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You may recall a previous article about medical homes

in this space. Well, it has been a busy few months,

and we want to update you on ACNP’s efforts to

ensure that nurse practitioners (NPs) can fully partici-

pate in any medical home demonstration project

(MHDP) the federal government undertakes. The

Medicare Improvement for Patients and Providers Act

of 2008 (Public Law [P.L.] 110-275), more commonly

referred to as “the Medicare bill,” became law on July

15, 2008, when Congress overrode the president’s

veto. The bill was debated for months and went

through many changes and more than a few votes

before becoming law. This bill contains an expansion of

the Medicare MHDP created by the earlier Medicare

Improvement and Extension Act of 2006 (P.L. 109-432).

The purpose of both the original and expansion

MHDP is to test the idea of providing Medicare bene-

ficiaries with a medical home and to give physicians a

bonus payment for such services. The original lan-

guage did not include any providers other than physi-

cians as medical home providers. Earlier this year,

when Congress started its attempts to expand the

project, ACNP learned that Congress was still using

physician-only language. ACNP, along with other key

NP advocates and organizations, immediately starting

educating lawmakers about including NPs as

providers in the demonstrations and worked with

other NP associations to have NPs added to the legis-

lation as an eligible provider for medical homes.

Generally, Hill offices are very supportive, but the pol-

itics of the bill and pushback from the physician organ-

izations were too much to overcome. There is, how-

ever, still a possibility of NP inclusion in the MHDP

because of the way the final language is written and

because some of our Senate friends have taken up

the challenge.

The Medicare Improvement for Patients and

Providers Act provides the secretary of Health and

Human Services with authority to expand the duration

and the scope of the MHDP, to the extent that any of

the following conditions are met:

• The expansion of the project is expected to

improve the quality of patient care without

increasing spending under the Medicare pro-

gram and/or

• The expansion of the project is expected to

reduce spending under the Medicare program.

We believe that NPs clearly can improve the quality

of patient care without increasing spending under the

Medicare programs, and NP participation may even

reduce spending. The fact that the secretary has dis-

cretion over how to expand the demonstration means

we have an opportunity to influence this decision.

To help influence the secretary’s decision on this

point, Sens Bingaman (D-NM), Harkin (D-IA), Collins

(R-ME), and Murkowski (R-AK) inserted a colloquy into

the official congressional record stating their support

for and urging the secretary to include NPs in the

demonstration. Sen Harkin has also agreed to circu-

late a letter for signature by colleagues urging the sec-

retary to include NPs. We will be calling on you to help

us make sure your senators are engaged in this next

important step! Stay tuned!

Check ACNP’s website, www.acnpweb.org, to

download both the full colloquy by the 4 senators and

the Dear Colleague letter from Harkin.

HHS Secretary Has Discretion toAdd NPs to Medical Home Demos

Jodie Curtis, Government Relations Director, Drinker Biddle & Reath LLP

The Senate passed S.901, the Health Centers reautho-

rization package, on July 22, 2008. The bill reconfirms the

core principles of the current federal Health Centers pro-

gram, while putting the funding for the program on track

to reach the goals of the ACCESS for All America plan.

The plan aims to reach 30 million patients by 2015. The

Senate-passed bill now heads to a conference commit-

tee with the House-passed version (H.R. 1343) to iron

out the remaining differences.

Sen Orin Hatch (R-UT), a co-sponsor of the leg-

islation with Sen Ted Kennedy (D-MA), said that

since 2001, additional funding provided under the

bill has allowed health centers in more than 750

communities nationwide to provide care to about

4 million new patients. Hatch said, “These centers

provide affordable and quality care to at-risk

Americans who otherwise might have to do

without.”

The National Association of Community Health

Centers (NACHC) says the Senate passage of S.901 is a

true testament to the success of the program and the

power of grassroots advocacy.

Senate Passes Legislation to Reauthorize Funding for Community Health Centers

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Congresswoman Allyson Schwartz (D-PA)

introduced the Home Health Care Planning

Improvement Act of 2008 (HR 6826) on

August 1, 2008, with 39 bipartisan cospon-

sors. This is the long-awaited companion bill

to Sen Susan Collins’ (R-ME) bill, S.1678,

introduced on June 21, 2007. Both bills

would allow NPs, CNSs, CNMs, and PAs to

be able to order home care services and

supplies for Medicare patients without

delay. The current Medicare law states that

only physicians may order home health care.

