Inside the Beltway is a member-only benefit developed by NAPNAP’s Health Policy Team to keep members up to date on key policy issues at the federal level.
As Unwinding of Medicaid Enrollment Provisions is Underway- PNPs Can Be Front Line Advocates
Contributed by Health Policy Committee member Allison Clark Young, MSN, APN, CPNP-PC
In May of this year, the Public Health Emergency (PHE) ended bringing with it major changes in health policy, perhaps the most significant being the end of continuous enrollment for those receiving Medicaid benefits. Approximately 94 million people in the U.S. are enrolled in Medicaid or the Children’s Health Insurance Programs (CHIP) and approximately half of those, over 42 million, are children. The unwinding of the Medicaid continuous enrollment provision has been expected to cause millions of Americans to lose coverage including children who rely on their insurance for routine preventative care, acute illness and complex medical needs. In July, the first reports were released that help us better understand how the unwinding process is going and what effects are being seen on the state and patient level.
The Results
The Centers for Medicare & Medicaid Services (CMS) has asked states to take a full 12 months for the unwinding process and to spread their renewals evenly across this timeframe. While some states have been completing Medicaid renewals and assessing eligibility throughout the PHE but refraining from taking any negative actions, other states have begun the onerous process of assessing eligibility after taking a several year pause during the pandemic. Not only is the renewal process new to many Medicaid beneficiaries, it is also new to many state staffers. As states have begun to publicly report their respective unwinding metrics and Medicaid eligibility, it has become clear that the majority of coverage loss – around 75% of known renewals – have been the result of procedural terminations. Procedural terminations mean that coverage was lost for administrative reasons. such as a form not being returned. not that the impacted beneficiary was factually ineligible. Children have been particularly impacted; one in three beneficiaries who have lost coverage to date are children.
The Effects
Due to political pressures, some states such as Arkansas and Idaho have decided to complete this challenging process more rapidly. State advocates have voiced alarm regarding these terminations. In Arkansas for instance, 29,067 children, including newborns, lost coverage in the first month of unwinding alone. Some families have noted challenges in even having sufficient time to respond to renewals. One family in Texas reported they had only two weeks to appeal after learning that their medically complex child would lose coverage. To minimize the negative impacts and coverage loss, CMS and HHS Secretary Becerra have urged states to pause terminations and to take on additional policy flexibilities. Some of these include renewing Medicaid eligibility using existing Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) data, and implementing Express Lane Eligibility (ELE) for children.
NPs Can Get Involved
As more states’ statistics come out, we see that children in the U.S. are being significantly affected by the loss of Medicaid coverage. Looking forward, we are not sure what effect this will have on the Vaccines for Children (VFC) program which provides millions of children with vaccines each year. For pediatric-focused nurse practitioners there are many things we can do:
- Communicate with parents about re-enrolling their children in Medicaid
- Discuss with parents that even if the parent is not eligible for coverage, the children may still be
- Provide guidance regarding the procedural issues and potentially long call center wait times
- Work with administrators in your health system or office to provide information to parents and caregivers about possible benefits and paperwork needed to complete re-enrollment and resources to help parents and caregivers complete these tasks
- Contact your representative to ensure your state is following CMS recommendations regarding timelines of implementation and providing a safety net for those children who are losing coverage due to procedural issues
Join us for our Sept. 6 Child Health Policy Learning Collaborative meeting to learn more.
Federal Regulators Approve First RSV Prevention Therapy for Infants
The first vaccine-like monoclonal antibody that protects all infants against respiratory syncytial virus (RSV), the leading cause of hospitalization among infants in the U.S., won the backing of the Centers for Disease Control and Prevention Aug. 3 after earlier approval by the Food and Drug Administration. The CDC Advisory Committee on Immunization Practices unanimously recommended Beyfortus, also called nirsevimab, after reviewing the data in an hours-long meeting, and CDC Director Dr. Mandy Cohen accepted the advisors’ recommendation the same day, calling on families to take advantage of the new drug. The CDC said Beyfortus should be available this fall and company spokespersons said AstraZeneca and Sanofi are prepared to roll out the treatment before RSV season and don’t foresee any challenges meeting demand.
The CDC advisors also voted unanimously to include the product in the federal Vaccines for Children Program, which provides vaccines to kids whose families are struggling financially. The program provides immunizations to about half of the nation’s children. Infants younger than 8 months entering their first RSV season would receive one dose, while kids 8 to 19 months who face an increased risk from the virus would receive another dose in their second RSV season. Access NAPNAP’s RSV resources.
Become a NAPNAP Advocacy Scholar
All current members are invited to apply for NAPNAP’s 2023 Advocacy Scholars program. Selected advocates will take a deeper dive into health policy priorities and increase the understanding of advocacy for children’s health and advanced practice nursing. Scholars will receive financial support to attend NAPNAP’s Capitol Hill Day in Washington, D.C. on Nov. 5-6, 2023. The deadline to apply is Sept. 4 so act now.
