Nurses and the Affordable Care Act

The Affordable Care Act, the new health care law, strengthens prevention and wellness efforts around the country and expands investments in primary care programs in which nurses play a vital role. Its emphases upon keeping people healthy, preventing illness, and managing chronic conditions, open new opportunities for nurses and capitalize on the expertise of the nursing profession. Below are descriptions of programs expanded or created by the Affordable Care Act to support the nursing profession and improve care to Americans:

Community Health Centers (CHC): HRSA’s health center network delivers primary and preventive care– including oral and behavioral health care – to about 19.5 million patients at more than 8,500 sites. CHCs are an important part of the nation’s safety net because they serve anyone who walks in, and nurses are an essential component of the health center workforce. Currently, about 16,000 nurses – including 4,300 advanced practice nurses – work at health centers across the U.S. Since the Obama Administration’s efforts to expand the health center program began in 2009, health centers have added about 3,000 nursing positions, including 800 in advanced practice.

School-based Health Centers (SBHC): School-based health centers improve the overall health and wellness of all children through health screenings, health promotion and disease prevention activities. Students and their families rely on school-based health centers to meet their needs for a full range of health care services. Students can be treated for acute illnesses, such as flu, and chronic conditions, including asthma and diabetes. The Affordable Care Act provides $200 million in funding from 2010 – 2013 to address significant and pressing capital needs to improve delivery and support expansion of services at SBHCs

National Health Service Corps (NHSC): The NHSC places primary care providers in underserved urban and rural areas for at least two years in exchange for paying down their student loans. Eligible nursing specialties are primary care nurse practitioners, certified nurse midwives, and psychiatric nurse practitioners. The health care law allocated $1.5 billion over five years to grow the NHSC. The number of nurse practitioners in the NHSC has more than doubled to 1,750, since 2009. New in 2012, the State Loan Repayment Program has expanded eligible disciplines in state-run programs to include registered nurses.

Nursing Education Loan Repayment Program (NELRP): Since 2009, the NELRP budget has more than doubled. Under this program, RNs and nurse practitioners who work for two years in a facility with a critical nursing shortage can get 60 percent of their school debt paid. Nurse faculty working at universities are also eligible for NELRP.

Home Visiting: The law created the new five-year, $1.5 billion Maternal, Infant, and Early Childhood Home Visitation Program. Under this program, nurses, social workers and other professionals visit pregnant women and young children, with the families’ consent, and offer counseling and intervention services to improve health outcomes. Last year, HRSA announced awards of $224 million to state agencies to implement this program. To date, 29 states have selected Nurse-Family Partnerships – one of the models – as the basis for their work.

Interprofessional Education and Collaborative Practice: The health care law’s promotion of “care coordination”, an intervention that nurses participate in and often lead, is at the core of efforts to improve health care quality and safety. Partnering with the Center for Medicare and Medicaid Services’ (CMS) Innovation Center, HRSA has engaged health-related foundations and experts from academia to promote interprofessional team-based care. Two of HRSA’s nursing programs, the Nurse Education, Quality, Practice and Retention Program and the Advanced Nurse Education Program are soliciting projects to develop interprofessional education and collaborative team-based practice, as well as supporting Innovation Center programs.

Graduate Nurse Education Demonstration (GNE): Under the GNE demonstration, a new Affordable Care Act initiative, CMS will provide up to $200 million over four years to up to five eligible hospitals for the reasonable cost of providing clinical training to advanced practice registered nurses (APRN). Hospitals participating in the demonstration must partner with accredited schools of nursing and non- hospital community-based care settings. The demonstration requires that half of clinical training occur in community-based non-hospital settings. The clinical training included in this demonstration will provide APRNs with the clinical skills necessary to provide primary care, preventive care, transitional care, chronic care management and other services appropriate for Medicare beneficiaries. Students receiving training funded by the demonstration will be encouraged to practice in non-hospital community-based settings, including in underserved areas.

Information provided by the US Department of Health and Human Services Health Resources and Service Administration. April 2012

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