Federal Issues
Barry Bontempo RN, CWOCN April 7, 2009
Health Insurance:
A report released by the advocacy group Families USA showed 86.7 million people under age 65 -- about one-third of that population -- did not have health insurance at some time in the past two years.
President Obama kicked off the first serious effort to overhaul the nation's health care system in 15 years at the White House Health Care Summit on Thursday, March 5th with a pledge to include Republicans and consider opposing views — and a vow to get it done this year. Among the toughest: how to pay for the overhaul, how to bring down costs, whether health insurance should be mandated and whether the government should compete with private plans.
The nursing profession was represented at the White House Health Care Summit by The American Nurses Association (ANA) President Rebecca M. Patton, MSN, RN, CNOR.
The President included $634 billion in his budget plan as a "down payment," with the likely cost rising above $1 trillion. Half would come from reduced Medicare and Medicaid payments to doctors, hospitals and other providers, and half from reducing tax breaks on couples making more than $250,000.
HHS also launched on Thursday 3/6/09 its new health reform website: Health Reform
Nurse Education:
If health care is expanded under the president's plan it would mean that it will fall directly on the shoulders of nurses who are already in short supply.
On March 12, 2009, President Obama signed into law The American Recovery and Reinvestment Act of 2009, including $500 million to address health care workforce shortages. Approximately $200 million of this funding will be dedicated to tackling the growing nursing and other primary care provider shortages by providing a much needed funding increase for the Title VII & VIII nursing and other health care workforce development programs. In addition, $250 million is allocated to the Department of Labor for competitive grants for job training and placement in high growth sectors with priority given to health care.
WOCN Promoting WOC Nurses Week: April 12-18, 2009:
Goal? To build awareness of WOC nursing and support the next generation of WOC nurses. With many WOC nurses retiring in near future, who will care for patients? We need to promote education and mentoring for future WOC nurses. Web site has WOC Nurse Brochure: The Path to Becoming a Wound Ostomy Continence Nurse, WOC Nurse Week Poster, Mentoring PowerPoint and Letter to the Editor template.
WOCN INFORMATION WEBSITE
PUAP Website:
Have you visited the NPUAP website lately? Among other things are quality color drawings of pressure ulcer stages that can be downloaded and used at no charge.
Reducing Mandatory Overtime in Order to Increase Safe Staffing:
In June 08; NY State Legislator passed a bill to end the practice of mandatory overtime in NY Hospitals and nursing home. Home care nurses are not included, APN's are. Fifteen states have restrictions on the use of mandatory overtime for for nurses. Twelve states have enacted legislation: CT, IL, MD, MN, NJ, NH, NY, OR, PA, RI, WA, and WV, while three states have provisions in regulations: CA, MO, and TX.
Nursing World Website
Hand-out on Inpatient Prospective Payment System
CMS October 1, 2007:
New rule mandating that hospitals must inspect and document skin assessment on admission.
1. All pressure ulcers will be under the jurisdiction of CMS under this new rule
2. Hospitals must document pressure ulcers and track them closely.
3. Have until the end of the second hospital day to identify a community-acquired
pressure ulcer.
4. This will change hospitals ability to add hospital-acquired pressure ulcers as a
secondary DRG for continued hospitalization and pay at a higher rate.
5. Pressure ulcer rates will be published and become part of the public domain.
6. Will probably not effect billing until October 2008.
DRG’s are changing. There will now be 2 types of DRG’s
1. Basic: paid at lower rate.
2. MSDRG: will reimburse hospitals more fairly
Federal Register announced the CARE tool, a combination tool for Home Care and LTAC. It encompasses the needs of both groups that are currently found in the Oasis tool and the MSDS tool. Changes are under the auspices of CDC. The Committee requested an acute care person be added to the committee, as the new changes will affect inpatients as well as patients in an LTAC or home setting. Ben Peirce and Lee Ann Krapfl are involved. It was approved by Congress and will be initiated upon discharge from acute care facility when making a home care referral of on transfer to an LTAC. WOCN Public Policy Committee: NIWI March 9-11, 2008- Some scholarships will be available from National Office and The Nursing Alliance also offers scholarships NPUAP and WOCNS feel codes by which CDC/CMS ruling have utilized for use in categorizing pressure ulcers do not do a fair job of capturing what is going on with pressure-related skin breakdown. Both are considering working on a joint statement to encourage the CDC to tweak the codes. CMS had posted their rule for public comment WOCN did respond with a letter and all issues were addressed. The issue of unavoidable pressure ulcers is to be visited. The ICD-9 codes do not address severity level. Currently coding of pressure ulcers is based on MD documentation, not nursing. More reimbursement for Stage III, IV and Unstageable pressure ulcers. CMS felt that “DTI” was too new of a “phenomenon” to be included. They feel there is not enough research of data to support including this in coding of pressure ulcers. Respectfully Submitted,
Cheryl Bealer is now a member of this National Committee.
