Legislative Update from AANP

FDA Panel Calls for Tighter Regulation of Painkillers

The FDA Drug Safety and Risk Management Advisory Committee voted last Friday (January 25) to recommend the reclassification of hydrocodone from Schedule III to Schedule II in response to pleas from the Drug Enforcement Administration, federal legislators, and consumer advocates to crack down on abuse of the prescription pain medication. Reclassification would limit prescription refills and increase storage security requirements. It could also prevent nurse practitioners from prescribing the drug in states where NP prescriptive authority is limited to Schedule III through V.

Several initial news reports erroneously indicated that the Advisory Committee recommendation would prohibit NPs and physician assistants from prescribing hydrocodone medications under any circumstances. AANP has been in contact with FDA officials and will file comments with the agency raising concerns about the impact that rescheduling hydrocodone could have on patients in need of pain medication.

The FDA must approve the recommendation before the Department of Health and Human Services would take action enabling the DEA to reclassify the drug. Senator Joe Manchin (D-WV), who supported an unsuccessful effort last year to amend prescription drug user fee legislation to require rescheduling of hydrocodone, told the FDA advisory panel that he would like to see the agency engage physicians, addiction specialists, pharmacologists, and other providers and patients in a serious dialogue about rescheduling the drug. The committee was warned that rescheduling would create barriers for patients without any assurance of reducing addiction or abuse, encouraging expanded use of electronic drug monitoring programs and tracking systems as an alternative.

Congress Moves to Suspend Debt Limit Until May

The House of Representatives passed legislation last Wednesday (January 23) to temporarily suspend the limit on the government’s borrowing authority until May 19, allowing Congress to turn its attention first to efforts to reduce federal spending. Dubbed the “No Budget, No Pay Act” (H.R. 325), the debt limit legislation also threatens to withhold salaries of members of Congress if they fail to pass a budget resolution by April 15 – something the Senate has been unable to do for three years. The Obama administration and Senate leaders indicated they would not oppose the short-term debt limit extension after House Republicans chose not to pursue a dollar-for-dollar exchange of spending cuts to increase borrowing.

House passage of the debt limit bill relied on Democratic votes as the Republican majority could muster only 199 of the 218 votes needed to approve it. The vote marked the third time in recent weeks that House Republican leaders have passed major legislation with less than a majority of their own party, following similar votes on the fiscal cliff agreement and supplemental disaster assistance funding.

NPs Raise Concerns on Medicaid Primary Care Pay Incentive

As states move to implement provisions of the health reform law intended to improve access to Medicaid primary care providers and services, AANP and other nurse practitioner groups are expressing concerns to federal officials regarding problems with policies related to the implementation of increased Medicaid payments for some primary care services. In addition to meeting with members of Congress, AANP has contacted the Centers for Medicare and Medicaid Services (CMS) and the Medicare and CHIP Payment and Access Commission (MACPAC) to discuss its concerns about restrictions on the ability of NPs to receive the two-year higher payment incentive.

The Centers for Medicare and Medicaid Services (CMS) have interpreted provisions of the Affordable Care Act to include primary care services provided by nurse practitioners, only if those services are provided “under the personal supervision” of an eligible physician. Their interpretation of the rule specifically excludes services provided by NPs in autonomous practices from the higher payments. NP groups submitted comments on proposed regulations last June, convincing the agency to drop a plan to require that NP services be billed under the physician’s enrollment number to qualify for higher payment.

Some members of Congress proposed to completely repeal the incentive provisions last year, expressing concerns about the cost of higher payments and doubts about whether the incentive would actually result in more physicians accepting Medicaid patients. Concerns about increasing federal spending also face efforts to expand the current incentive policy to directly include services provided by NPs.

HRSA Nurse Corps Loan Repayment Program

The Health Research and Services Administration (HRSA) recently announced that its NURSE Corps Loan Repayment Program, formerly the Nursing Education Loan Repayment Program, is now accepting 2013 applications through February 28. In exchange for a two-year commitment to work in a hospital or other facility with a critical shortage of nurses or at an accredited nursing school, the program assists nurse practitioners and other registered nurses, advanced practice nurses and nurse faculty with repayment of their educational loans. To meet the increasing demand for nurse practitioners, up to half of the program funding is reserved for NPs. More information on program eligibility and requirements is available on HRSA’s website or the new NURSE Corps web page.
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