Gaining Traction and Momentum for Full Practice During and Beyond COVID-19
Contributed by: Health Policy Committee Member Nicole Garritano, DNP, APRN, CPNP-AC
The COVID-19 pandemic has upended our health care system and our professional practice. While we have seen the hardships of the COVID-19 pandemic on our health care workforce, our patients, and our friends and family, we have also realized an opportunity to further reduce barriers that prevent APRNs from practicing to the full extent of their education and certification which in turn increases patient access to care.
With the influx of patients in recent months our health care systems have been overrun requiring additional health care providers. In response, governors in many states have enacted emergency orders lifting practice restrictions during the pandemic. This creates an opportunity for advanced practice providers to collect data related to reduced restrictions and examine patient and health care system outcomes. Collection of this data is crucial for introducing future full practice bills in state legislatures.
The question becomes how can you step up and help these efforts? There are ways to contribute whether you already live in a full practice authority state or not. Below are some actionable ideas to move the effort forward.
You live in a state WITHOUT full practice authority but emergency orders have TEMPORARILY lifted practice restrictions.
- Form coalitions between your NAPNAP chapter and other NP organizations in your state to track and collect the data in your state while restrictions are lifted
- Use collected data and coalition relationships with legislators to advocate for the need for permanently lift restrictions via legislation and regulation
- Identify a NAPNAP chapter in a state with full practice authority and create a liaising relationship to better understand their full practice data and disseminate best practices to members in your state
- Engage with Shared Governance in your practice setting to collect data and outcomes within your institution
You live in a state WITHOUT full practice authority and without emergency orders regarding practice.
- Form letter writing campaigns with your NAPNAP chapter Legislative Chair asking for temporary lifting of restrictions during the pandemic highlighting increased need during states of emergency and in the event of a future resurgence of COVID or other type of disease or disaster
- Identify a NAPNAP chapter with full practice authority and create a liaising relationship to better understand their full practice data and disseminate best practices to members in your state
- Engage with Shared Governance in your practice setting and educate colleagues on the importance of advocating and involvement with professional organizations
You live in a state WITH full practice authority.
- Reach out to colleagues in states with restricted practice authority and offer to share data and outcomes that helped your state gain full practice authority
Need help with state specific advocacy resources? COVID—19 resources, including practice policy issues, can be found on our Coronavirus Safety page. Visit NAPNAP’s Health Policy State Repository page or our Advocacy Resources and Links page for more information.
As Coronavirus Persists, Administration and Congress Turn to Economic Impact
After a broadly bipartisan effort to provide an urgent response to the coronavirus outbreak in the U.S. including $3 trillion in emergency federal assistance, work on a fourth COVID-19 relief bill slowed as priorities among Republican and Democratic leaders diverged. White House and Republican negotiators said June 11 they aren’t planning to hold formal negotiations until late July, when Congress returns July 21 from an extended Independence Day recess – ten days before increased unemployment insurance and other emergency aid payments are set to expire.
The slowdown in negotiations came as data from Johns Hopkins University on June 12 indicated that the rate of COVID-19 cases was increasing in 19 states, several of which were at record or near-record highs, causing some states to delay phased reopening plans. The Centers for Disease Control and Prevention said June 12 that the rising number of coronavirus deaths in the U.S. could reach 130,000 by July 4.
In previous action, House Democrats passed the massive $3 trillion “Health and Economic Recovery Omnibus Emergency Solution (HEROES) Act” (H.R. 6800) on a 208 to 199 vote May 15 with only one Republican, Peter King of New York, voting for the bill and 14 Democrats opposing it. But Senate Republican leaders refused to consider the bill, with Majority Leader Mitch McConnell saying his party’s members are still “assessing what we’ve done already” while raising concerns about the impact of emergency spending on the federal debt. McConnell and Senate Republicans also said the next relief bill would have to include liability protections for businesses as states moved to reopen their economies.
Lawmakers and the Trump administration has previously agreed in late April on the $484 billion “Paycheck Protection Program and Health Care Enhancements Act” (H.R. 266), replenishing funds for the grant protect intended to help small and mid-sized businesses with payroll, rent and other expenses, as well as $100 billion for struggling hospitals. That bill was followed by the June 5 signing of the “Paycheck Protection Program Flexibility Act of 2020” (H. R. 7010), giving businesses more time to spend grant money on a broader range of business expenses.
HHS Releases $15 billion in Medicaid Provider Relief Funds
After weeks of pressure from NAPNAP and other provider organizations along members of Congress, the Department of Health and Human Services on June 9 announced the availability of $15 billion in relief funds for providers largely dependent on Medicaid and the Children’s Health Insurance Program (CHIP) who weren’t eligible for previous finance assistance – although concerns remained about whether the amount would be enough for individual practices.
