Healthcare Workforce Provisions in the Patient Protection and Affordable Care Act

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1 Title text here Healthcare Workforce Provisions in the Patient Protection and Affordable Care Act Winifred V. Quinn, PhD AARP and the Center to Champion Nursing in America September 21, 2010 Columbia, SC

2 Funding for All Healthcare Workers Title text here Workforce Planning Grants To comprehensively plan for all levels of workforce in the state About to be awarded (about 20 of 31 applicants will receive) Up to $150K/state Did SC apply? This is complemented by a Workforce Implementation Grant (only 1 state)

3 Funding for All Healthcare Workers Title text here NHSC Specifically for Community Health Centers Mandatory vs Appropriated This is mandatory $1.5B (approximately 10% for nursing) 2011 through 2015 Scholarship for students and loan repayment for current clinicians

4 Funding for Nursing and Nursing Education The Problems: 99K prospective students turned away from nursing schools in 2009 (NLN, 2009) Title text here SC s BSN & MSN programs accepted 2,859 students and turned away 587 qualified prospective students (AACN, 2010) (17%) , NLN data shows that 48% of those turned away were qualified (schools accepted a total of 25% of their applicants and 27% not qualified) Lack of nursing educators, especially in clinical settings Lack of incentives for APRNs to teach Aging Out (national averages) RN average age 47 (HRSA, 2008) 44% of RNs over age 50 (was 33% in 2000 and 25% in 1980) Faculty Ages: Doctor prepared: 60.1 (full), 56.9 (assoc), and (assistant) 52.1 years Masters prepared:56.9, 55.7 and 50.6 years

5 Funding for Nursing and Nursing Education, cont d Solutions: sharing resources, streamlining application processes, developing Title text skills based here curricula to be shared among schools to expedite transfer from ADN BSN programs, the Oregon model, developing a more diverse workforce and faculty, funding to increase nursing faculty Today: Federal Funding for Nursing Education Mandatory vs Annual Appropriations Title VIII vs? Medicare & Diploma programs The ACA includes two main sources of mandatory funding to increase nursing education capacity Medicare Graduate Nursing Education The Prevention and Public Health Fund

6 Funding for Nursing and Nursing Education, cont d Title Medicare text heregne 4 years $200 Million 2012 through 2015 At least 50% must go through to community based settings Prevention and Public Health Investment Fund $30 million 2010 to transition more than 600 PT nursing students to FT

7 Funding for Nursing and Nursing Education, cont d RE Authorized Title VIII and created more capacity provisions: Advanced Education Nursing Grants: Title text Eliminate here the 10% cap on doctoral programs for AEN grants Allow funds to go directly to students not only to schools Loan Repayment & Scholarship Program: Nurses and nursing students qualify for the repayment and scholarship program, respectively if they serve as faculty at an accredited nursing school for two years. Includes faculty as eligible participants National Education, Practice & Retention Grants: Remove Nurse Retention and creating its own section thereby rendering it the Nurse Education and Practice grant program. Expand the career ladder program and funding for nursing internships and residency programs in collaboration with accredited schools of nursing.

8 Funding for Nursing and Nursing Education, cont d RE Authorized Title VIII and created more capacity provisions (cont d): Title Nurse text Faculty here Loan Repayment Program: Create an Eligible Individual Student Loan Repayment program that will support graduate students or recently graduated masters or doctoral students who agree to serve as a full time faculty at an accredited school of nursing for at least four years Increase the loan repayment amounts up to $40,000 for master s students and $80,000 for doctoral students Funding priority will be awarded under both programs to doctoral nursing students

9 Funding for Nursing and Nursing Education, cont d RE Authorized Title VIII and created more capacity provisions (cont d): Workforce Diversity Grants Title text here Stipends for diploma or associate degree nurses to enter bridge or degree completion programs, scholarship or stipends for accelerated degree programs, pre entry preparation, advanced education preparation, and retention activities ADDITIONS!: Accelerated Bachelors of Science in Nursing (BSN) or Masters of Science (MSN) in Nursing: for individuals with undergraduate degrees in other fields who enter a BSN or MSN program Bridge BSN or MSN programs: for Registered Nurses returning to school for their BSN or MSN or a BSN level nurse entering a doctoral program in nursing

10 Funding for Direct Care Workers* Demonstration Grants to Develop Personal Care Aide Title Competencies, text here appropriated $85 million per year for 5 years (FY ) for all demos, with no more than $5 million per year for 3 years (FY ) allowed for personal and home care aide demonstration. Other Training Opps, appropriated Training Opportunities for Direct Care Workers $10m for for DCWs in home care, NHs, ALFs, etc Geriatric Ed (to develop current faculty skills in geriatrics and in turn would teach) *thanks to Phi National for their analysis

11 Title text here Funding for Physicians, Physician Education, Physician Assistants Mandatory & Appropriated/Annual Funding Medicare & Title VII Funding

12 Funding for Physicians, Physician Education, Physician Assistants, Cont d Title $125M text here in 2010 and sums as necessary year grants for: Accredited residency or internships program in family medicine (FM), general internal medicine (GIM), or general pediatrics (GP)* Traineeships/fellowships for medical students, interns, residents, or practicing physicians who plan to specialized in/work in FM, GIM, GP Programs to train physicians who plan to teach in FM, GIM, GP Traineeships/fellowships for physicians planning to teach in or conduct research in a FM, GIM, GP training program (Heinrich, HRSA, September 2010)