White Paper Available on-line re: Clean vs. Sterile Intermittent Catheterization.
Cheryl Bealer
September 2009 Report
A-2238:
Requires insurers to cover children with autism that are 21 years old or younger. New Jersey has the highest rate of autism in the country with 1 in 94. The national average is 1 in 150.
S2471/A1264:
Requires public reporting of each hospital's patient safety performance and rates of serious medical errors. Included are serious adverse events such as objects left inside patients during surgery, accidental cuts and punctures to patients, or hip fractures suffered in a post surgery fall. The goal is to help people make more informed health care decisions to help hospitals prevent medical errors.
A-2539/S-1125:
Requires health care insurance carriers to reimburse physicians in installment payments for maternity services provided over the term of a woman's pregnancy, rather than after the birth of the child. Covered payments will occur on an on going basis and include office visits, other prenatal care, as well as the delivery of a baby. Until now physicians had to wait until the baby's birth to be paid.
S-2231/A-3110:
Adds nurse midwives as a medical professionals who can certify medical conditions for the Temporary Disability Benefits Law" and "Work First New Jersey Act." During a preganancy," it is often a nurse midwife who has substantial direct contact with the mother and therefore has expert knowledge regarding a disability, or a serious health condition requiring temporary leave from work," said Sen. Loretta Weinberg (D-Bergen), Vice - Chairwoman of the Senate Health Committee. "It's only appropriate that licensed nurse midwives have the latitude to make these determinations."
State Preparations for H1N1:
September 3rd Governor Corzine announced an initiative aimed at combating any resurgence of H1N1 influenza. It includes: free vacinations for the uninsured, a public education campaign to encourage preventative measures and a "Find a Flu Shot" website at www.nj.gov/health where locations to get vaccinations can be found.
Food Stamp Recipients can now use their Family First Electronic Benefiits Transfer cards to purchase Jersey Fresh produce at many community farmers markets. Maintaining good nutrition, while living on a very limited budget is something that Food Stamp recipients deal with every day. The pilot program aims to make healthier food choices more available to lower income residents.
NJ received a commitment of $286 million from the Federal Government for New Jersey's Children's Health Insurance Program (NJ Family Care). New Jersey has emerged as a national leader using the Express Lane Eligibility option and is currently the only state in which tax return data is being provided for outreach and enrollment. NJ Family Care is a state and federally funded health insurance program that provides free and low cost health insurance for uninsured children and certain low income parents. As of July 2009 the NJ Health Care Reform Act of 2008 prioritized NJ Family Care outreach efforts and mandated that all children 18 and under have health insurance by through employer sponsored insurance, Medicaid, NJ Family Care or NJ Family Care Advantage.
9/09 - Smoking is now banned on the grounds of state psychiatric hospitals as a means to support patient and employee health. The Department of Human Services began implementing smoking cessation programs for staff and patients. This month Greystone and Ancora Psychiatric hospitals became entirely smoke free environments, the other state psychiatric facilities will follow. People with mental illness live an average of 25 years less than the general population. Approximately 75 percent are estimated to be addicted to nicotine, which contributes to premature death.
Submitted by Barry Bontempo RN, CWCN, OCN
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Bedsore Bill" Passes N.J. Legislature
A bill unanimously passed by both houses of the New Jersey Legislature would require nursing homes in the state to provide residents with pressure-relieving mattresses to prevent the development of bedsores.The legislation would require facilities to switch all their mattresses from regular, spring-filled models to specially designed pressure-redistribution mattresses.
New Jersey nursing homes had a higher rate of bedsores than the national average. According to the bill, the Centers for Medicare and Medicaid Services reported that New Jersey ranked fourth among all states and the District of Columbia in the percentage of nursing home residents with bedsores. Beginning one year after the enactment of the bill, any time a nursing home replaces a mattress used by a resident, it must swap it for a pressure-redistribution model.
Within three years, all nursing home mattresses would have to be designed to address stage I pressure ulcers at a minimum.
