Inside the Beltway - February 2024

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.

Extreme Risk Protection Orders:
A Firearm Safety Policy to Help Prevent Suicide

Contributed by Health Policy Committee member Jessica Francois, DNP, CPNP-PC

Extreme Risk Protection Orders (ERPOs) or Red Flag laws are a vital tool for communities to prevent firearm deaths. These laws are a means for law enforcement, family members and in some states health care professionals to petition a court for an order to temporarily remove firearms and prevent purchase of a firearm from someone at serious risk to themselves or others. For PNPs, FNPs and our fellow pediatric providers, the mental health crisis is something we know all too well. In 2021, 7,126 youth aged 10-24 died by suicide. Firearms are the most lethal and most common method of suicide. We can help prevent youth suicide by advocating for ERPO laws, and intervening when our patients show warning signs and have lethal means.

The Evidence Behind ERPOs

Connecticut was the first state to enact an ERPO in 1999. Research by Kivisto & Phalen (2018) found that Connecticut’s ERPO law, after stricter enforcement post Virgina Tech shooting, was associated with a 13.7% reduction in firearm suicides.

Maryland is a state that allows doctors and mental health practitioners, in addition to law enforcement and family members, to petition the court for ERPOs. In a study by Frattaroli et al. (2019) they found that the barrier to using the law was limited knowledge and that once awareness among physicians improved, they were more likely to use it.

ERPOs are just one type of firearm safety policy, that along with other laws including background checks, secure storage and more can help to prevent future deaths. In an analysis by KFF, they found that states with the fewest gun laws had the highest rate of suicide by firearms.

What NPs Can Do to Advance ERPOs at the State Level

Does your state have an Extreme Risk Protection law? If not, NPs can advocate for legislation to create and implement these laws.
- Review this interactive map from Everytown to see if your state has an ERPO law.
- In 2022, the federal Bipartisan Safer Communities Act was passed. A section of the bill provides grants to states to implement ERPO programs.
If your state already has an ERPO law determine if health care workers are included as community members who can petition the court for temporary removal of firearms from an individual who is deemed a risk to self or others.
- The following states include variations of medical professionals in their ERPO laws: Colorado, Connecticut, Hawaii, Maryland, Michigan, and New York.
- If health care workers are not included, advocate for expanded legislation to include health care workers.
Advocate for increased awareness of ERPO laws.
- Educate community members to increase awareness on use of ERPOs.
- Advocate for stricter enforcement and streamlined implementation of ERPOs.

Suicide can be prevented. Pediatric-focused NPs must collaborate with key stakeholders in their communities to make sure ERPOs are enacted and promoted as evidence-based prevention tools to save lives from suicide and other firearm violence.

Resources

View Our Recent Child Health Policy Learning Collaborative Session About Violence Prevention

NAPNAP recently hosted three community leaders to discuss their successful community strategies to prevent firearm violence and address safety for kids and their families.

Congress Scrambles to Wrap Up Nursing Funding

After passing a third short-term funding extension to avoid a government shutdown, Congress is facing a March 8 deadline to complete action on all 12 of the appropriations bills for fiscal 2024 including the Labor-HHS-Education bill providing money for nursing education, workforce, and research programs. Congressional leaders affirmed the topline funding allocations for defense and non-defense domestic programs and appropriations leaders agreed on allocations for the 12 separate spending bills, but it’s unclear how much is targeted for nursing programs – advocates expect a lower overall funding level for the Department of Health and Human Services. The House advanced a plan last year that would cut funding for nursing programs under Title VIII of the Public Health Service Act by nearly $20 million and eliminate the Nursing Workforce Diversity Program, while Senate appropriators proposed a $2 million increase for the Title VIII programs.

With deadlines for passing the first four of the 12 spending bills – Agriculture-FDA, Military Construction-VA, Energy and Water, and Transportation-Housing – by March 1, the odds are increasing that lawmakers will have to combine measures in two or more “minibus” packages. Leaders also have yet to resolve a host of controversial policy riders that could endanger passage of the bills. Lawmakers could be forced to pass a fourth stopgap funding extension to buy more time for negotiations or possibly consider a full-year continuing resolution through September that could result in across-the-board cuts to domestic programs based on provisions in last year’s legislation to raise the federal debt limit.

House Send Child Tax Credit Expansion to Senate

The House overwhelmingly passed bipartisan legislation last month to cut taxes for working families and restore certain corporate tax breaks, but the bill appears to be facing long odds in the Senate as supporters try to rush the measure to President Joe Biden’s desk before the end of tax filing season in April. The “Tax Relief for American Families and Workers Act” (H.R. 7024), which passed the House by a vote of 357 to 70 with the support of 188 Democrats and 169 Republicans, would expand eligibility for the child tax credit among the lowest-income families and adjust payments for inflation for the 2024 and 2025 filing years. It would also bolster certain business tax credits, including deductions for research and development, interest expenses and investments in equipment, that were limited in an effort to cap the total costs of former President Donald Trump’s 2017 tax cut law. Supporters of the child tax credit are disappointed that the bill isn’t as generous as the policies Congress adopted in the 2021 American Rescue Plan Act, which reduced child poverty by 46 percent.

