Inside the Beltway – October 2024 - NAPNAP

Inside the Beltway – October 2024

Inside the Beltway – October 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.

Educate Yourself to Vote on Nov. 5

Contributed by Health Policy Committee member Allison Grady, MSN, PPCNP-BC

Now is the time when Americans cast their votes. While the presidential contest garners the most attention, it is not necessarily the most consequential race. With less than 10 seats separating the majority from the minority in the U.S. House of Representatives, one chamber of the federal body that controls the purse strings, passage of laws and the confirmation of the presidential cabinet, House elections could be some of the most significant races. However, state and local elections could have the most direct impact on individuals. This article will highlight some of the state and federal issues that could impact communities and children’s health. Because this article cannot cover every state and local issue, we encourage you to educate yourself on your local candidates’ positions and local referenda. Websites such as vote.org can help in supplying this information1.

As advanced practice nursing professionals who care for the health of children, we urge NAPNAP members to consider several legislative issues. Title VIII supports nurse faculty loans, nursing education, the nurse corps and workforce diversity. This initiative provides financial support that will bring qualified people to the profession and ensure that the work force is representative of the families we care for. With projected health care provider shortages being forecasted in many specialties including pediatrics, it is essential that we have advocates in Congress who will support Title VIII and other advanced practice nursing issues.

The future of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and school lunch programs, which are under the USDA budget, will be determined by the priority Congress assigns to nutrition and child well-being. Regulations and laws associated with climate change will originate in Washington, D.C, but the support of states to mitigate the effects of pollution and global warming will have the largest influence on the health of our children today and into the next generation. Consider which candidates best represent your professional interest in these issues.

The role of science and public health is also on the ballot. Although beyond the crisis days of the COVID-19 pandemic, debate remains about the role of public health, individual autonomy and preparations for the next disease outbreak. These subjects play out on the national stage through funding of organizations such as the CDC, but the impact is felt locally with vaccine mandates (or exceptions) prior to school entry, management and guidance of local disease outbreaks, and research funds for the vaccines developed at publicly-funded universities.

On the state side, APRN practice authority remains a key issue. Currently, 15 states have reduced/collaborative practice and 11 have restricted/supervised practices2. Eliminating unnecessary legislative and regulatory barriers would allow nurse practitioners to practice to the full extent of their education and certification, increase access to much needed evidence-based, equitable health care services, and help close the primary care provider shortage. Because practice issues are state-based, consider which state candidates support our profession.

As election day nears, we encourage you to learn more about federal and state issues that most affect the health of the children in your life. Websites such as Kaiser Family Foundation (KFF) have a comparison of the presidential candidates on health topics3. The Vot-ER website4 also describes issues for health care professionals and allies. Whatever website or publication you use to educate yourself, we encourage you to vote like kids’ lives depend on it (#NPsforkids) and to reach out to candidates to share your experience, health care knowledge, expertise and priorities.

References:

  1. Vote.org. (2024). See what’s on your ballot. https://www.vote.org/ballot-information/.
  2. Feeney, A. (23 May 2024). Nurse practitioner practice authority: A state-by-state guide. Nurse Journal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/.
  3. (2 October 2024). Compare the candidates on health policy. https://www.kff.org/compare-2024-candidates-health-care-policy/
  4. Vot-er. (2024). About vot-er. https://vot-er.org/about/