The legislation now awaits the signature of Democratic Gov. Jon Corzine.
http://news.findlaw.com/scripts/printer_friendly.pl?page=/andrews/h/nlr/20090306/20090306_njlegislation.html
Encouraging nursing education approved in N.J. Senate budget committee
The bill, S-626, would establish the Nursing Faculty Loan Redemption Program in the Higher Education Student Assistance Authority. The program would provide loan redemption in exchange for full-time faculty employment at a school of nursing in New Jersey for a five-year period following the completion of a State-approved graduate program. Under the bill, loan redemption would only be available to State residents who had graduated from an approved graduate degree in nursing program, who maintained a grade-point average of 3.0 or higher, who had finished their approved coursework within a one-year period prior to being hired for full-time faculty employment, and who are working as a full-time nursing educator in New Jersey. The bill now heads to the full Senate for consideration.
http://www.njsendems.com/release.asp?rid=2592
Barry Bontempo RN, CWOCN
April 6, 2009
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Report from Karen Long
Nursing Care Quality Protection Act (A1752/S3527)
Requires hospitals and nursing homes to disclose information related to nurse staffing levels and nursing qulity indicators (falls, medication errors, and pressure ulcers).
This would make information available to the consumer as well as regulatory bodies. Passed Assembly, Senate. Waiting Governor's signature as of 9/14. NYSNA in favor of bill, HANYS against. Hospitals would be required to report the numbers of RNs and LPNs providing direct care; the incidence of adverse patient events such as medication errors and injuries; and the method the hospital uses for determining and adjusting staffing levels.
Safe Staffing Ratios (A2264)
Establishes minimum nurse to patient ratios in all of healthcare facilities. Bill was agreed upon by labor unions in NYS that represent registered nurses. In Senate Health and Assembly Ways & Means Committees.
Educational Advancement (A2079/S1074)
Requires that nurses earn their baccalaureate within ten years of initial licensure while "grandfathering" nurses already in practice and nursing students already enrolled. In Senate & Assembly Higher Ed Committeess.
Preventing Workplace Violence (A31303)
Increases penalties for an individual convicted of assualting a nurse while he or she is at work. Passed Senate, in Assembly Codes Committee.
Safe Patient Handling (A2047)
Requires all facilities implement a safe patient handling policy to reduce the manual lifting of patients by direct car staff. In Senate reules and Assembly Ways & Means Committees.
H1N1 Flu
NYS Department of Health mandate influenza vaccinations for hospital personnel. This will apply to vaccination from H1N1 if it is developed.
Respectfully submitted by Jody Scardillo MS, RN, CWOCN
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September 2009
Safe Staffing Ratios (A2264)- Establishes minimum nurse-to-patient ratios in all of healthcare facilities. Bill was agreed upon by labor unions in NYS that represent registered nurses. In Senate Health and Assembly Ways & Means committees.
Educational Advancement (A2079/S1074)- Requires that nurses earn their baccalaureate within ten years of initial licensure while “grandfathering” nurses already in practice and nursing students already enrolled. In Senate & Assembly Higher Ed committees.
Preventing Workplace Violence (A3103)- Increases penalties for an individual convicted of assaulting a nurse while he or she is at work. Passed Senate, in Assembly Codes committee.
Safe Patient Handling (A2047)- Requires all facilities implement a safe patient handling policy to reduce the manual lifting of patients by direct car staff. In Senate /rules and Assembly Ways & Means committees.
Lobby Day 2009
NYSNA’s Lobby Day has been scheduled for April 21, 2009 at the Capitol in
2009 Budget
Medicaid Restorations
The new spending plan will include a major shift in Medicaid reimbursement: fees paid for primary care will increase while reimbursement for inpatient care will decrease. The plan also reduces Medicaid payments to nursing homes and home care agencies by $293 million. Finally, the state budget eliminates burdensome requirement for families to re-enroll in Medicaid. The provisions requiring face-to-face interviews, finger-imaging and asset testing have been removed. The agreement would also divert $143 million from graduate medical education to a pool that pays for hospital care for those who cannot afford it.
SUNY Expansion of Nursing Programs
The final budget restores a $300,000 cut to a 2008-09 initiative to expand nursing programs at 18 SUNY schools across the state. This makes the original appropriation whole at $2.0 million. The Executive budget did not cut the $2.0 million 2008-09 CUNY initiative for expansion of nursing programs.