Despite the strong bipartisan backing in the House, the bill has run into problems in the Senate where some Republicans have called the child tax credit “excessive” and “another entitlement program.” Opponents contend that undocumented aliens could receive the child tax credit, which the bill’s supporters refute, and want to impose additional work requirements in order for families to qualify for it. NAPNAP has issued a call to action for members to urge their senators to support expanding the child tax credit and to oppose any efforts to weaken the provisions.

Advocates Push Congress to Act on Health Policies

The combination of a crowded legislative calendar and election-year politics is hampering efforts to advance legislation on a wide range of health policies despite bipartisan support for addressing prescription drug prices, hospital payment transparency, adult and child mental health care, and health care workforce shortages. Earlier resolutions to avoid government shutdowns included provisions to temporarily extend funding for community health centers and delay cuts in Medicaid payments to safety-net hospitals, but advocates are hoping to attach permanent fixes for those and other policies to final fiscal 2024 spending bills in the coming weeks.

In December the House passed the “Lower Costs, More Transparency Act” (H.R. 5378) requiring greater transparency from hospitals and pharmacy benefit managers on their costs and pricing policies, which could be the basis of a broader health policy package. The Senate Health, Education, Labor, and Pensions Committee approved the “Bipartisan Primary Care and Health Workforce Act” (S. 2840) last September that would $1.2 billion in grants to increase the number of students enrolled in two-year registered nursing programs as well as $28.5 million for the Nurse Faculty Loan Program and a $15 million faculty salary demonstration program. NAPNAP and other nursing organizations are also urging leaders to include provisions of the “Improving Care and Access to Nursing (ICAN) Act” (H.R. 2713/S. 2418), eliminating barriers to nursing practice, and the “Future Advancement of Academic Nursing (FAAN) Act,” authorizing $1 billion in grants to expand and improve nursing education infrastructure and faculty, in any comprehensive health package.

Senate Panel Presses Online Safety Concerns

Advocates are urging lawmakers to pass legislation to protect children from harmful online content after executives of Meta, TikTok, Discord, Snap and X, the company formerly known as Twitter, were challenged by lawmakers from both parties for their failure to address child sexual abuse on their platform during a four-hour Senate Judiciary Committee hearing this month. Senators and children’s advocates are pressing to advance legislation that would require online platforms to implement more safety precautions – but opposition from tech firms over First Amendment free speech concerns have stalled that legislation thus far.

Families are pressing for passage of the “Kids Online Safety Act” (S. 1409), which would require social media companies to limit access to or allow minors to opt out of certain features, like automatic video playing and algorithmic recommendations, and would legally obligate tech platforms to prevent the promotion of content about suicide, eating disorders and self-harm. Advocates are also calling for action on the “Eliminating Abusive and Rampant Neglect of Interactive Technologies (EARN IT) Act” (S. 1207) and the ““Strengthening Transparency and Obligations to Protect Children Suffering from Abuse and Mistreatment (STOP CSAM) Act (S. 1199).

In Other News…

EPA Issues Rule to Strengthen Soot Limits
The Environmental Protection Agency this month issued some long-awaited regulations strengthening limits on fine particulate matter, one of the most widespread deadly air pollutants, prompting praise from public health experts and backlash from business groups. The EPA is lowering the annual soot standard to 9 micrograms per cubic meter of air, down from the standard of 12 micrograms. When fully implemented in 2032, the stricter limit could prevent up to 4,500 premature deaths and 290,000 lost workdays per year, according to the agency.

NAPNAP and other nursing organizations have actively pushed for stricter standards – the new rule doesn’t go as far as groups wanted to tighten the daily emission standard as well as the annual requirement, but it is still a significant improvement, particularly for communities of color near power plants, refineries, and other major polluters. Business groups don’t dispute the enormous health benefits but argue that the standards could cost manufacturing jobs across the country – the rule is likely to be challenged in court.

New Rules Permanently Expand At-Home Opioid Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) issued regulations this month permanently extending telehealth flexibilities offered to opioid treatment programs during the pandemic for patients seeking treatment for opioid use disorder. The final Medications for Opioid Use Disorder rule permanently allows audio-visual and audio-only telehealth visits for the initiation and ongoing management of buprenorphine for opioid treatment without an in-person visit requirement. The rule applies to certified opioid treatment programs but doesn’t apply to virtual prescribing of controlled substances more broadly through Drug Enforcement Administration regulation. DEA is working on proposed rules for virtual prescribing of controlled substances including buprenorphine after 2024, when eased pandemic rules expire. It’s not clear when those will be proposed, but DEA has said it will finalize them by the fall.

In addition, SAMHSA will allow opioid treatment programs to induct new patients into methadone treatment pursuant to an audio-visual telehealth visit. The rule would still require the patient to obtain doses of methadone in person at the OTP clinic and does not allow methadone treatment to be initiated via audio-only telehealth because of the risk factors of the medication. The rule also secures other pandemic-era flexibilities such as making it easier for patients to obtain take-home doses by removing as sole consideration the length of time the person has been in treatment and required rigid toxicology testing. It also puts into effect the removal of the Drug Addiction Treatment Act (DATA) waiver – or X waiver – that was removed by the 2023 Consolidated Appropriations Act.