The Patient Protection and Affordable Care Act

On Tuesday, March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. AACN did not take an official stance on healthcare reform
legislation. The information below provides an overview of sections included in the law that will impact AACN member schools, their students, and practicing nurses.
Specifically, these provisions address nursing workforce development, primary care, prevention, and health promotion expansion, care coordination and improved
patient outcomes as well as patient and provider rights. This chart is a tool for AACN members and interested stakeholders to understand the content of the bill and
future implications for the profession. It is not a comprehensive review of the law, nor does it connote AACNs position on the provisions. For information on AACNsupported provisions and sections AACN believes need further attention, see the accompanying document.
To read the text of Public Law No: 111-148 see:
Provision Title Section Number Original Provision Expansions Under the New Law
Title VIII Nursing Workforce Development Reauthorization (42 U.S.C. 296 et seq.)
Definitions Sec. 5000
Pages 473-474
Definitions (Sec. 801of the Public Health Service
Act [PHSA]) identifies an accredited school of
nursing as: a collegiate, associate degree, or
diploma school of nursing in a State.
Expands the current language to clearly articulate that the Title VIII
programs are for graduates of nursing programs in which the
students sit for the NCLEX-RN.
Includes a definition of accelerated degree programs and bridge or
degree-completion programs so that these programs and students are
eligible for funding under Title VIII.
Nursing Student
Loan Program
Sec. 5202
Page 489
Nursing Student Loan (NSL) Program
(Sec. 835 of the PHSA) was established in 1964
to address nursing workforce shortages. The
revolving fund provides each accepted nursing
student, undergraduate or graduate, a maximum
of $13,000 at 5% interest with a preference for
those in financial need. The repayment period is
10 years. The NSL program may provide $2,500
in non-taxable loans to nursing students during
each of their first two years of study and $4,000
for their last two years. Funds are loaned out to
new students as existing loans are repaid.
Updates current educational loan amounts under the NSL program
from $2,500 to $3,300 and increases the loan amounts for the last
two academic years from $4,000 to $5,200. The updated aggregate
loan levels for all academic years will increase from $13,000 to
$17,000. These loan amounts will be enacted during fiscal year (FY)
After FY 2011, such loan amounts shall be adjusted to provide for a
cost-of-attendance increase for the yearly loan rate and the aggregate
of the loans.
Patient Protection and Affordable Care Act
Public Law No: 111-148
Nursing Education and Practice Provisions
Education and
Training; Career
Sec. 5305
Pages 504-507
Education and Training Relating to
Geriatrics (Sec. 753 of the PHSA) awards grants
to schools of medicine or dentistry to improve
training of health professionals in geriatrics,
disseminate curricula, support continuing
education in geriatric care, among others.
Comprehensive Geriatric Education
(Sec. 885 of the PHSA) grants are awarded to
schools of nursing or healthcare facilities to
better provide nursing services for the elderly.
These grants are used to educate nurses who will
provide direct care to older Americans, develop
and disseminate geriatric curriculum, and prepare
faculty members.
Expands Sec. 753 to include a fellowship program for short-term
intensive courses that focus on geriatrics, chronic care management,
and long-term care that provide supplemental training for faculty
members in medical schools and other health professions schools
with programs in psychology, pharmacy, nursing, social work,
dentistry, public health, allied health, or other health disciplines, as
approved by the Secretary. The fellowship program is authorized at
$10.8 million for FY 2011-2014.
Expands Sec. 753 to include Geriatric Career Incentive Awards that
will be given to Advanced Practice Registered Nurses (APRNs) and
other healthcare professional that agree to teach or practice in the
field of geriatrics, long-term care, or chronic care management for a
minimum of 5 years. The Geriatric Career Incentive Awards is
authorized at $10 million for FY 2011-2014.
Expands the Geriatric Faculty Fellowship program under Sec. 753(c)
to include nurse faculty.
**Note Public Law 111-148 provides authorizing authority only for this
program and cannot be considered a mandatory spending threshold. As is the case
with all discretionary spending, funding must ultimately be appropriated each
fiscal year by the House and Senate Appropriations Committee, passed by both
bodies of Congress and signed by the President, before it represents its true
Establishes traineeships for individuals who are preparing for
advanced education nursing degrees in geriatric nursing, long-term
care, gero-psychiatric nursing or other nursing areas that specialize in
the care of the elderly population.
