Inside the Beltway – October 2023 - NAPNAP

Inside the Beltway – October 2023

Inside the Beltway – October 2023

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.

House Faces Leadership Fight After Dodging Government Shutdown

After passing a bipartisan stopgap funding measure Sept. 30 to keep federal agencies open after failing to enact fiscal year 2024 appropriations, far-right House Republicans threw California Rep. Kevin McCarthy out as House Speaker three days later – the first time in U.S. history the chamber fired its leader, setting off a chaotic scramble to elect a new presiding officer and leaving the House unable to act on any legislation. The paralysis halted action on appropriations bills with the short-term extension of government funding set to expire Nov. 17, when lawmakers had hoped to have completed all 12 of the annual spending bills and will face another potential government shutdown.

The short-term continuing resolution provided a temporary reprieve not only for nursing workforce and education programs under Title VIII of the Public Health Service Act, but also extended funding for community health centers, teaching health centers, and the National Health Service Corps and also delayed scheduled cuts in Medicaid disproportionate share payments to safety-net hospitals. However, the extension didn’t include pandemic surveillance and response programs under the Pandemic and All-Hazards Preparedness Act, HIV/AIDS assistance under the President’s Emergency Plan for AIDS Relief (PEPFAR), or substance use disorder programs under the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.

Fiscal 2024 Funding for Nursing Education, Research Remains Stalled

Although the short-term continuing resolution temporarily extended funding for nursing education and research programs at their current fiscal year 2023 levels, Congress has made little progress in reaching agreement on appropriating fiscal year 2024 funding for the programs. House and Senate appropriators are still roughly $100 billion apart on overall 2024 funding levels and differ by more than $77 billion on their Labor-HHS-Education appropriations bills that includes funding for nursing education, workforce, and research programs.

The Senate has yet to vote on the bill (S. 2624) approved by the Appropriations Committee in July 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 vote at the full committee level on the measure by their Labor-HHS-Education Subcommittee on a party-line vote. It is unclear what funding level the House bill includes for Title VIII programs, but the subcommittee cut funding for the workforce programs supporting all health professions by about $54 million, including eliminating the Nursing Workforce Diversity program.


on-demand. Guest speakers from CMS and Georgetown University McCourt School of Public Policy’s Center for Children and Families addressed the impacts that the public health emergency expiration has on children and families, especially those relying on Medicaid/CHIP/VFC programs. Learn what NPs need to know!

If you’re not already a member of our Child Health Policy Learning Collaborative, email [email protected] to be added to our invitation list. We meet the first Wednesday of the month, September – May, at 8 p.m. ET. Each month, members of our national health policy committee moderate conversations with policy experts on topics relevant to your practice and patients.


Nearly 2 Million Children Are Losing Medicaid Coverage

In the six months since states began re-determining the eligibility of people enrolled in their Medicaid programs for the first time in three years, more than 8.5 million Americans have lost their Medicaid benefits, according to current data – including more than 1.7 million American children. Roughly 1 in 10 people covered by Medicaid have lost their health insurance in a matter of months, and after the U.S. hit historic lows in its uninsured rate during the pandemic, millions of Americans are now falling off the rolls – and many of those are losing coverage because of administrative procedures and would otherwise be eligible, a problem that is disproportionately impacting children.

The Biden administration announced last month that it had detected a problem with how states were conducting their eligibility checks. A majority of states were automatically disqualifying everybody in a family if they found that one person (most likely a parent) was no longer eligible for Medicaid. While it might simplify the process for states, that approach risks kicking eligible children off the program. Most states have more generous eligibility rules for children than they do for parents, so while a parent may no longer qualify for Medicaid, their child still might. The administration has demanded states take steps to make sure they are evaluating the eligibility of each individual, to ensure children are not being unnecessarily removed from Medicaid.

NAPNAP Urges Administration to Strengthen Children’s Mental Health Protections

In comments on proposed regulations to improve enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA), NAPNAP urged the Biden administration to address the national crisis in children and adolescent mental health and suicides, calling for health plans to respect independent professional medical and clinical standards of care and improve payment for care provided to children whose behavioral health symptoms don’t meet the clinical criteria of a diagnosed disorder. “We urge you to align parity enforcement requirements for commercial payers with those for Medicaid and CHIP to the extent possible,” NAPNAP President Regena Spratling, PhD, RN, APRN, CPNP-PC, FAANP, FAAN said.

NAPNAP also responded to the administration’s request in the proposed rule for information on “ways to improve mental health and substance use disorder benefits through other consumer protection laws,” urging officials to swiftly issue proposed regulations to implement protections that prohibit health plans from discriminating against pediatric APRNs and other health professionals in structuring their provider networks. The association asserted that patients should have access to providers for all types of care they require, including mental health and substance use disorder treatments.

In Other News…

Telehealth Prescribing Rules Extended Through 2024
The Drug Enforcement Administration announced earlier this month that it is extending flexible pandemic rules for prescribing controlled substances via telehealth service through the end of 2024. The new regulations would allow all patients – not just those with preexisting providers – to be prescribed controlled substances without an in-person visit. The agency said it plans to issue new “standards or safeguards” by fall 2024. “The purpose of this Second Temporary Rule, like the one before it, is to ensure a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions, as well as allowing adequate time for providers to come into compliance with any new standards or safeguards,” the agency said in the new regulations.

The agency said the extension will allow it, along with HHS, to craft regulations that will “most effectively expand access to telemedicine encounters,” while also preventing misuse. It said it is limiting the extension to the end of 2024 to discourage new telemedicine firms from engaging in “problematic” prescribing. The agency proposed curtailing the pandemic-era flexibilities in May but received more than 38,000 comments, including those submitted by NAPNAP, mostly urging an extension. The initial extension was set to expire Nov. 11 for new patients and a year later for established patients.

Workforce Legislation Faces Uncertain Fate
Acknowledging the impact of national shortages of nurses and health professionals, Congress has proposed legislation to strengthen federal support for education and training – but neither chamber has been able to pass its measures yet. The Senate Health, Education, Labor and Pensions Committee approved a bipartisan $26 billion package of initiatives last month aimed at strengthening access to primary care but concerns about its cost and how to pay for it have slowed its progress. The House was poised to vote on its own health cost transparency and workforce bill last month, but disagreements delayed action.

The Senate’s “Bipartisan Primary Care and Health Workforce Act” (S. 2840) authorizes billions in funding for community health centers and to bolster the physician, nursing and dentist workforces. It also includes $1.2 billion in grants to community colleges and state universities to increase the number of students enrolled in accredited, two-year registered nursing programs, $28.5 million for the Nurse Faculty Loan Program, a $15 million faculty salary demonstration program, and increased funding for NURSE Corps scholarship. However, it doesn’t include additional funding for baccalaureate and doctoral nursing programs that were part of an earlier draft of the bill. The House’s more austere “Lower Costs, More Transparency Act” (H.R. 5378) would reauthorize funding for community health centers and the National Health Service Corp, as well as requiring providers to disclose more information about health care costs and impose new requirements on pharmacy benefit managers. But the House’s funding levels are less generous that the Senate’s proposal.

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