Patricia K. McGee Nursing Faculty Scholarship and Loan Forgiveness Program
The final budget restores $1.433 million to make the total appropriation for both programs at $3.933 million. This is slightly down from the original level of $4.0 million. The program sustained a small cut as part of 2008 budget deficit reduction efforts. The formula of splitting the program’s resources 50/50 continues to exist: half is provided for loan forgiveness and half to scholarship.
Private Nursing School Funding
$941,000 has been allocated to high-needs nursing programs for private colleges and universities. This is at the level proposed in the Executive Budget.
Respectfully submitted,
Jody Scardillo, MS, RN, CWOCN
April 2, 2009
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WOCN Northeast Region
Legislative Report- New York
October 13, 2008
Legislation
A1898/S6342 Mandatory Overtime- This bill prevents facilities from requiring RN’s and LPN’s to remain on duty longer than their usual shift. Calls for zero tolerance unless there is an emergency. Passed Senate & Assembly & signed by Governor in August 2008.
A6119/S1551 Safe Staffing would establish minimum nurse to patient ratios.
Currently in health committee Senate & Assembly Ways & Means Committee.
A2480/S294 Education Advancement would require RN’s to attain a BSN within ten years of their initial licensure in order to re-register to practice in NY. First introduced in 2005, related to link between higher education levels of nurses and safe patient care. Current licensed nurses are exempt. In higher Ed committee both Senate & Assembly
A3873/S1865 Adds nursing to the list of physically taxing jobs in NYC providing NYC nurses the same benefits as other city employees.
In Senate Civil Service Committee, Assembly Ways & Means committee.
A6186/S3441 Workplace violence adds attacks on RN’s or LPN’s to same as attacks on police, firefighters or EMT’s. Passed Senate, in Assembly Codes Committee.
Budget
NYSNA asked for $7.7 million to be allocated for nursing scholarships, $4million budgeted.
Respectfully submitted,
Jody Scardillo, MS, RN, CWOCN
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WOCN Northeast Region
Legislative Report- New York
October 12, 2007
NYS Dept of Health initiative “War on the Sore” started December 2006, based on state nursing home pressure ulcer prevalence data compared to other states. See NYSDOH website for detail.
Legislation
A1898/S6342 Mandatory Overtime- This bill would prevent facilities from requiring RN’s and LPN’s to remain on duty longer than their usual shift. Calls for zero tolerance unless there is an emergency. Passed Assembly, on Senate calendar.
A6119/S1551 Safe Staffing would establish minimum nurse to patient ratios.
Currently in health committee Senate & Assembly.
A2480/S294 Education Advancement would require RN’s to attain a BSN within ten years of their initial licensure in order to re-register to practice in NY.
In higher education committee both Senate & Assembly.
A3873/S1865 Adds nursing to the list of physically taxing jobs in NYC providing NYC nurses the same benefits as other city employees.
NYC City Council did not enact a message rule to advance this bill.
A6186/S3441 Workplace violence adds attacks on RN’s or LPN’s to same as attacks on police, firefighters or EMT’s. Passed Senate, in Assembly Codes Committee.
Budget
Nursing Faculty Support $4 million to students through the Patricia McGee Scholarship Loan Forgiveness Program. Provides assistance to RN’s who are earning advanced degrees in order to teach nursing. This is an increase from $1 million.
Support for Nursing Programs $1 million in new money to assist independent colleges to expand and improve their nursing programs. Assistance provided on a per student basis.
The Commission on Health Care Facilities in the 21st Century report was submitted on Dec 1, 2006. This group, also known as the “Hospital Closing Commission” or the Berger Commission recommended closing many hospitals through out the state and merging others. These recommendations became law on January 1, 2007. Several hospitals and unions (UUP, PEF, CSEA) have filed suit to fight these recommendations. The commission recommended closing 9 hospitals, 7 nursing homes and merging other hospitals for a decrease in 4000 beds by June of 2008. The state is offering up to $550 million in financial assistance to facilities to help implement the mandates.
Respectfully submitted,
Jody Scardillo, MS, RN, CWOCN
Legislative Report Fall 2009:
PA is the only state without a fiscal 2009 - 2010 budget. Main issue for the $28 billion budget is education and health care. With spending to possibly offset by legalization of poker and other table games at casinos, higher business tax and a
25 cent per pack increase in the cigarette levy.
CLEAN AIR INDOOR ACT
One year anniversary is 9/11/2009. Smoke free air will save 52 hospitality workers lives annually. Department of Health issued 8 citations and Bureau of Liquor Enforcement issued 249 citations and 288 warnings over the past year.