Nursing Grants
Sec. 5308
Page 511
Advanced Education Nursing (AEN)
Grants (Sec. 811 of the PHSA) support projects
that enhance masters and doctoral nursing
education programs. The AEN grants help to
prepare our nations nurse practitioners, clinical
nurse specialists, nurse midwives, nurse
anesthetists, nurse educators, nurse
administrators, public health nurses, and other
nurse specialists requiring advanced education.
Extends participation in the Advanced Education Nursing Grant
program to those nurse-midwifery programs that are accredited by
the American College of
for Midwifery Education.
Removes the 10% cap on doctoral student education under the
AEN program.
Nurse Education,
Practice, and
Retention Grants
Sec. 5309
Pages 511-513
Nurse Education, Practice, and Retention
Grants (Sec. 831 of the PHSA) help schools of
nursing, academic health centers, nurse-managed
health centers, state and local governments, and
healthcare facilities strengthen programs that
provide nursing education.
Revises the Nurse Education, Practice, and Retention Grants to
focus on Nurse Education, Practice, and Quality priorities.
Creates a Sec. 831A that solely focuses on Nurse Retention programs
and expands on the priorities that currently exist under the law
-A career ladder program, and
-Funding for nurse internships and residency programs in
collaboration with an accredited school of nursing.
Loan Repayment
and Scholarship
Sec. 5310
Page 513
Nurse Loan Repayment and Scholarship
Programs (Sec. 846 of the PHSA) The Loan
Repayment program repays up to 85 percent of
nursing student loans in return for at least two
years of practice in a designated healthcare
The Scholarship program offers individuals who
are enrolled or accepted for enrollment as fulltime nursing students the opportunity to apply
for scholarship funds. Upon graduation,
recipients are required to work in a healthcare
facility with a critical shortage of nurses for at
least two years.
Expands the Loan Repayment and Scholarship program to allow
nurses (Loan Repayment) and nursing students (Scholarship)
educational loan funding if they agree to serve as nurse faculty for at
least two years at an accredited school of nursing.
Nurse Faculty Loan
Sec. 5311
Pages 513-515
Nurse Faculty Loan Program (NFLP)
(Sec. 846A of the PHSA) increases the number of
qualified nurse faculty by creating a student loan
fund within individual schools of nursing.
Students must agree to teach at a school of
nursing in exchange for cancellation of up to 85
percent of their educational loans, plus interest,
over a four-year period.
Expands the current program by creating a School of Nursing
Student Loan Fund, which will function as the current NFLP.
Additionally, the provision expands the educational loan repayment
amount from $30,000 to $35,500.
Creates an Eligible Individual Student Loan Repayment program.
This program will support current graduate students or recently
graduated masters/doctoral students who agree to serve as a faculty
full-time member at an accredited school of nursing, for a total
period f at least 4 years.
The loan repayment amounts include up to $40,000 for masters
students and $80,000 for doctoral students.
Funding priority will be awarded under both programs to
doctoral nursing students.
Authorization of
Appropriations for
Parts B through D
of Title VIII
Sec. 5312
Page 515
Funding provided for all Title VIII programs in
FY 2010 was $243.872 million.
Authorized funding for all Title VIII Programs: $338 million in FY
2010, and such sums as may be necessary for each of the FY 2011
through 2016.
**Note Public Law 111-148 provides authorizing authority only for these
programs and cannot be considered a mandatory spending threshold. As is the
case with all discretionary spending, funding must ultimately be appropriated each
fiscal year by the House and Senate Appropriations Committee, passed by both
bodies of Congress and signed by the President, before it represents its true
Workforce Diversity
Sec. 5404
Page 531
Workforce Diversity Grants (Sec. 821 of the
PHSA) prepare disadvantaged students to become
nurses. This program awards grants and contract
opportunities to schools of nursing, nurse
managed health centers, academic health centers,
state or local governments, and nonprofit entities
looking to increase access to nursing education
for disadvantaged students, including racial and
ethnic minorities under-represented among RNs.
Expands the Workforce Diversity Grants to include:
-Stipends for diploma or associate degree nurses to
enter bridge or degree completion programs,
-Scholarship or stipends for accelerated degree
-Pre-entry preparation,
-Advanced education preparation, and
-Retention activities.
