CNAP Interim Update - April 27, 2012
Questions or Comments, contact Pattie Featherston, CNAP Director of Public Policy: firstname.lastname@example.orgTechnical Difficulties with CNAP EmailDuring the staffing transition in recent months we have experienced an array of difficulties with technology. As one result, we have only just this week discovered that our main email address, email@example.com, has been inoperable for probably at least a month. On April 4, a message was sent to all CNAP contacts introducing the new CNAP staff, followed by a few localized requests for volunteers. If any of you replied to sender, it would normally have gone to the main email address, firstname.lastname@example.org, but apparently we have not received anything sent to this address for weeks. If you attempted to reply, please know that we were not intentionally unresponsive and would appreciate it if you could resend your message if you have not had a response by the time you get this email. We were able to retrieve a handful of lost messages but know that we have not found them all. If your comments or questions are related to policy or advocacy, please send to Pattie Featherston at email@example.com. If they are administrative in nature, you could send them directly to Jennifer Fontana at firstname.lastname@example.org. We should also soon have the email@example.com address operational again. Thank you for your patience.Continuity in Lobbying – Kathy Hutto Still CNAP LobbyistJust for clarification, although CNAP has had staffing transitions in recent months, long-time CNAP advocate Kathy Hutto continues to be the hired lobbyist. Kathy will continue to lead the charge for CNAP legislative initiatives, and we are very fortunate for her continued dedication and hard work for advanced practiced registered nurses.Interim Legislative StudiesDuring the interim period between legislative sessions, each standing committee of both the House and Senate conduct interim studies. The directives for these studies, known as “interim charges”, are issued by the presiding officers, the Speaker of the House and the Lt. Governor. Committee Chairs and their staff then organize the collection of input and data that will go into a final report shortly before the Legislature returns for the next regular session in January. Efforts center round hearings during this time period, and the resulting reports typically include recommendations that will likely be the basis for legislation next session.CNAP will monitor several interim charges of possible interest to APRNs. The Senate Health and Human Services Committee has begun its studies. Details can be found on the Senate Web site at:The Senate committee will meet May 8, and the agenda will include one of the committee’s charges to:Monitor implementation of initiatives aimed at improving health care quality and efficiency in Texas, including: the transition of Medicaid and the CHIP to quality- based payments, establishment of the Texas Institute of Health Care Quality and Efficiency, implementation of the Health Care Collaborative certificate, patient-centered medical home for high-cost populations, development and use of potentially preventable event outcome measures, and reduction of health care -associated infections. Include recommendations on how to improve and build upon these initiatives, including improving birth outcomes and reducing infant and maternal mortality. Each of these topics was the subject of legislation last session, and the charge is for the purpose of monitoring implementation of the new law.Likewise, the House Committee on Public Health will soon begin deliberation regarding its charges. Details can be found on the House Web site at:The House committee will meet May 15 to consider issues related to access to care. The hearing will reflect the interim charge that directs the committee to:Examine the adequacy of the primary care workforce in Texas and assess the impact of an aging population, the passage of the Patient Protection and Affordable Care Act, and state and federal funding reductions to graduate medical education and physician loan repayment programs. Study the potential impact of medical school innovations, new practice models, alternative reimbursement strategies, expanded roles for physician extenders, and greater utilization of telemedicine. Make recommendations to increase patient access to primary care and address geographic disparities.CNAP is working will each of its member organizations and other nursing groups to develop appropriate input and testimony both at this hearing and throughout the interim study leading up to a final report.“Roundtable” Discussions and DevelopmentsNursing interests have joined together from all areas of the profession to formulate strategy to advance the work of nurses in a group we have called the “Roundtable”. CNAP and its members have met numerous times with the Texas Nurses Association and the Texas Team. The Texas Team is an organization of an array of stakeholders, including businesses and health care professionals. Texas Team is charged with implementing the provisions of the recent Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health.The report, among other things, recommends that “Nurses should practice to the full extent of their education and training”. The IOM report was funded by the Robert Wood Johnson Foundation, and Texas Team is sponsored by both the RWJ Foundation and AARP.The Future of Nursing report and associated developments have provided a reviving backdrop for laying the groundwork before the next legislative session. We are hopeful about how these developments could produce greater progress for the