PSNA will hold a work shop, "Best Practices Environmental Health in the Home, Work and Community", September 24, 2009 at IUP. For info visit www.panurses.org/envtaskforce
In August, Vice President Biden stated, "With electronic health records, we are making health care safer, we are making more efficient, we are making you healthier and we are saving money along the way". This was while his office said that grants totalling
$598 million would establish about 70 Health Information Technology Regional Extension Centers, which will provide health care providers with technical assistance.
HOUSE BILL 594-61009 FINAL PASSAGE - referred to Senate. Act providing for a program for the disposal of home generated medical sharps, and for powers and duties of the Department of Environmental Protection.
HOUSE BILL 1445-091009 - set on the House voting schedule. Act providing standards for carbon monoxide alarms and duties of the Department of Labor and Industry and penalty.
STATE BILL 89 061009 - APPROVED BY THE GOVERNOR (ACT 3). Amends the Health Care Cost Containment Act further providing policy declaration, definition, for the Council and powers, for data submission and collection and for collection for Council data;
establish the Health Care Cost Containment Review Committee.
STATE BILL 464-091009 set on House voting schedule. Act providing for the use of volunteer time by health care workers in meeting continuing education requirements.
Respectully submitted,
Melissa C. Stolley BA, BSN, RN, CWOCN
Pennsylvania Legislative Representative for thw WOC Nursing Society
:mstolley@pinnaclehealth.orgActive
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Active Legislation as of April 5, 2009 HB 33(3) SAFE DRUG DISPOSAL ACT OF 2009 Introduced 01-26-09. An amendment to the Controlled Substances Act in the interest of public safety to require retailers to have environmentally responsible disposal practices and allows end users means to safely dispose of unused Rx drugs and OTC drugs. Provides take-back programs so that drugs are not disposed of through waterways or landfills. Civil penalties imposed for infractions. HB 212 HB 890 HB 103 SB 32 SB 41 (3) SB 88 SB 174 SB 311 SB 464 American Recovery and Reinvestment Act of 2009 Respectfully submitted, -------------------------------------------------------------------------------------------------------------------- HB1019- Loan Forgiveness. Referred to education committee 4/3/2007 SB968-Mcare Act- decrease and prevent health care associated infections. Governor signed 7/20/2007
Introduced 02-02-09. Companion Bill HB 341. Amends The Professional Nursing Law providing for further definitions; providing for certified RN anesthetist qualifications.
Introduced 03-12-09. Act establishing a nursing and nursing educator loan forgiveness and scholarship program.
Set on House Calendar 04-20-09. Designation of May 6 through 12, 2009 as “Nurses Week” in PA.
Introduced & referred 01-20-09. Companion Bill SB 649. Act requiring LTC facilities to maintain staffing levels to protect health and safety of residents and employees. Powers to Department of Health to impose penalties.
Introduced and referred 01-20-09. Amends Medical Care Availability and Reduction of Error (MCARE) Act providing for medical professional liability insurance.
Received in the House 03-25-09. Established Health Cost Containment Review Committee and provides for its powers.
Referred to Senate Appropriations 03-23-09. Companion Bill HB 926. Establishes the PA Center for Health Care Careers.
Introduced and referred 02-20-09. Companion Bill SB 214. Amends The Professional Nursing Law establishing the Nurses Health Program.
Set on Senate Calendar 04-20-09. Companion Bill SB 1451. Act providing for use of volunteer time by health care professionals in meeting continuing education requirements.
WOCN was among a large number of national nursing associations and societies that requested the $600 million House provision for nursing and health provisions be included in the final stimulus package.
Melissa C. Stolley BA, BSN, RN, CWOCN
HB1581- Nursing Scholarship- Referred to education committee. 6/20/2007
SB 246- Smoke-Free Environment Act. Referred to Rules and Executive Nominations Committee 7/16/2007
HB720- Clean Indoor Air Act- Referred to Health and Human Services Committee 3/9/2007
HB539- 211 dialing code- Referred to Health and Human Services Committee 7/8/2007
Act 48- Signed by Governor Rendell 7/20/2007. Requires CRNPs to have malpractice insurance of 1mil per occasion/3mil aggregate
ACT 49- Signed by Governor Rendell 7/20/2007- Official Recognition of CNS. State Board to determine licensure.
Mandatory CEUs- Still undetermined as to reporting system by the State Board of Nursing.
Pennsylvania Legislative Report
October 12, 2007
Submitted by Cheryl Bealer