Includes the National Coalition of Ethnic Minority Nurse
Associations as one of the organizations the Secretary shall consult
with on recommendations regarding nursing diversity.
Support for Advanced Practice Registered Nurse Education
Grants for Family
Nurse Practitioner
Training Programs
Sec. 5316
Pages 877-878
No current existing program. Creates a training demonstration program for family nurse
practitioners to employ and provide one-year of training for nurse
practitioners who have graduated from a nurse practitioner program
for careers as primary care providers in Federally qualified health
centers (FQHCs) and nurse-managed health clinics (NMHCs).
Grants will be awarded for three years to eligible entities, such as
FQHCs and NMHCs. Family nurse practitioners who participate will
receive 12 full months of full-time, paid employment and benefits
consistent with the benefits offered to other full-time employees of
such entity.
Funding for each grant will not exceed $600,000. Overall funding for
the program is such sums as necessary for FY 2011 through 2014.
**Note Public Law 111-148 provides authorizing authority only for these
programs and cannot be considered a mandatory spending threshold.
Graduate Nurse
Sec. 5509
Pages 556-558
No current existing program. Amends Title XVIII of the Social Security Act to provide payment
to five hospitals for the costs of expanded APRN training programs.
Total awards will include $50 million over four fiscal years (FY 2012-
2015) for a total of $200 million. The amount reimbursed will be
based on growth within APRN programs when compared to the
average growth in APRN programs from 2006-2010.
The five hospitals that receive this funding must have written
agreements with one or more accredited school of nursing that
1) Qualified training and
2) How the hospital will reimburse the school(s) for the costs
associated with qualified training.
The agreement will also include two or more applicable non-hospital
where APRN education occurs. A
waiver is established for hospitals in rural and medically underserved
communities where 50% of the education would not occur in
community-based care settings. Federally qualified health
centers, rural health clinics, and other non-hospital settings as
determined appropriate by the Secretary are considered communitybased care settings.
Qualified training means training that provides an advanced practice
registered nurse with the clinical skills necessary to provide primary
care, preventive care, transitional care, chronic care management, and
other services appropriate for individuals entitled to, or enrolled for,
benefits under part A of Title XVIII of the Social Security Act, or
enrolled under part B of such title.
An evaluation of the demonstration program will be conducted and
reported to Congress no later than October 17, 2017. The report
must include the growth in the number of advanced practice
registered nurses with respect to a specific base year as a result of the
**Funding for this program is not subject to the regular appropriations process as
programs under the Social Security Act provide mandatory funding. Therefore,
starting in FY 2012, $50 million will be allocated. No hospitals have been
selected to date.
National and State Workforce Support
National Health
Sec. 5101
Pages 474-481
No current existing program. Creates a National Health Workforce Commission that will serve as
a resource to Congress, consult with agencies of jurisdiction, among
other duties. The Commission will include 15 members who have
experience in healthcare workforce analysis, healthcare economics,
healthcare education, as well as public stakeholders.
The charge of the commission will be:
-Dissemination and communication of health workforce findings,
-Review of health workforce annual reports, and
-Make recommendations to Congress.
Topics to review include, but are not limited to:
-Supply and distribution of the workforce,
-Health professions education and training programs
such as Title VII and Title VIII (of the PHSA), and
-Graduate Medical Education.
One of the high priority review areas is nursing workforce capacity at
all levels.
State Healthcare
Sec. 5102
Pages 481-485
No current existing program. Creates a competitive grant program for state partnerships to plan
and implement strategies to address healthcare workforce
The planning grants will offer a maximum of $150,000 for one year
and the partnerships must include a representative from each of the
-Healthcare employer,
-Labor organization,
-A public 2-year institution of higher education,
-A public 4-year institution of higher education,
-The recognized state federation of labor, and
-The state public secondary education agency, among others.
Required activities include:
-Analyzing state labor markets,
-Identifying current and projected demands in health professions,
-Describing state secondary and postsecondary education and
training policies, models, or practices for the healthcare sector,
among others.
Health Care
Sec. 5103
Pages 485-488
Health Professions Workforce Information
and Analysis (Sec. 761 of the PHSA) provides
for the development of information describing
the health professions workforce and the analysis
of workforce related issues; and provides
necessary information for decision-making
regarding future directions in health professions
and nursing programs in response to societal and
professional needs.
