortage areas. Improving Women’s Health. Establishes an Office of Women’s Health in the Office of the Secretary, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration and the Food and Drug Administration. Online workforce training programs. Through the Department of Labor’s Workforce Investment Act (WIA) monies will be made available to carry out online training for healthcare occupations such as nursing, nursing assistants, dentistry, pharmacy, health administration, public health, health information systems, medical assistants and others. $50 million is authorized to be appropriated from 2011 to 2020.

6. Quality Related Provisions Interagency Working Group on Health Care Quality. Creates an Interagency Working Group on Health Care Quality comprised of Federal agencies to collaborate on the development and dissemination of quality initiatives consistent with national strategy. Quality Measure Development. Authorizes $75 million over 5 years for the development of quality measures at AHRQ and CMS. Clinical Practice Guidelines. Requires the Secretary to contract with the Institute of Medicine for the identification of existing and new clinical practice guidelines. Health Care Delivery System Research; Quality Improvement Technical Assistance. Enables the Director of AHRQ to identify, develop, evaluate, disseminate and provide training in innovative methodologies and strategies for quality improvement practices in the delivery of health care services that represent best practice in health care quality, safety and value.

7. Prevention Related Provisions National Prevention, Health Promotion and Public Health Council. Establishes the National Prevention, Health Promotion and Public Health Council. Prevention and Public Health Fund. Establishes a Prevention and Public Health Investment Fund to provide for investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public center health costs. School –Based Health Centers. Establishes a grant program for eligible entities to support the operation of “school-based health centers.” Student to School Nurse Ratio Demonstration. Directs the Secretaries of Education, HHS and Director of CDC to make grants available to schools to reduce the student-to-school ratio in public elementary and secondary schools.

8. Immunizations. Authorizes the Secretary to negotiate and enter into contracts with manufacturers of vaccines for the purchase and delivery of vaccines to adults. Better Diabetes Care. Directs the Secretary of HHS to develop a national report care on diabetes to be updated every 2 years. National Diabetes Prevention Program. Establishes a national diabetes prevention program targeted at adults for high risk for diabetes in order to eliminate the preventable burden of diabetes through community-based prevention services.

9. Workforce Commission National Health Care Workforce Commission. Establishes a 15 member national commission tasked with reviewing the healthcare workforce and projected workforce needs

10. Other Demonstrations and Payment Reforms that will Impact Nursing September 23, 2010 Demonstration Project to Provide Access to Affordable Care. Not less than 6 months after enactment, the Secretary acting through HRSA shall establish a 3-year demonstration in 10 states to provide access to comprehensive health care services to the uninsured at reduced fees. October 1, 2010 Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers.

11. January 1 2011 Establishment of a Center for Medicare and Medicaid Innovation within CMS. Establishes within CMS a Center for Medicare and Medicaid Innovation. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements (models) to improve the quality and reduce the cost of care provided to patients in each program. Appropriates $5 million from the Treasury not otherwise appropriated for the design, implementation, and evaluation of models for FY 2010; appropriates $10 billion for Center activities over the next 10 years.

12. March 23, 2011 Advancing Research and Treatment for Pain Care Management. Not later and 1 year after funds are appropriated to carry out this section, the Secretary shall seek to enter into an agreement with the Institute of Medicine to convene a conference on pain management. Advancing Research and Treatment for Pain Care Management. Not later than 1 year after enactment, establish an Interagency Pain Research Coordinating Committee to coordinate all efforts within HHS and other federal agencies that relate to pain research.

13. October 1, 2011 Graduate Nurse Education Demonstration Program. Directs the Secretary to establish a demonstration program for up to 5 eligible hospitals to increase graduate nurse education training under Medicare.

14. January 1 2012 Independence at Home Demonstration Program. Creates a new demonstration program for chronically ill Medicare beneficiaries to test a payment incentive and service delivery system that utilizes physicians and nurse practitioners directed in home-based primary care teams aimed at reducing expenditures and improving health outcomes. Demonstration Project to Evaluate Integrated Care Around a Hospitalization. Establishes a bundled payment demonstration under Medicaid in up to 8 states which will begin January 1.2012 and end on December 31, 2016.

15. October 1, 2012 Hospital Readmission Reduction Program. Adjusts payments for hospitals paid under the inpatient prospective payment system based upon exceeding certain readmission thresholds. Patient-centered Outcomes Research Trust Fund. Establishes this trust fund for Patient – Centered Outcomes Research Institute and its activities. January 1. 2013 National Pilot Program on Payment Bundling. Establishes a 5- year national voluntary pilot program on payment bundling for hospitals, physicians, and post-acute care providers. Value-Based Purchasing. Creates a value-based purchasing program for physicians, hospitals, and ambulatory surgical centers. January 15, 2014 Independent Payment Advisory Board. Creates a 15 member Independent Payment Advisory Board (IPAB) which will provide to Congress comprehensive proposals to reduce excess cost growth and improve quality care for Medicare beneficiaries. Hospitals are exempt for 5 years.

16. October 17, 2017 Graduate Nurse Education Demonstration Program. The Secretary will report on the nurse education demonstration program. Next Steps Continue to work with Congress to make refinements and technical corrections to programs impacting nursing and the nursing workforce.

17. AONE Legislative Priorities for 2010 Appropriations Request for FY 2011 – The President’s Budget flat lines Title VIII Nursing Education Programs at $244 million. AONE and the Nursing Community is requesting a 10 percent increase of $267.3 million for FY 2011 Expand the Nursing Workforce Promote the Role of Nursing in Primary Care Support the role of Nursing to Improve Patient Outcomes, Increase Care Coordination and Decrease Healthcare Costs Support Data Gathering and Research Activities to Articulate the Economic Value of Nursing Support the Rights of International Nurse Migration Promote the Role of Nursing in Disaster Preparedness Promote Efforts to Achieve Healthcare Reform through Collaboration with the Greater Healthcare Community

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