AANP Urges FDA To Reconsider Hydrocodone Reclassification
Arguing that federal and state authorities already have tools to prevent abuse of prescription pain medication, AANP urged FDA Commissioner Margaret Hamburg, MD, to consider the harmful consequences of an advisory committee’s recommendation to reclassify medications containing hydrocodone from Schedule III to Schedule II controlled substances.
In comments submitted last Friday (February 1), AANP President Angela Golden, DNP, FNP-C, FAANP, pointed out that several states limit or prohibit nurse practitioners from prescribing Schedule II drugs. “We are deeply concerned that the advisory committee’s recommendation will have the unintended consequence of denying appropriate and effective treatment to patients with a legitimate clinical need during a critical time in the healing process,” she said. “If all forms of hydrocodone medication were reclassified to Schedule II, nurse practitioners in the affected states would no longer be able to make these treatments available to their patients.” The FDA is expected to review the advisory committee’s recommendation later this year.
Congress Suspends Debt Limit, Renews Debate on Cutting Spending
The Senate approved legislation last Thursday (January 31) to suspend the limit on the national debt until mid-May as Congress resumes efforts to prevent across-the-board cuts in federal spending due to take effect at the end of the month. Congress delayed the “sequestration” of discretionary spending until the end of February as part of the year-end “fiscal cliff” agreement. With less than a month until the cuts take effect, lawmakers sound increasingly pessimistic about reaching an agreement on alternative spending cuts in time to replace sequestration. Advocates are concerned that Congress could make even deeper cuts in federal health programs than required by sequestration in order to protect spending on other priorities.
Congress and the Obama administration also face a second deadline at the end of March with the expiration of a continuation of funding for federal programs in the absence of a fiscal year 2013 budget. Lack of action on the 2013 budget contributed to the White House missing the February 4 deadline to submit a proposed budget for fiscal year 2014 to Congress. The debt limit suspension approved last week includes provisions that threaten to withhold salaries of members of Congress if they fail to pass a 2014 budget by April 15.
Workforce Issues Raise Concerns on Capitol Hill
With the health reform law’s deadline to expand insurance coverage rapidly approaching, Congress is exploring strategies to increase and expand the workforce of primary care providers. At a Senate Health Education Labor and Pensions subcommittee hearing on primary care workforce last Tuesday (January 29), Senator Bernie Sanders (I-VT) released a report that called for expanding community health centers, increasing opportunities for primary care education and residencies in community settings rather than teaching hospitals, increasing scholarship and loan repayment opportunities and expanding the role of nurse practitioners and physician assistants to boost the primary care workforce. Sanders argued that Medicare medical residency funding should be changed to promote training of primary care physicians, but medical school representatives responded that attempts to influence specialty choice through GME payments have failed.
AANP and other nursing organizations continue to work with members of the House and Senate on policies and legislation to increase and improve federal support for workforce development, including the graduate nurse education demonstration created in the Affordable Care Act, and to eliminate barriers in federal statutes and regulations that prevent nurse practitioners from filling gaps in primary care for women, children, and families, particularly in rural or underserved areas.
CMS Proposes Rule Intended to Ease Regulatory Burdens
The Centers for Medicare and Medicaid Services (CMS) released new proposed regulations on Monday (February 4) aimed at reducing the burden of Medicare and Medicaid regulations on providers and suppliers. The agency also issued a request for information on the use of clinical quality measures in Medicare provider reporting programs. AANP is closely examining both proposals, which each have 60-day periods for public comment and are scheduled for publication in Thursday’s (February 7) Federal Register.
Among the requirements the agency is proposing to eliminate, modify, or streamline are several that AANP has advocated for, including clarifying that a hospital’s medical staff may include nurse practitioners and other non-physician providers, consistent with State laws, and allowing providers not on a hospital’s medical staff to order outpatient services when authorized by the medical staff and permitted by state law. CMS also proposes to eliminate the current requirement that physicians must be onsite at least once every two weeks in critical access hospitals, rural health centers, and federally qualified health centers. CMS also proposes to change the definition of “physician” in the conditions of participation for federally qualified health centers to conform to the definition in Medicare payment regulations.
CMS Issues Guidance on Medicaid Preventive Care Incentives
Federal officials provided guidance to state Medicaid directors last Friday (February 1) on how to qualify for a one percent increase in federal funds to offer preventive services and vaccinations to adults at no out-of-pocket cost. However, some state officials voiced concerns that the funding bump is too small to cover increased administrative expenses. The health reform law authorized the extra funding to any state that agrees to offer preventive services rated A or B by the U.S. Preventive Services Task Force or vaccinations recommended by the Advisory Commission on Immunization Practices. The services are optional, but any alternative benefit plans will have to cover the services by next January 1.
The latest guidance follows concerns about the effectiveness of primary care incentives in the Affordable Care Act that would raise provider payments for some Medicaid services to at least Medicare rates through 2014. Nurse practitioners in autonomous practices are not able to qualify for the payment increase, and physician groups have warned that the temporary two-year increase may not be sufficient to convince more doctors to accept Medicaid patients.