Creates a National Center for Healthcare Workforce Analysis. The
center will be responsible for describing and analyzing the healthcare
workforce, including annually evaluating programs under Title VII of
the Public Health Service Act; developing and publishing
performance measures; and creating, maintaining, and publicizing an
online registry of Title VII grants. The national center will be
awarded $7.5 million each year from FY 2010 through 2014.
The Secretary will also award grants to State and Regional Centers
for Workforce Analysis providing $4.5 million for each year, FY
2010 through 2014. Grants will also be provided for longitudinal
workforce analysis and will be appropriated such sums as necessary
for year, FY 2010 through 2014.
**Note Public Law 111-148 provides authorizing authority only for this
program and can not be considered a mandatory spending threshold.
Nurse Managed Health Clinics
Health Clinics
Sec. 5208
Pages 494-495
Health Centers (Sec. 330 of the PHSA). This
section defines health centers, outlines the
required primary health services, and awards
grants for health centers.
Expands the Health Centers program to include grants for NMHCs.
The term nurse managed health clinic means a nurse-practice
arrangement, managed by advanced practice nurses, that provides
primary care or wellness services to underserved or vulnerable
populations and that is associated with a school, college, university or
department of nursing, federally qualified health center, or
independent nonprofit health or social services agency (pg. 495).
The grants will be awarded for the operating costs of NMHCs. In
awarding the grants, the Secretary must assure that:
-Nurses are the major providers of the services and that at least
one APRN holds an executive management position,
-The NMHC will continue providing comprehensive primary health
care services or wellness services without regard to income or
insurance status of the patient for the duration of the grant period,
-No later than 90 days of receiving a grant under this section, the
NMHC will establish a community advisory committee.
The authorized funding level for this program is $50 million in FY
2010 and such sums as necessary for FY 2011-2014.
**Note Public Law 111-148 provides authorizing authority only for this
program and cannot be considered a mandatory spending threshold.
Primary Care, Prevention, and Health Promotion Expansion
National Prevention,
Health Promotion
and Public Health
Sec. 4001
Pages 420-423
No current existing council. Creates a National Prevention, Health Promotion and Public Health
Council to provide corrordination at the federal level with respect to
prevention, health promotion, wellness, the U.S. public health
system, and integrated health care. The Council will consist of
Secretaries from major federal agenicies of jursidiction such as the
Department of Health and Human Services, Department of Labor,
and Department of Education.
Sec. 4001 also creates a public Advisory Group on Prevention,
Health Promotion, and Integrative and Public Health. The Advisory
Group will consist of 25 members who are licensed health
professionals and have expertise in worksite health promotion,
community health centers, public health education, and geriatrics,
among others.
Starting on July 1, 2010 and continuing through January 1, 2015, the
Council will report to Congress recommendations on such issues as a
national strategy for health promotion and prevention, lifestyle
behavior modifications, and disease risk reduction.
Prevention and
Public Health Fund
Sec. 4002
Page 423
No current existing fund. Establishes a Prevention and Public Health Fund that will be
administred through the Department of Health and Human Services.
The fund seeks to provide for expanded and sustained national
investment in prevention and public health programs to improve
health and help restrain the rate of growth in private and public
sector health care costs.
The funds shall be transferred from accounts within the Department
of Health and Human Services for programs authorized by the
PHSA that focus on prevention, wellness, and public health activities
such as the Community Transformation grant program, the
Education and Outreach Campaign for Preventive Benefits, and
immunization programs.
FY 2010=$500,000,000
FY 2011= $750,000,000
FY 2012= $1,000,000,000
FY 2013= $1,250,000,000
FY 2014= $1,500,000,000
FY 2015 and each fiscal year thereafter= $2,000,000,000
Clinical and
Preventive Services
Sec. 4003
Pages 423-426
Sec. 915 of the Public Health Service Act (42
U.S.C. 299b4)
Creates a Preventive Services Task Force that will review the
scientific evidence related to the effectiveness, appropriateness, and
cost-effectiveness of clinical preventive services for the purpose of
developing recommendations for the health care community, and
updating previous clinical preventive recommendations, to be
published in the Guide to Clinical Preventive Services.