Senate Panel Advances Children’s Online Safety Bills
The Senate Commerce, Science, and Transportation Committee on July 27 approved two NAPNAP-endorsed bills aimed at strengthening safeguards to protect children from harmful online content. The panel unanimously approved the “Children and Teens’ Online Privacy Protection Act (COPPA 2.0)” (S. 1418) and the “Kids Online Safety Act (KOSA)” (S. 1409) by voice vote, signaling bipartisan support for bills that President Biden has urged Congress to pass.
COPPA 2.0, an update to a 1998 law, would extend the original law’s prohibitions on internet companies collecting and using personal information from children younger than 13 to children as old as 16 without their consent. KOSA would establish a legal standard for internet companies to protect minors and require additional parental controls. Children’s advocates were generally pleased with the bills’ provisions, but civil liberties and tech trade groups are lining up to oppose them, warning that they could require collection of more information on children for age verification and privacy settings. Groups that focus on LGBTQ+ issues also fear that state attorneys general could use KOSA to censor content.
NAPNAP Takes Part in Black Maternal Health Caucus Summit
NAPNAP Health Policy Committee member Sarah Green, DNP, CPNP joined Biden administration officials, members of Congress, and leaders of women’s and children’s health groups Aug. 1 in discussing strategies to improve the nation’s maternal mortality and health at the Black Maternal Health Caucus’s 2023 Stakeholder Summit at the U.S. Capitol. Health and Human Services Sec. Xavier Becerra, White House domestic policy staff, and leaders from the Health Resources and Services Administration and the National Institute of Child Health and Human Development joined Caucus Co-Chair Rep. Lauren Underwood (D-IL) in celebrating recent legislative and administrative policy achievements and sharing ideas for improving and advancing the “Black Maternal Health Momnibus Act of 2023.” Speakers outlined additional polices to improve access to maternal health care, and federal officials provided guidance on responding to federal funding opportunities and drafting effective grant proposals.
Join us in D.C. for Capitol Hill Day 2023
We are pleased to announce our 2023 Capitol Hill Day will be Monday, Nov. 6 in Washington, D.C. with a pre-event learning session on Sunday, Nov. 5. This is your chance to join fellow members in our nation’s capital to raise awareness on children’s health and advanced practice nursing priorities. No advocacy experience is needed to attend Capitol Hill Day and you will be paired with colleagues for Hill Day meetings. NAPNAP will provide necessary materials and schedule meetings with your elected officials’ offices for your convenience.
Our Capitol Hill Day experience will be hosted in conjunction with our Pediatric Seminar: Primary Care Office Emergencies event on Nov. 4-5. Learn more about this amazing weekend in D.C. and register now to save.
Focus Smoking Cessation on Child Prevention, NAPNAP Advises HHS
Responding to a request for information on its Draft 2023 Framework to Support and Accelerate Smoking Cessation, NAPNAP urged HHS Assistant Sec. for Health Adm. Rachel Levine “to approach addiction to nicotine and tobacco as a lifelong public health concern that is usually initiated in youth.” The framework was drafted to focus on ending the use of combustible tobacco products across all ages and to defer policies on prevention and cessation of the use of e-cigarettes and other products later, but NAPNAP warned that strategies focused on adults will be ineffective if they don’t also target preventing the initiation of tobacco and nicotine addiction in children and adolescents.
NAPNAP called on HHS to finalize and implement the Food and Drug Administration’s proposed rules on tobacco product standards for menthol in cigarettes and flavored cigars; improve coverage of tobacco cessation treatment in Medicare, Medicaid, and private insurance; and encourage the development of additional cessation medications for both adults and children. The agency’s request didn’t indicate when a final smoking cessation framework would be released.
Chapters Join NAPNAP in Urging Funding for HPV Vaccination Efforts
Applauding President Joe Biden and First Lady Jill Biden for relaunching the Cancer Moonshot, 13 NAPNAP chapters and two special interested groups joined the national association in urging the White House to give special recognition to the importance of HPV vaccination as part of its cancer prevention efforts and supporting the appropriation of $15 million in the fiscal 2024 budget to increase HPV vaccinations. The groups urged the President and First Lady to promote proven cancer prevention practices such as HVP vaccination, as well as expanding outreach and education for both health care providers and the public, making better use of information technology, and protecting members of the military and their families through HPV vaccinations.