The department launched an expanded portal June 10 for Medicaid and CHIP providers to report their annual patient revenue, along with answers to frequently asked questions. Eligible providers will receive at least 2 percent of reported gross revenue from patient care and could see payments as soon as 10 days after they submit their application. HHS estimated nearly 1 million providers would be eligible, so, if all apply for funding, they could see about $15,000 each, capturing the nearly 40 percent of Medicaid providers who were excluded from the initial $50 billion in general distribution emergency relief based on Medicare claims data. The new allocation makes $15 billion available to eligible providers and another $10 billion to safety net hospitals.
Administration Rescinds ACA Patient Non-Discrimination Rules
The Trump administration on June 12 finalized its controversial and long-expected reinterpretation of Section 1557 of the Affordable Care Act removing non-discrimination protections for transgender individuals and women seeking abortion and required robust language translation services. Despite facing months of pressure to scrap its reinterpretation of the ACA provision, the HHS Office of Civil Rights said that, after reviewing 25,000 comments, it decided to finalize the regulation as proposed, with some technical changes narrowing its scope.
NAPNAP joined members of Congress, state officials, and other health care advocates in opposing the move, while some transgender advocates vowed to sue to block the rule. Groups warned that the rollback would make it easier for hospitals and health care workers to discriminate against patient based on gender or sexual orientation in the midst of the coronavirus pandemic. Referring to its “Health Risks and Needs of Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescents Position Statement” warning that discriminatory actions can have a profound negative effect on the emotional and physical health of transgender adolescents, NAPNAP said “It remains imperative that pediatric healthcare professionals continue to advocate for equal treatment and acceptance of transgender children, adolescents and young adults.”
Congress could have recourse as the rule may fall under the Congressional Review Act which allows lawmakers to reverse an administrative rule with a simple majority if it was issued within 60 legislative days before the end of a session. However, it’s unclear if the rule will fall under the act since Congress can still add days to the legislative calendar.
NAPNAP Cautions Against Withdrawing from World Health Organization
NAPNAP and NAPNAP Partners for Vulnerable Youth joined a broad range of health care organizations in urging the Trump administration to reconsider its May 29 decision to end U.S. participation in the World Health Organization (WHO) after President Trump initially froze funding for the agency and criticized its leadership for mishandling the international response to the coronavirus pandemic. Trump said the administration would redirect more than $400 million in annual funding to unspecified “worldwide and deserving urgent global public health needs.”
“As pediatric healthcare experts, we believe it is imperative that our national leaders maintain a global perspective and collaborate with our colleagues across the world to develop solutions to improve health outcomes,” NAPNAP and NAPNAP Partners for Vulnerable Youth said in a statement. “We must join with international health partners to optimize child and family health because diseases are not contained by borders, they are contained by diligent monitoring, research and development of and administration of vaccines and healthcare protocols. We urge President Trump to reconsider his decision to withdraw from WHO and re-engage with our worldwide colleagues to promote the health and wellbeing of all families.” Read our full statement.
In Other News…
Supreme Court Rejects Efforts to End DACA Program
The U.S. Supreme Court on June 18 rejected the Trump administration’s effort to terminate the Deferred Action for Childhood Arrivals (DACA) program, a victory for 650,000 undocumented immigrants brought into the U.S. as children. Chief Justice John Roberts joined the Court’s more liberal justices in a 5 to 4 decision that found the Trump administration’s move to wind down the program lacked a sound legal basis. President Trump has tried since 2017 to terminate the program, which President Obama authorized through executive action in 2012 to protect law-abiding immigrants brought by their parents, some of whom have entered the nursing profession. The decision doesn’t foreclose future moves to end DACA, but it would be difficult for the administration to put in place a new framework to end the program before November’s presidential election.
The ruling followed concerns raised by members of Congress and immigrant advocates in mid-May following reports that U.S. Immigration and Customs officials had resumed enforcement of policies separating immigrant children and families in the midst of the coronavirus pandemic. Lawyers for immigrant families said officials gave families in federal detention a “binary choice” of remaining in custody for extended periods of time or being separated from children who could be released to relatives or held as unaccompanied aliens. policy forces families held in ICE detention centers to make an unimaginable choice: remain detained or separate parents from their children.
A California federal district judge overseeing the implementation of the 1997 Flores Settlement Agreement, which requires the release of minors from federal custody after 20 days, ordered Immigration and Customs Enforcement in April to conduct individualized release assessments for children in custody – an order that federal officials apparently interpreted as grounds for approaching parents and asking them to choose between remaining in detention or releasing their children to suitable sponsors.
Administration Continues Rollback of Environmental Rules
President Trump signed an executive order June 6 instructing federal agencies to waive long-standing environmental requirements to speed up federal approval of new mines, highways, pipelines and other projects in response to the coronavirus-related economic “emergency.” The order invokes federal laws allowing “action with significant environmental impact” without complying with normal requirements imposed by laws such as the Endangered Species Act.
The order followed the Environmental Protection Agency’s May 29 submission of regulations for final review that would rescind Obama-era requirements for oil and gas companies to reduce methane gas emissions. The 2016 regulations were the last climate rules issued by the Obama administration, applying only to new and heavily modified facilities to require installation of low-emission equipment.