The task force will be composed of individuals with appropriate
Section 4003 also creates a Community Preventive Services Task
Force to collaborate with the Prevention Services Task Force. The
task force shall review the scientific evidence related to the
effectiveness, appropriateness, and cost-effectiveness of community
preventive interventions for the purpose of developing
recommendations, to be published in the Guide to Community
Preventive Services.
Establishing a
Ready Reserve
Sec. 5210
Pages 496-497
Commissioned corps; composition;
appointment of Regular and Reserve officers;
appointment and status of warrant officers
(Sec. 203 of the PHSA)
Amends Sec. 203 of the PHSA to create a Ready Reserve Corps.
The purpose of the Ready Reserve Corps is to fulfill the need to
have additional Commissioned Corps personnel available on short
notice (similar to the uniformed services reserve program) to assist
regular Commissioned Corps personnel to meet both routine public
health and emergency response missions.
Funding for this program includes $5 million for each year, FY 2010
through 2014. Recruitment and training initiatives for the Ready
Reserve Corps will receive $12.5 million for each year, FY 2010
through 2014.
**Note Public Law 111-148 provides authorizing authority only for this
program and cannot be considered a mandatory spending threshold.
United States Public
Health Sciences
Sec. 5315
Page 518-524
Title II of the PHSA (42 U.S.C. 202 et seq.) Amends Title II of the PHSA to create a United Stated Public
Health Services Track.
This program will provide grants to accredited schools that grant
advanced degrees that uniquely emphasizes team-based service,
public health, epidemiology, and emergency preparedness and
response. Students in the disciplines of medicine, dentistry,
physician assistant, pharmacy, behavioral and mental health, public
health, and nursing are eligible. Through this grant program, 250
nurses as well as 100 physician assistant or nurse practitioner
students must graduate annually.
Students will be provided tuition and a stipend during their
education. Requirements include maintaining an acceptable academic
standing among others. Students will be obligated to serve in the
National Health Care Workforce Commission equal to the length of
time spent in their education program or at least two years.
Beginning with fiscal year 2010, the Secretary shall transfer from the
Public Health and Social Services Emergency Fund such sums as
may be necessary to carry out this part.
Expanding Access
to Primary Care
Services and
General Surgery
Sec. 5501
Pages 534-536
No current existing program. Expands Sec. 1833 of the Social Security Act (42 U.S.C. 1395l) to
include incentive payments for primary care services.
In the case of primary care services furnished on or after January 1,
2011, and before January 1, 2016, by a primary care practitioner, in
addition to the amount of payment that would otherwise be made
for such services, there also shall be paid (on a monthly or quarterly
basis) an amount equal to 10 percent of the payment amount for the
A primary care provider under this new incentive program includes
nurse practitioners and clinical nurse specialists as defined by Sec.
1861(aa)(5)) of the Social Security Act.
Care Coordination, Improved Patient Outcomes, and Decreased Cost
Maternal, infant,
and early childhood
home visiting
Sec. 2951
Pages 216-226
No current existing program. Amends Title V of the Social Security Act (42 U.S.C. 701 et seq.) to
offer a new optional coverage of home visitation services to new
mothers to improve the care for and well-being of low-income and
at-risk families. Specific participant outcomes include improvements
in prenatal, maternal, and newborn health, including improved
pregnancy outcomes among others.
Funding for this program includes:
FY 2010= $100,000,000
FY 2011= $250,000,000
FY 2012= $350,000,000
FY 2013= $400,000,000
FY 2014= $400,000,000
** This program is also funded by transferring monies out of the Treasury.
Independence at
Home Medical
Sec. 3024
Page 286-290
No current existing program. Amends Title XVIII of the Social Security Act to create a new
demonstration project that tests a payment incentive and service
delivery model that utilizes physician and nurse practitioner directed
home-based primary care teams designed to reduce expenditures and
improve health outcomes.
The model will focus on comprehensive, coordinated, continuous,
and accessible care that results in:
-Reducing preventable hospitalizations,
-Preventing hospital readmissions,
-Reducing emergency room visits,
-Improving health outcomes commensurate with the beneficiaries
stage of chronic illness
-Improving the efficiency of care, such as by reducing duplicative
diagnostic and laboratory tests,
-Reducing the cost of health care services covered under this
program, and
-Achieving beneficiary and family caregiver satisfaction.