Key NAPNAP Advocacy Activities

  • NAPNAP President Dr. Daniel Crawford participated in a Sept. 9 White House meeting of national nursing organizations with the White House Council on Environmental Quality, the Environmental Protection Agency, and the Department of Health and Human Services to discuss the critical importance of addressing extreme heat and plan for future actions to help communities become more resilient to climate changes.
  • NAPNAP President Dr. Daniel Crawford also took part in a White House Healthcare Safety Forum on World Patient Safety Day Sept. 17 with key health organization leaders, patient and workforce advocates, healthcare system executives, the White House Office of Science and Technology Policy and Biden-Harris Administration officials to announce new actions to improve patient and health care workforce safety.
  • Submitted a letter to the House Energy and Commerce Committee Aug. 16 commenting on its “Reforming the National Institutes of Health: Framework for Discussion” and focusing on the proposed mergers of the National Institute of Nursing Research and the National Institute of Child Health and Human Development into larger centers and elimination of dedicated appropriations for their specific research.
  • Submitted comments to the Centers for Medicare and Medicaid Services Sept. 8 and 9 on proposed regulations including codification of 12-month continuous eligibility for children in Medicaid and the Children’s Health Insurance Program and hospital health and safety standards for obstetrical care in the “Hospital Outpatient Prospective Payment” proposed rule and on payment for telehealth services and valuation of relative value codes in the proposed rule on “CY 2025 Payment Policies Under the Physician Fee Schedule.”
  • Coordinated with staff for Reps. Kathy Castor (D-FL) and Yadira Caraveo (D-CO) Aug. 30 on NAPNAP’s endorsement of the “Keep Kids Covered Act” (H.R. 9688) expanding the 12-month continuous eligibility protections for children in Medicaid and the Children’s Health Insurance Program, providing multi-year continuous Medicaid and CHIP eligibility for children up to age 6 and a 24-month continuous coverage period for eligible children and teens ages 6 to 18.


Congress Faces Daunting Post-Election Agenda

Anxious to return to the campaign trail, Congress passed a 12-week extension of funding for federal agencies at the end of September after House Republicans failed in a bid to put off final spending decisions until March of 2025. The “Continuing Appropriations and Extensions Act, 2025’’ (H.R. 9747) extends current funding for nursing workforce and education programs and most federal agencies to Dec. 20, leaving it to the next president-elect to tell lawmakers to either wrap up spending negotiations quickly or hand the unfinished budget to the new administration. Those post-election talks will be complicated by pressure to pass supplemental disaster assistance after two crippling hurricanes.

Congressional leaders will also have to deal with a shortfall in funding for veterans’ health programs despite approving a nearly $2.9 billion emergency funding bill last month. The “Veterans Benefits Continuity and Accountability Supplemental Appropriations Act, 2024” (H.R. 9468) prevented payment delays for veterans’ October benefits, but the VA still anticipates a funding gap of about $12 billion over the next year as it provides extra benefits under a 2022 law that expanded aid for vets exposed to toxic substances.


Year-End Health Legislation in Flux

Lawmakers left behind a lengthy list of unfinished business when they adjourned for the November election including a host of high-priority health care policies and programs ranging from funding for community health centers and the National Health Service Corps to expiring telehealth flexibilities and pandemic preparedness programs. Providers hope to stop scheduled cuts to Medicare Part B fee-for-service payments and Medicaid payments to safety net hospitals. Children’s health groups are hoping for the inclusion of measures to improve access to care for children including mental health services, while nursing groups seek to include provisions to address workforce shortages, support nursing education and faculty, and eliminate federal barriers to nursing practice as provided in the “Improving Care and Access to Nurses (ICAN) Act” (H.R. 2713/S. 2418).

How much can be included in a year-end package will be limited by the short time lawmakers will have to reach agreement not only on specific policies but how to pay for them. Pharmacy benefit manager reforms could be used to help pay for the package, but spending on other programs could also be targeted for cuts. Many issues will wind up being left behind for the next Congress and administration to deal with.


CMS Releases Guidance on Children’s Early Screening, Treatment

The Centers for Medicare and Medicaid Services on Sept. 26 released the most comprehensive guidance in the last 10 years on Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements, the program’s pediatric benefit that requires states to cover comprehensive services for more than 38 million eligible children. With most children in Medicaid covered by managed care organizations, the State Health Officials (SHO) letter underscores that EPSDT requirements apply regardless of the delivery system and reinforces the fact that the state is ultimately accountable to the child. The guidance responds to a mandate from Congress in the 2022 Bipartisan Safer Communities Act and outlines how states can meet the federal EPSDT requirements, although it doesn’t establish a timeline to ensure states are meeting the requirements. Along with additional technical assistance and guidance, the letter is intended to provide state officials, children’s health providers, and families with the information they need to maximize EPSDT benefits.

