New legislation supported by nurse practitioner (NP) and PA organizations addresses the shortages of health care workers in primary care, as described in this month’s Legislative Update. Also included are updates on state laws enacting permanent independent practice authority for advanced practice registered nurses (APRNs) in response to the COVID-19 pandemic and the Dr Lorna Breen Health Care Provider Protection Act, which was just passed by Congress.

Medicare Initiative Increases Nurse Practitioners in Primary Care Shortages

Medicare support for clinical training for NPs would increase their numbers which would in turn address the national shortage of primary care providers, according to a study published in Health Affairs.

The study showed that universities that participated in the $200 million Graduate Nurse Education (GNE) Demonstration had a significant increase in NP enrollment and graduates. The GNE Demonstration was launched under the Affordable Care Act and provided select hospitals with Medicare funding to help offset costs associated with the NP clinical training.


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The funded hospitals were the Hospital of the University of Pennsylvania in Philadelphia, PA; Duke University Hospital in Durham, NC; Rush University Hospital in Chicago, IL; Scottsdale Healthcare Medical Center in Scottsdale, AZ: and Memorial Hermann-Texas Medical Center in Houston. The hospitals created partnerships with university NP educational programs.

Modernizing Medicare payments for nursing education to support NP clinical training costs is a promising option for increasing primary care providers, the study authors concluded.

COVID-19 Drives Increase in Practice Authority for APRNs

Significant progress toward increased independent practice authority for advanced practice registered nurses (APRNs) has been made as temporary emergency changes in responses to COVID-19 pandemic have become permanent, as described in a legislative update in The Nurse Practitioner.

Delaware and Massachusetts passed amendments resulting in full practice authority; in Massachusetts, APRNs must complete a 2-year supervised transition to practice (TTP) before independent prescriptive authority is granted. With its new law, Delaware joins North Dakota as the second state to enact the APRN Compact, which allows APRNs to hold 1 multistate license with a privilege to practice in other compact states, as described in the article.

In Arkansas, a new pathway for full independent practice authority was enacted for NPs who complete a TTP period of 6240 hours of practice under a collaborative practice agreement with a physician. Several other states – including Florida, Illinois, Louisiana, North Carolina, and Oklahoma – have enacted new laws or updated regulations improving practice authority for APRNs.

Laws authorizing APRNs and other providers to provide and be reimbursed for home health care and telehealth were adopted by several states. Arkansas, Louisiana, Maine, and Washington implemented other changes that aim to improve reimbursement for APRN services.

PAs Omitted from Critical Provisions in STRONG Act

The Veteran Affairs PA Association (VAPAA) and AAPA Federal Advocacy staff are strongly advocating for Congress to include PAs in the Support the Resiliency of Our Nation’s Great (STRONG) Veterans Act of 2022 (HR 6411).

This legislation, which was introduced in January 2022, is intended to give the Department of Veterans Affairs (VA) new authorities and resources to support veterans’ mental health and well-being through increased training, outreach, mental health care delivery, and research. Currently, PAs are omitted from the verbiage on which VA mental health professionals are eligible for newly funded training opportunities and scholarships.

The American Academy of PAs (AAPA) encouraged PAs to take action and ask Congress to include PAs in the STRONG Veterans Act language.

Act to Support Health Care Workers Suffering From Burnout

Congress passed the Dr Lorna Breen Health Care Provider Protection Act, which if enacted will provide support for health care workers and prevent burnout, suicide, establish grants, and mental and behavioral health issues. The bill is sponsored by Representative Susan Wild and is currently waiting to be signed into law by President Biden.

Under the act, the Department of Health and Human Services (HHS) will award grants to hospitals, medical professional associations, and other health care programs to provide mental health and resiliency among health care providers. In addition, the HHS will conduct a campaign to encourage health care providers to seek support and treatment for mental and behavioral health concerns, and disseminate best practices to prevent suicide and improve mental health and resiliency among these providers.

The American Association of Nurse Practitioners (AANP) applauds Congress for passing this bill. “The importance of passing this bill can’t be overstated. By providing much-needed mental health services and support to NPs, registered nurses, physicians and other health care providers, we are offering a lifeline to those who often put their patients before themselves. Taking care of health care providers’ mental health positively impacts their ability to serve others and will help prevent suicide among so many who are feeling extreme burnout, said April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of AANP.”

The bill itself is named for Lorna Breen, MD, who supervised the emergency department at New York-Presbyterian Allen Hospital and died by suicide during the COVID-19 pandemic in April 2020.

References

1. University of Pennsylvania School of Nursing. Successful Medicare initiative increases the supply of nurse practitioners to address primary care shortages. Accessed February 16, 2022. https://www.nursing.upenn.edu/details/news.php?id=2080

2. Phillips SJ. 34th Annual APRN legislative update: trends in APRN practice authority during the COVID-19 global pandemic. Nurse Pract. 2022;47(1):21-47. doi:10.1097/01.NPR.0000802996

3. Heuer T. ACT NOW! Tell Congress to Include PAs in Veterans Mental Health Legislation! Updated February 11, 2022. Accessed February 23, 2022. https://www.aapa.org/news-central/2022/02/act-now-tell-congress-to-include-pas-in-veterans-mental-health-legislation/

4. American Association of Nurse Practitioners. AANP applauds Congress for passing bill that provides support for health care workers suffering from burnout. February 18, 2022. Accessed February 24, 2022. https://www.aanp.org/news-feed/aanp-applauds-congress-for-passing-bill-that-provides-support-for-health-care-workers-suffering-from-burnout