Nothing in this section shall be construed to prevent a nurse
practitioner or physician assistant from participating in, or leading, a
home-based primary care team as part of an independence at home
medical practice. Nurse practitioners and physician assistants must
act consistent with state laws.
The number of practices that are eligible for the demonstration
program cannot exceed 10,000. A report will be created for Congress
to evaluate the demonstration program if it achieved coordination
of care, applicable beneficiary access to services, and the quality of
health care services provided to applicable beneficiaries.
Funds for this program will be transferred to the Secretary for the
Center for Medicare & Medicaid Services Program Management
Account from the Federal Hospital Insurance Trust Fund and the
Federal Supplementary Medical Insurance Trust Fund (in
proportions determined appropriate by the Secretary) $5,000,000 for
each FY 2010 through 2015.
**Funding for this program is not subject to the regular appropriations process as
it is authorized under the Social Security Act and funded by transferring monies.
Care Transitions
Sec. 3026
Pages 295-297
No current existing program. Creates a program for which the Secretary provides funding to
eligible entities that deliver improved care transition services to
high-risk Medicare beneficiaries.
Grants will be awarded to hospitals, community-based organizations
that provide transitional care services, or a partnership of a hospital
and a community-based organization. Grants must outline the
intervention program that provides transitional care. This may
-Offering transitional care services to patients 24-hours after
-Providing timely post-discharge information, and
-Providing medication review and management.
This program will be funded by transferring monies from the
Federal Hospital Insurance Trust Fund under section 1817 of the
Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary
Medical Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in such proportion as the Secretary determines
appropriate, of $500,000,000, to the Centers for Medicare &
Medicaid Services Program Management Account for the period of
fiscal years 2011 through 2015.
**Funding for this program is not subject to the regular appropriations process as
it is authorized under the Social Security Act and funded by transferred monies.
Patient Centered
Outcomes Research
Sec. 6301
Pages 609-620
No current existing program. Amends Title XI of the Social Security Act (42 U.S.C. 1301 et seq.)
to establishes a new section under the Social Security Act for Patient
Centered Outcomes Research.
Comparative clinical effectiveness research is defined as evaluating
and comparing health outcomes and the clinical effectiveness, risks,
and benefits of two or more medical treatments, services.
The new section creates a Patient Centered Outcomes Research
Institute, which will establish a research project agenda and priority
areas. To carry out and fund the agenda, the Institute will enter into
contracts with federal agencies, academic research, private sector
research, or study-conducting entities. Preference will be given to the
Agency for Healthcare Research and Quality and NIH.
In collecting and analyzing the data for the research project agenda,
expert advisory panels will be created. Also, a Board of Governors
will be created for the Institute, and at least one nurse must serve.
Providers and Patients Rights
in Health Care
Sec. 2706
Page 42
No current existing language. Prohibits a health plan or insurer from discriminating against healthcare
providers with respect to participation and coverage if they are acting
within the scope of that providers license or certification under applicable
State law.
Improved Access
for Certified NurseMidwives Services
Sec. 3114
Page 305
Section 1833(a)(1)(K) of the Social Security
Act (42 U.S.C. 1395l(a)(1)(K))
Increases the payment rate for nurse-midwives for covered services from
65% of the rate that would be paid were a physician performing a service
to the full rate. This is effective January 1, 2011.
Medicare Shared
Savings Program
Sec. 3022
Pages 277-281
Title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) is amended by adding
this new section.
Establishes a shared savings program that promotes accountability for a
patient population and coordinates items and services and encourages
investment in infrastructure and redesigned care processes for high quality
and efficient service delivery.
Groups of providers and suppliers meeting criteria specified by the
Secretary may work together to manage and coordinate care for Medicare
fee for-service beneficiaries through an accountable care
Face to Face
Encounter with
Patient Required
Before Physicians
May Certify
Eligibility for Home
Health Services or
Durable Medical
Equipment under
Sec. 6407
Pages 651-652
Section 1834(a)(11)(B) of the Social Security
Act (42 U.S.C.1395m(a)(11)(B))
Requires, as a condition of payment for durable medical equipment, that
an order be written pursuant to the physician documenting that a
physician, a physician assistant, a nurse practitioner, or a clinical nurse
specialist has had a with the individual involved
during the 6-month period preceding such written order, or other
reasonable timeframe as determined by the Secretary.
