In the waning days of the last session of Congress, lawmakers passed and President Clinton signed a legislative package (public law 106-554) designed to help relieve the financial pressures on America's hospitals (which have exacerbated the crisis in nurse staffing). The bill contained three appropriations measures as well as the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), which restores $35 billion in Medicare funding during the next five years. The ANA was one of several health care groups pushing for the enactment of the BIPA to restore the larger-than-expected cuts in Medicare funding authorized by the 1997 Balanced Budget Act.
Specifically, the law increases Medicare's payments to hospitals by $14 billion over five years. It increases funding to skilled nursing facilities by $1.6 billion, including a 16.7% increase in payments for nursing services. The ANA strongly supports this provision, which makes continuation of the increased nursing funding dependent on a verifiable increase in nurse staffing ratios.
"The ANA believes that nurse staffing in this country is a public health crisis," said ANA President Mary Foley, MS, RN. "Congress responded to our concerns. Now it's imperative that hospitals across the country respond by reinvesting in essential nursing services and addressing inadequate and inappropriate nurse staffing."
The Medicare home health benefit received a much-needed $2 billion spending increase. The BIPA delays until 2002 the scheduled 15% reduction in home health care payments, restores a full payment adjustment for inflation in 2001, and increases reimbursements to rural home health care providers by 10% for two years. The legislation also increases the base payment for hospice services by 5% as of April 1, and it specifies that providers will no longer be penalized if a patient receives hospice services for longer than six months (previously, providers could be subject to accusations of fraud if a Medicare beneficiary receiving hospice care outlived his six-month prognosis).
Medicare beneficiaries will find their benefits expanded and enriched under the BIPA. The bill provides coverage for screening for glaucoma and colon cancer; provides coverage of nutritional, diagnostic, and counseling services for beneficiaries with diabetes and renal disease; modifies the mammography benefit to allow for the use of new technologies; and removes the waiting period for coverage for amyotrophic lateral sclerosis. It accelerates reductions in beneficiaries' copayments for outpatient hospital services, removes obstacles to coverage for adult day-care services, and revises the Medicare coverage and appeals processes to grant beneficiaries the ability to appeal coverage determinations before an independent review board.
The BIPA also contains changes to the current system of payment to community nursing organizations (CNOs), which are nurse-operated programs serving Medicare beneficiaries in home- and community-based settings. These changes will allow CNOs in New York and Illinois to remain in operation, although in modified form.
The legislation addresses advanced practice nursing by requesting a Medicare Payment Advisory Commission (MedPAC) study on the appropriateness of Medicare reimbursements for services provided by certified nurse midwives, physician assistants, nurse practitioners, and clinical nurse specialists. The ANA will work with the Government Accounting Office and MedPAC to ensure that the interests of advanced practice registered nurses are well represented.
The ANA also successfully lobbied for much-needed increases in funding for nursing education and research programs. Funding for the National Institute of Nursing Research was increased by 16.5% to $104.3 million in fiscal year 2001. Nurse Education Act programs, which provide funding to nursing students, were increased by 16.6% to $76.5 million. And funding for the nurse loan repayment program will remain level.
"Increased funding for nursing education is vital to the stability of the profession," said Foley. "Given our current concerns about adequate nurse staffing and educational preparation, funding for nursing education is necessary to ensure a strong nursing workforce."