advancement of nursing and the overall health and well-being of Texans.Texas Medical BoardClose Call and CNAP Watching Future IntentionsStaff of the Texas Medical Board (TMB) developed draft rules that would have imposed additional restrictions to sites serving medically underserved populations (SSMUP). The proposal would have adversely affected the delivery of primary care to already underserved populations by reducing the number of sites able to qualify as a SSMUP.CNAP and other organizations, including the Texas Nurses Association, attended a TMB staff-conducted Stakeholder Meeting at the end of February, and submitted written comments for consideration prior to the April TMB meeting. We also expressed our concern to TMB staff, as well as key staff in the offices of Governor Rick Perry, Lt. Governor David Dewhurst, Speaker Joe Straus, Senator Jane Nelson (Chair, Senate Health and Human Services Committee), Representative Lois Kolkhorst (Chair, House Public Health Committee). We asked them to talk to TMB Board members and staff. On 4/12/12, after a lengthy discussion by the TMB Standing Orders Committee, the staff proposal stalled and was not considered at the TMB board meeting the following day. We will continue to stand alert, though, as comments by the TMB staff indicated this could be revisited in the future if the Legislature does not change the law in 2013.The following day, the TMB considered their proposed rules on pain management which included language stating that ownership of a pain management clinic is the practice of medicine. In spite of excellent comments submitted by TANA and supported by CNAP, as well as strong testimony provided by Carla Cox, TANA's General Counsel, this language was adopted. The statute and the rules continue to contain an exemption for APRNs who prescribe drugs used for pain management as long as it is done in conjunction with other therapeutic measures. However, we would caution APRNs to avoid advertising your practice as a pain management clinic based on this recent action by the TMB.
The Board also adopted rules related to office-based anesthesia. We were not concerned about the rules that were proposed. However, at the meeting, representatives of the Texas Society of Anesthesiologists recommended some major changes that could be problematic. The Board did not act on those, but agreed to create a stakeholder group to explore whether further changes are warranted. TANA has requested a seat at the table and we will continue to monitor this situation.
The takeaway from each of these is that APRNs must stay engaged and active. Much progress has been made through the years, but that can so easily evaporate. Good language in the statute can be negated by the passage of bad rules. Have you done your part lately to support our efforts to protect and enhance your practice environment? If not, please make a contribution now on the CNAP Web sitehttp://www.cnaptexas.org/displaycommon.cfm?an=1&subarticlenbr=31. Call your State Representative and Senator to schedule a visit with them or their staff. Educate them about your practice and the challenge you have because of the current law.DPS Needs Timely Submission ofPhysician-Controlled Substance RenewalsAPRNs cannot get a DPS controlled substances registration if their delegating physician has not timely renewed his/her own registration. Texas physicians are required to obtain a controlled substance registration from DPS on an annual rolling basis. Controlled substance registration renewals are sent 90 days from the expiration date. Renewal is contingent upon verifying current board certifications, which could delay the renewal process. Physicians can check registration update status on the DPS Web site.
Graduate Nurse Education Demonstration – CMS Funding for APRN Training
Please note the following excerpt from the CMS announcement at innovation.cms.gov/initiatives/gne.In March 2012, the Centers for Medicare & Medicaid Services (CMS) issued a call for applications for a new initiative designed to increase the nation’s primary care workforce by supporting facilities that train Advanced Practice Registered Nurses (APRNs). Under this new initiative, CMS will begin making payments from the $200 million of funds available in 2012 to eligible hospitals, helping them offset the costs of clinical training for APRN students.The Graduate Nurse Education Demonstration was mandated by Section 5509 of the Affordable Care Act. The primary goal of the demonstration is to increase the provision of qualified training to APRN students. The clinical training included in this demonstration will provide APRNs with the clinical skills necessary to provide primary care, preventive care, transitional care, chronic care management, and other services appropriate for Medicare beneficiaries.
The demonstration will be operated by the Center for Medicare and Medicaid Innovation (Innovation Center). Under the Graduate Nurse Education Demonstration, CMS will provide reimbursement to up to five eligible hospitals for the reasonable cost of providing clinical training to APRN students added as a result of the demonstration.Hospitals participating in the demonstration must partner with accredited schools of nursing and non-hospital community-based care settings. Under certain circumstances, hospitals participating in the demonstration may also partner with other hospitals in an effort to expand the number of APRN students trained. The demonstration is expected to run for four years.For more information, including how to apply, visit the Graduate Nurse Education Demonstration website at:innovation.cms.gov/initiatives/gne. Applications must be submitted by May 21, 2012.