Certain other
Providers Permitted
to Conduct Face to
Face Encounter for
Home Health
Sec. 10605
Page 888
Section 1814(a)(2)(C) of the Social Security
Act (42 U.S.C. 1395f(a)(2)(C))
Includes nurse practitioners, clinical nurse specialist, certified nursemidwives, and physicians assistants to conduct the home health visit under
the supervision of the physician.
For information, contact the American Association of Colleges of Nursing, One Dupont Circle, Suite 530, Washington, DC
Phone: (202) 463-6930 Fax: (202) 785-8320 Web Address:
Updated April 14, 2010 13
AACNs Overview of Supported Provisions and Sections Requiring Attention
While the American Association of Colleges of Nursing (AACN) did not take an official stance on the recently enacted
healthcare reform legislation, Patient Protection and Affordable Care Act, the organization did support many provisions that
improved nursing education, research, and practice. Below is an overview of these provisions.
Title VIII Nursing Workforce Development Programs: Expanding and Strengthening the Nursing Workforce
(Secs. 5000, 5202, 5305, 5309, 5310, 5311, 5312, 5404)
One of the most significant reform efforts this law includes for nursing education is the reauthorization of the Title VIII
Nursing Workforce Development Programs (42 U.S.C. 296 et seq.). The Title VIII programs are the largest source of federal
funding for nursing education and have not been reauthorized since 2002. AACN has worked with our colleagues in the
nursing community for nearly a decade to see critical revisions made to these programs, particularly those that limited support
for doctoral students. The new law:
Removes the 10% cap previously imposed on support for doctoral students under the Advanced Education Nursing
Grants. The elimination of this cap will address the need for more doctorally prepared faculty and Advanced Practice
Registered Nurses (APRNs).
Updates the educational loan amounts for nurses and nursing students who receive funding under the Nursing Student
Loan Program, Loan Repayment and Scholarship Program, and the Nurse Faculty Loan Program. This revision is
critical to ensure recipients are awarded funding consistent with current educational costs.
Expands the Comprehensive Geriatric Grant program to provide traineeships for nursing students pursuing a career in
geriatrics. Traineeships for students with a background in gerontological nursing are essential as the aging population
grows. According to the U.S. Census Bureau, 36.3 million Americans are over the age of 65, which represents 12% of
the total population. It has been projected that by 2050, 86.5 million Americans will be over the age of 65. This
represents a 147% increase between the years 2000 and 2050.
Creates an individual nurse faculty loan fund in addition to the Nurse Faculty Loan Program awarded to schools of
nursing. Both programs will place a priority on funding doctoral students. According to a Special Survey on Vacant Faculty
Positions released by AACN in August 2009, a total of 803 faculty vacancies were identified in a survey of 554 nursing
schools with baccalaureate and/or graduate programs across the country. Most of the vacancies (90.6%) were faculty
positions requiring or preferring a doctoral degree.
Expands the Nurse Education, Practice and Retention Grant program to include a quality priority. With the need for
continual assessment and improvement of quality standards in the healthcare delivery system, nurses will need a strong
background in this area.
Expands the Nursing Workforce Diversity Program to include stipends, traineeships, and retention activities to improve
nursings workforce diversity. The initial findings from the 2008 National Sample Survey of Registered Nurses show that while
graduates entering the nursing profession represent greater cultural diversity, when compared to the U.S. population, the
profession still does not represent the current demographics of this country. Nurses from racial and ethnic minorities
underrepresented in nursing contribute significantly to the provision of healthcare services and are leaders in the
development of models of care that address the unique needs of our nations populations.
Graduate Nurse Education Demonstration: Expanding APRN Education (Sec. 5509)
AACN has a long-standing position that APRNs are ideal primary, transitional, and preventive care providers and their
education requires a significant investment from the federal government. During the healthcare reform process, AACN
worked collaboratively with our colleagues in the advanced practice community and AARP to develop a Graduate Nursing
Education program. This program provides Medicare dollars to support the clinical education of APRNs. While AACN
strongly supports this provision, we will work to see that during the regulatory process the language regarding costs covered
accounts for all types of clinical training appropriate to the APRN education. Additionally, this program is limited to five
hospitals, and we will advocate for expanding the programs reach.
Patient Protection and Affordable Care Act
Public Law No: 111-148
AACN is pleased to have helped our colleagues in the community advance provisions critical to their specific discipline or
expertise within nursing. Below are a number of provisions that will positively impact the profession.