The guidance offers “best practices” examples from states and includes a variety of policies related to the screening and treatment benefits focused on helping states make improvements in three areas: promoting awareness of the benefit among families, expanding the child-focused health care workforce, and improving care for EPSDT-eligible children with specialized needs including better collaboration with child welfare agencies to care for foster youth or expanding managed care plan enrollment to children with disabilities. To address workforce challenges, the letter encourages states to authorize a broader range of providers to offer care through telehealth, improve interprofessional consultations and incorporate oral health into children’s primary care visits.


Facing Pushback, Regulators May Extend Teleprescribing Rules

Concerns from members of Congress, health care providers, and patient advocates may have convinced the Drug Enforcement Administration to reverse course and once again extend temporary rules allowing the prescribing of controlled substances via telemedicine. A final rule titled “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” reached the White House for review Oct. 10, although it is unclear how long and extension would be for.

Senators and representatives are circulating letters urging the White House and the DEA to extend current policies, which will expire at the end of the year, while providers are collecting data on patients who would be affected if restrictions on prescribing are imposed. An earlier DEA proposal, which has been under the review of the Office of Management and Budget and had not been released, would reportedly prohibit virtual prescribing of Schedule II drugs, including Adderall for ADHD and methadone for opioid use disorder, without an in-person visit first unless the prescriber is a specialist and would allow no more than half of a provider’s prescriptions to be issued virtually. Reports indicate that it would require providers prescribing any controlled substances to check prescription drug monitoring programs intended to prevent diversion in all 50 states even though a system linking the programs doesn’t connect to every state – which could make telemedicine prescribing virtually impossible. The DEA and the Department of Health and Human Services have been at odds over that draft rule.

If an extension is finalized, this would be the second time the DEA has floated tightened rules and then retreated amid a backlash from providers. In February 2023, the agency proposed rolling back eased rules ahead of their expiration along with the public health emergency but reversed course and extended the rules after receiving an agency record 38,000 comments, many of them negative, and significant industry pressure.


Executive Order Seeks to Boost Gun Violence Prevention

On the anniversary of the establishment of the White House Office of Gun Violence Prevention, President Joe Biden issued an executive order Sept. 26 directing federal agencies to improve school-based active shooter drills and combat the emerging threats of conversion devices and firearm kits, as well as other actions to reduce gun violence. The order establishes an Emerging Firearms Threats Task Force to assess threats posed by machinegun conversion devices and unserialized, 3D-printed firearms and directs federal agencies to publish information for K-12 schools and institutions of higher education regarding organizing and improving school-based active shooter drills.

The order also authorizes states to use Medicaid funds to reimbursement health care providers for providing firearms safety guidance like counseling parents on safe gun storage, complimenting a recent announcement that state Medicaid programs can also pay for violence intervention programs. The administration also announced that the Department of Justice will award an additional $85 million for violence prevention initiatives, including cognitive behavioral therapy and hospital-based interventions. The Centers for Disease Control and Prevention is also working to improve its data visualization tool to provide more local information on gun deaths and injuries and the Substance Abuse and Mental Health Services Administration is preparing actions to support trauma recovery following gun violence.


In Other News…

EPA Requires Removal of Lead Pipes by 2034
The Environmental Protection Agency finalized a rule Oct. 8 requiring water utilities to replace all lead pipes within a decade, a move aimed at eliminating a toxic threat that continues to affect tens of thousands of American children each year. The regulations, which also limit the amount of lead allowed in the nation’s drinking water, come nearly 40 years after Congress determined that lead pipes posed a serious risk to public health and banned them in new construction. Replacing the lead pipes will cost tens of billions of dollars, and state environmental secretaries said their programs must have enough funding to pay for additional regulators and enforcement, calling current funding “a drop in the bucket” compared with what will be needed.