13 Funding for Physicians, Physician Education, Physician Assistants, Cont d Title Title text VII here funding cont d Physician Assistant education programs Programs for training physicians teaching in community based settings Provide training in new competencies recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry (including patient centered medical homes) Joint degree programs providing interdisciplinary, Inter professional graduate training in public health and other health professions ***15% of total annual training funding goes to Physician Assistants

14 Funding for Physicians, Physician Education, Physician Assistants, etc., Cont d Geriatric Workforce Grants: Title text here Geriatric WF Development Fellowships: Fellowships to educate faculty members (multiple disciplines) in areas of geriatrics so to help produce more geriatric educators A fellowship shall be offered either at the geriatric education center that is sponsoring the course, in collaboration with other geriatric education centers, or at medical schools, schools of dentistry, schools of nursing, schools of pharmacy, schools of social work, graduate programs in psychology, or allied health and other health professions schools approved by the Secretary with which the geriatric education centers are affiliated. Awardee needs to offer free of charge 2 courses/yr caring for frail elders to family caregivers and direct care workers Amount: $10.8M; Grant amounts = $125K through 2014

15 Funding for Physicians, Physician Education, Physician Assistants, etc., Cont d Geriatric Workforce Grants, cont d: Title text here Career Incentive Awards Provided to existing professionals (multiple disciplines) to train them in geriatrics Must commit to working in area of geri for 5 years $10M 2011 through 2013

16 Funding for Physicians, Physician Education, Physician Assistants, etc Medicare Reimbursement Incentive: Title text here 10% bonus for primary care services provided to Medicare beneficiaries 2011 through 2015 Clinicians include physicians, nurse practitioners, clinical nurse specialists, physician assistants in family medicine Also includes a 10% increase for general surgeons in HPSAs Medicaid Reimbursement Incentive: To increase #s of primary care providers for Medicaid beneficiaries, physicians will receive a Medicare level of reimbursement in 2013 & 2014

17 Funding for Physicians, Physician Education, Physician Assistants, etc Title Other text Medicare here Incentives: Teaching hospitals can request unused residency slots 75% must be for primary care or general surgery Preference in rural & HPSAs Can transfer residency positions from a teaching hospital that closes Relaxing rules to allow more residencies in community settings such as physician offices, clinics, etc

18 Funding for Other Workforce Areas Grants for Dentistry Training: general, pediatric, and public health dentistry (appropriated): Title text here Traineeships, loans, and traineeships and fellowships to develop more faculty and doctoral and post doctoral training Priority given to depts working in collaboration with primary care medicine, record of producing large numbers of professionals, track record to educate people from rural/disadvantaged/underrepresented minorities, collaboration with community health ctrs, HIV/AIDS, curricula that includes cultural competency/health literacy, high rt of placements in underserved areas, plans to develop oral health ctrs for people with D or DD, cognitive impairment, elderly $30M for 2010 and funds as necessary

19 Funding for Other Workforce Areas Grants for Alternative Dentistry Training: community dental health coordinators, advance Title text here practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, and any other health professional that the Secretary determines appropriate. $4M for 5 years, beginning March 2011

20 Funding for Other Workforce Areas Grants for Mental and Behavioral Health To recruit more students in undergrad and grad Title text programs here At least 4 of the awardees must be historically black colleges 2011 through 2013 $8M for SW $12M for grad psych of which at least $10M for doctoral, post doc, internship $10M for child and adolescent

21 Good Opportunities for South Carolina to Leverage Federal Dollars National spending on HCBS grew to 41% from 19% from Title text here (KFF, 2009) SC s #s of HCBS consumers decreased 30K 27K SC s #s of Medicaid Home Health Consumers decreased 10K 7K SC doesn t have optional Medicaid Personal Care Services SC s HCBS waiver funding has remained in the $19 20M range SC s total Medicaid HCBS funding (home health & 1915(c) waivers) increased $166M $288M However it decreased $8M from Consumers served: 12.8K aged/disabled 5K MR/DD 1.2K HIV/AIDS 500 TBI 48 physically disabled

22 Good Opportunities for South Carolina to Leverage Federal Dollars, cont d Distribution Title text here of Overall Medicaid LTC Spending for SC in FY 2008 (KFF, StateHealthFacts.org2010): ICF MR 13.6% Mental Health Facilities 3.4% NFs 44.5% Home Health & Personal Care 38.5% FMAP for SC is 79% (a 10% boost with ARRA funds) :30 Fed:State split compared to 57:43 national average

23 Good Opportunities for South Carolina to Leverage Federal Dollars, cont d State Title Balancing text here Incentive Program For states that spent at least 25% but less than 50% of LTC spending on HCBS Requirements: Single Entry Point, conflict free case management, and core standardized assessment instruments for eligibility Community First Choice Options New state plan option Covers HCBS attendant services Increase of 6% of FMAP

24 Title text Does here More Funding Equate with Greater Access? Scope of Practice APRNs must be supervised by physicians to diagnose, treat, and prescribe Rural & Urban under served areas, a population group, or a medical facility 117 Primary Care Health Professional Shortage Areas in SC (HRSA, 2010) Who will provide the primary care to all who reside in those areas?

25 Title text herequestion of Criminal Background Checks AARP expert is Naomi Karp, JD Senior Strategic Policy Advisor Consumer and State Affairs Team AARP Public Policy Institute 601 E St., NW Washington, DC (voice) (fax)

26 Title text here Winifred V. Quinn, PhD Senior Legislative Representative AARP 601 E St., NW Washington, DC Thank You

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