Demonstration Grants for Family Nurse Practitioners (FNP): Increasing Access to Quality Primary Care (Sec. 5316)
This demonstration program provides federally qualified health centers or nurse managed health centers three-year grants to
fund recent FNP graduates. Through this funding, the FNPs will receive a one-year imersion program with full-time, paid
employment and benefits. This program will help increase access to quality primary care.
Nurse Managed Health Clinics: Expanding Access to Care and Nursing Education (Sec. 5208)
The new law creates a funding stream for Nurse Managed Health Clinics (NMHCs). NMHCs provide services at a lower cost
than other safety-net clinics, and the preventative care they provide saves millions of dollars each year. Last year, NMHCs
recorded over 2.5 million client visits and provided primary care services to over a quarter of a million patients nationwide.
NMHCs not only deliver primary care to the underserved, but also provide a clinical setting critical to nursing education.
Primary Care, Prevention, and Health Promotion Expansion (Sec. 5207, 5209, 5210, 5315, 5501, 4002)
A number of the provisions included in the new law promote primary care, disease prevention, and wellness by strengthening
our nations public health workforce infrastructure. A mandatory Prevention and Public Health Fund is established for
programs under the Public Health Service Act that focus on prevention and public health; funding for the National Health
Service Corps is significantly increased; a Ready Reserve Corps is created through the U.S. Public Health Service Commission
Corps; and a public health service science track is created under the new law. The law also provides incentive payments for
primary care services given by health professionals including nurse practitioners and clinical nurse specialists.
Community-Based Care Transitions Program: Improving Care Coordination and Decreasing Costs (Sec. 3026)
Medicare claims data shows that more than one-third of beneficiaries discharged from the hospital are re-hospitalized within
90 days a great expense to the health of these patients as well as Medicare. The will
reduce costly re-hospitalizations by ensuring patients and caregivers are informed by, and have the assistance of, healthcare
professionals to navigate the complex treatment needs of those most at risk for re-hospitalization.
Independence at Home Medical Practice Demonstration Program: Recognizing NPs Role (Sec. 3024)
The program creates an incentive payment and delivery model that uses Nurse Practitioners (NPs) and physicians to direct
home-based primary care teams to reduce cost and improve health outcomes. AACN applauds this demonstration programs
as it states that nothing shall prevent an NP from participating in, or leading a home-based primary care team.
Certified Nurse-Midwives Obtain Full Reimbursement (Sec. 3114)
Under the new law, the payment rate for covered services under Medicare provided by Certified Nurse-Midwives (CNMs) will
increase from 65% of the rate that would be paid were a physician performing a service to the full rate. CNMs provide a range
of healthcare services and 90% of visits to CNMs are for primary and preventive care.
New Federal Commissions and Task Forces
The new healthcare reform law creates a number of federal commissions and task forces, with many requiring the service of at
least one nurse. AACN will be working with the Nursing Community to ensure that nurses with appropriate expertise will be
nominated for these important commissions including:
The National Health Workforce Commission (Sec. 5316)
Prevention, Health Promotion, and Integrative and Public Health Advisory Group (Sec. 5501)
Preventive Services Task Force and Community Preventive Service Task Force (Sec. 4003)
Board of Governors for the Patient Centered Outcomes Research Institute (Sec. 6301)
Finally, AACN believes a few provisions require further attention.
Sec. 3022 creates a Medicare Shared Saving Program that will promote accountability for a patient population and coordinate
items and services and encourage investment in infrastructure and redesigned care processes for high quality and efficient
service delivery. The language in the law includes nurse practitioners and clinical nurse specialists. During the regulatory
process AACN will work to ensure all APRNs are included in the provider group as appropriate.
Sec. 6407 requires as a condition of payment for durable medical equipment that a physician sign-off on the face-to-face
encounter conducted by a nurse practitioner or clinical nurse specialist. AACN will work with our colleagues in the NP and
Clinical Nurse Specialist (CNS) community to ensure that these APRNs can order durable medical equipment.
Sec. 10605 allows NPs, CNSs, and CNMs to conduct a home health visit, but it must be under the supervision of a physician.
AACN will work with the APRN community to ensure that NPs, CNSs, and CNMs can order home health.
April 13, 2010

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