The groundbreaking regulation, called the Lead and Copper Rule Improvements, will establish a national inventory of lead service lines and require that utilities take more aggressive action to remove lead pipes on homeowners’ private property. It also lowers the level of lead contamination that will trigger government enforcement from 15 parts per billion (ppb) to 10 ppb. The rule also establishes the first-ever national requirement to test for lead in schools that rely on water from public utilities. It mandates that water systems screen all elementary and child care facilities, where young children who are the most vulnerable to lead’s effects are enrolled, and that they offer testing to middle and high schools.

Separately on Oct. 4, the Supreme Court refused to block new Biden administration rules requiring fossil-fuel-fired power plants to slash emissions of mercury and other toxic substances and oil and gas firms to curb methane, a potent greenhouse gas, from their operations. The issues were two of three playing out on the court’s emergency docket over administration plans to clean up fossil fuels – justices have yet to rule on an emergency request to block a plan to curb greenhouse gas emissions from coal and gas-fired power plants.

Supreme Court Opens New Term, Declines Emergency Abortion Case
The Supreme Court opened a new term Oct. 7 that will include cases dealing with gender-affirming care, firearms, e-cigarettes, and online protections for children. In an initial decision, justices chose not to hear a Texas case on whether a state abortion ban conflicts with a federal emergency care law. The Biden administration warned hospitals in anti-abortion states that they must provide needed emergency treatment to all patients, including those that may require an abortion, following the court’s narrow ruling on an Idaho law and the federal Emergency Medical Treatment and Active Labor Act (EMTALA). Texas sued the administration, arguing that the law was improperly applied.

The first oral arguments of the term involved a challenge to the Biden administration’s regulations of “ghost guns,” the untraceable firearms made from homemade kits. A majority of the justices appeared sympathetic to the Biden administration’s restrictions on the kits, requiring that gun makers and sellers must be licensed to sell the kits, the products must be marked with serial numbers so they can be traced and buyers must pass a background check.

In two upcoming cases, the court will decide to what lengths the government may infringe on constitutional rights to protect children. In U.S. v. Skrmetti, the justices accepted the Biden administration’s challenge to a Tennessee state law that restricts access to gender-affirming care for minors in the state, a statute similar to those in more than two dozen states banning or restricting gender transition care for minors. The court will also hear a challenge to a Texas law requiring adult websites to verify a user’s age before allowing them to access content “harmful to minors” that plaintiffs contend infringes on adults’ rights to access protected speech.

The court will also weigh whether the Food and Drug Administration wrongly blocked marketing applications for sweet-flavored vaping products amid rising youth e-cigarette use in FDA v. Triton Distribution. Justices have yet to decide if they will grant a Justice Department request to reverse a lower court ruling in Braidwood v. HHS challenging the Affordable Care Act mandate that insurers cover preventive services recommended by the U.S. Preventive Services Task Force, a case that could potentially affect coverage of vaccines.

Administration Releases Final Mental Health Parity Rule
Shortly after Labor Day, the Biden Administration finalized a long-awaited sweeping expansion of regulations that require insurers to cover mental health and addiction care on the same terms as other care, largely in line with what the White House proposed a year ago. The rules reinforce requirements that insurers are barred from using tools like prior authorization and out-of-network payment rates for mental health services that are more restrictive than for other types of care. The regulations also mandate that insurers address material differences in access to care for mental health and substance use disorder care.

Administration officials and mental health advocates have said that insurers have flouted the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) requiring mental health parity, and the administration is now expanding the rules with potential fines for violators. The White House pointed to a 2022 report to Congress that found that not one of the 156 insurance plans and issuers studied followed requirements to measure their compliance with the 2008 law.

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