Medicare Proposes to Increase NP Payment, Address Practice Barrier
Nurse practitioners billing Medicare for services under the Part B fee schedule could see a 2 percent increase in 2024 payments under policies proposed July 13 by the Centers for Medicare and Medicaid Services (CMS). In its annual proposed rule on Part B fee-for-service policies, the agency reduced overall calendar year 2024 payments by 1.25 percent but proposed significant increases for primary care and other direct patient care. The rule also proposed to authorize NPs, clinical nurse specialists, and physician assistants to supervise cardiac and pulmonary rehabilitation programs and to enable NPs, CNSs, certified nurse-midwives and other professionals to be paid for training and involving caregivers to support Medicare patients with dementia or some other diseases or illnesses in carrying out a treatment plan. The agency will receive public comments on the proposed rule through Sept. 11.
The proposed rule also included significant changes in the Medicare Shared Savings Program including providing greater recognition of the role of nurse practitioners, physician assistants and clinical nurse specialists in delivering primary care services. The rule proposed to revise the definition of primary care services used for purposes of assigning beneficiaries to Medicare accountable care organizations, allowing patients who receive their primary care exclusively from NPs, CNSs, or PAs to be enrolled in the programs. The rule also proposed to delay for 2024 the implementation of a payment policy for split or shared evaluation and management visits provided in part by physicians and in part by nurse practitioners or other professionals in hospitals and other institutional settings.
In Other News…
First Postpartum Depression Drug Wins Federal Approval
The Food and Drug Administration approved a new prescription drug to treat postpartum depression Aug. 4, the first pill authorized to be marketed for people experiencing the debilitating condition after pregnancy. The agency approved Biogen and Sage Therapeutics’ Zurzuvae, formerly known as zuranolone, to treat both postpartum depression and major depressive disorder as a 14-day, rapid-acting course, with patients taking one pill a day. The drug’s price and when it will be available haven’t been announced. The only other treatment marketed specifically for postpartum depression is brexanolone, an infusion approved in 2019 that’s administered over a 60-hour period during which patients must be monitored in health care facilities for excessive sedation and loss of consciousness.
Shutdown Threat Looms As Congress Struggles With Government Funding
With about 17 legislative days on its calendar once members return to Capitol Hill after Labor Day, Congress will face the possibility of a government shutdown when the current federal fiscal year ends Sept. 30. With none of the 12 fiscal 2024 appropriations bills completed, lawmakers appear to have little choice but to pass a short-term extension to give them more time to agree on full-year funding. Negotiators are under pressure from the conservative House Freedom Caucus to pass the 12 spending bills individually without relying on rescinding previous funding to cut government funding by more than $1.3 billion. If any of the appropriations bills aren’t enacted into law by the end of the year, provisions of the recent deal to raise the federal debt limit will impose an across-the-board 1 percent cut on all agencies and programs on Jan. 1, 2024.
House and Senate appropriators are facing a $100 billion gap in their 2024 funding levels including a difference of more than $77 billion in the Labor-HHS-Education measure that includes funding for nursing education, workforce, and research programs. The Senate Appropriations Committee approved a measure (S. 2624) July 27 that would provide a $2 million increase for the nursing programs under Title VIII of the Public Health Service, while House appropriators have yet to release the details of the proposal advanced July 14 by the Labor-HHS-Education Subcommittee. However, the House bill would cut funding for the workforce programs supporting all health professions by about $54 million and the panel’s top-ranking Democrat, Rep. Rosa DeLauro of Connecticut, said the bill would eliminate funds for the Nursing Workforce Diversity program. The proposal, which hasn’t yet been considered by the full House Appropriations Committee, would also cut funding for the National Institutes of Health by $3.8 billion, the Centers for Disease Control and Prevention by $1.6 billion, and the Substance Abuse and Mental Health Services Administration by $234 million.
Health Workforce Bills on Fall Congressional To-Do List
Despite a crowded legislative agenda, health committees in both chambers of Congress are planning to advance measures this fall to address shortages in the nursing and health professionals workforce. Just before the congressional recess, Senate Finance Committee Chair Ron Wyden (D-OR) said July 27 that his committee will join the Senate Health, Education, Labor, and Pensions (HELP) Committee in its efforts to reauthorize funding for graduate medical education, community health centers and the National Health Service Corps, and to incentivize health care providers to partner with schools to develop health professionals from medical assistants to advanced practice nurses. Wyden’s statement followed HELP Committee Chair Bernie Sanders’ (I-VT) decision to pull back on plans to take up his sweeping workforce bill and work on a bipartisan proposal with the panel’s ranking Republican Sen. Bill Cassidy (R-LA).
Sanders’ proposed “Primary Care and Health Workforce Expansion Act” includes a host of initiatives to expand the number of health care workers including a $2 billion grant program to expand two-year nursing degree programs, a $1 billion grant program for nursing schools to increase teachers and class sizes, and another $1 billion program to provide grants to states, nonprofits and community colleges to encourage more training recruiting and hiring of direct care workers. Cassidy put forward a Senate version of a House package advanced earlier in the year in the House that would reauthorize some current programs but at much lower funding levels.