In a statement forwarded to Rep

Schwartz’ office to accompany her press

release, ACNP President Julie Stanik-Hutt

said, “We commend Rep Schwartz for intro-

ducing this important legislation. This bill

will enhance patient access to critical, cost

saving home health services and will

improve patient safety by assuring that the

provider of record, whether a nurse practi-

tioner or a physician, is clearly identified as

the prescriber of home care services. In this

way, both patients and home health care

providers will know who to contact should

they have questions or information to share

regarding the patient.”

Prior to introducing the bill, Schwartz’

office received several poignant vignettes

from NPs in Pennsylvania and others col-

lected by ACNP giving examples of home

care service delays due to difficulties in

finding a physician to sign an order. Please

stay tuned! This is yet another issue on

which national NP organizations are collabo-

rating. Watch for Action Alerts from ACNP

and others, as advocacy is needed from

grassroots NPs!

For full language of this bill, see http://

thomas.loc.gov.

Finally! House Version of Home Health Care

Planning Improvement Act Introduced

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At 10-year intervals, the Office of Management

Bureau of Labor Statistics (BLS) collects data on the

current labor environment based on the Standard

Occupational Classification (SOC) Principles. The

SOC, a national system for categorizing and analyzing

occupations in the public, private, and military sec-

tors, will be updated for 2010. Thus far, the only nurs-

ing information collected has been for RNs. In July

2006, nine advanced practice nursing associations

sent a joint letter to the BLS requesting that nurse

practitioners (NPs), nurse anesthetists (NAs), nurse

midwives (NMs), and clinical nurse specialists (CNSs)

be included in future collection of SOC data. The May

16, 2008, Federal Register notice included an

announcement by the Office of Management and

Budget with updates to the Standard Occupational

Classification – Revision for 2010. The proposed revi-

sion includes newly created categories for NPs, NAs,

and NMs, as requested by the advanced practice

associations; CNSs are not included.

Nurse Practitioners Includedin 2010 SOC Recommendations

Incentives for E-Prescribing in Final Mediicare Legislation

Simmy Randhawa, MS, MBA, RN, CPN, and Angela

Martin, APRN, MSN, both DNP students from George

Washington University, attended ACNP’s Advanced

Public Policy Institute for Health Professionals (PPI) in

March 2008. Here are their key observations and actions.

Simmy said one of the most valuable lessons learned

at the PPI was to focus on tangible things she could actu-

ally accomplish. Using Robert Wood Johnson

Foundation materials for the “Cover the Uninsured

Week,” Simmy set up a booth to assist staff at the

Children’s National Medical Center who were uninsured

and offered educational materials about health insurance

options and availability in both English and Spanish. She

said, “I have been truly enlightened since attending the

PPI. I know I will continue to take a proactive role in learn-

ing more about what I can do as an individual to help

influence and advocate for others.”

Angela, an APRN in private practice and a small busi-

ness owner, focused on learning what was needed to

pass a bill that would make health insurance more afford-

able and accessible for small businesses and the self-

employed. She said, “The major difference in this course

and earlier experiences was the depth and breadth of the

knowledge obtained. I really enjoyed the PPI provided by

ACNP. It was comprehensive and global in its perspec-

tive and highly motivating for taking action.”

Mark your calendar for the next Public Policy Institute

February 18 – 20, 2009!

1555-4144/08/$ see front matter © 2008 American College of Nurse Practitionersdoi: 10.1016/j.nurpra.2008.08.011

DNP Students Learn Advocacy Skills at ACNP’s Public Policy Institute

DNP Students Learn Advocacy Skills at ACNP’s Public Policy Institute

The Medicare Improvements for Patients and

Providers Act of 2008 (P.L. 110-275), passed in July

2008, includes incentives to encourage prescribers to

adopt electronic prescribing technology. This new leg-

islation will provide positive Medicare payment incen-

tives of up to 2% for practitioners who use qualified e-

prescribing systems in 2009 through 2013 and a reduc-

tion in payments of up to 2% to providers who fail to

e-prescribe by 2012.

Is your practice ready to begin e-prescribing on

January 1, 2009? The Center for Improving Medication

Management has provided a useful assessment at

www.GetRxConnected.com that will assist you in your

practice. After completing the brief E-Prescribing

Readiness Assessment, you will receive a report that

lets you know whether your practice’s electronic med-

ical record (EMR)/e-prescribing technology is certified

for a direct electronic connection with pharmacies and

the steps you should take to establish your connection.

Your practice may be using an EMR system but may

not have set up an electronic connection to pharma-

cies yet. Taking the readiness assessment would be

useful in seeing what is needed for establishing an e-

prescribing process in the practice.

713-716_TJNP722_ACNP_CP 10/2/08 11:17 AM Page 715

Nashville Convention Center Nashville, Tennessee October 29 – November 2, 2008

Take Advantage of:■ Dynamic keynotes

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