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How a Bill becomes a Law Step by Step.

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Reference: The legislative process. Children’s Hospital Association (2015, January).

Public Policy and Advocacy Report
October 2017


  • ANA will focus this year on a Culture of Safety. This will reflect Nurse to Nurse as well and violence toward health care professionals. ANA with public statement after Utah RN was arrested.
  • Gun violence again a hot topic after Las Vegas shooting, pushing CDC to do research.

ANA Principles on Health Care System Reform – Talking Points

America’s 3.6 million registered nurses (RNs) are profoundly committed to ensuring and providing high quality care for all. Nurses provide expert, compassionate care for people through all stages of life and work in every health care setting. As the nation’s largest group of health care professionals and most trusted profession, nurses are the linchpin of the health care delivery system and at the forefront of improving the health of our nation.

The American Nurses Association (ANA) opposes efforts to repeal the Affordable Care Act without first putting forward a comprehensive health care plan that embraces the following principles:

1. Protect Americans against being denied insurance coverage because of pre-existing conditions and provide access to affordable health insurance coverage plans that offer a minimum standard of benefits including:

2. Promote and support cost-effective preventive health services.

3. Embrace innovative health delivery models that encourage wellness, prevention, and coordinated care in order to bring down cost and make health insurance affordable for all.

  • Continue to move away from a fee-for service reimbursement model and reward quality care and the effective utilization of resources.
  • Ensure that deductibles and co-payments are not a barrier to receiving care.
  • Eliminate lifetime caps or annual limits on coverage.
  • Incentivize all Americans to purchase insurance coverage - maintaining federal subsidies based on an income-based sliding scale is critical to achieving that goal.
  • Retain coverage for children under the age of 26 under their parents insurance.
  • Support the expansion of Medicaid as a safety net for the most vulnerable, including the chronically ill, elderly and poor.
  • Empower consumers to make informed choices about their healthcare options by making prices and quality metrics more transparent.

4. Build a workforce that meets the demand of a growing and challenging health care system and population.

  • Encourage workforce development policies to ensure an adequate supply of well-educated, well-distributed registered nurses.
  • Incentivize people to enter primary care through grant and loan repayment programs.
  • Ensure an adequate nursing faculty to support the demand for a robust nurse workforce.
  • WOCNCB is looking into “safe” ratios of WOC RN’s; this is likely a 2018 initiative.

WOCN Hot topics:


  • Competitive Bidding: WOCN is working on two phased response.  Phase 1 development of sheet below. WOCN is encouraging reading the document, understand it and share with legislators, patients, clinicians and advocates.

The Dire Implications of Competitive Bidding:

  • CMS Publishes Final Rule on Home Health Conditions of Participation

CMS has published its final rule outlining the Medicare and Medicaid Conditions of Participation (CoP) for Home Health Agencies (HHA). This update is the first in 20 years. Explains qualification to participate in Medicare and Medicaid programs. Long document outline withstanding and new policies

  • (New) Condition of Participation:
    • “Care planning, coordination of services, and quality of care.”
      • HHA description of the patient a plan of care that would set out the care and services necessary to meet the patient-specific needs, assessment and outcomes.
    • “Infection prevention and control,” Requires that HHAs follow infection prevention and control best practices, which include the use of standard precautions, to curb the spread of disease. Education of best practices for prevention and control.
    • Considered a “skilled professional services.” Instead of specifically identifying tasks, broad description of expectations to be identified .Skilled professional services include physician services, skilled nursing services, physical therapy, speech-language pathology services, occupational therapy, and medical social work services.
  • Redefines the requirements, qualifications, and supervision of home health aides.

Attended League of Women votes meeting in Dec. 2016.  This was a wealth of information and passionate people. This experience opened my eyes to how many groups are out there working to better the common good.  Here is a list for more info if there is something you want to learn more about.
(click to view and open in new window)

NIWI attendance. Please see editorial on MAR website. 
This was valuable experience that truly spring loaded my next steps.  My focus has been health care related.  I made many phone calls and sent many emails to my legislatures in regards to defeating the health care legislation that was presented.  Although I believe competitive bidding will haunt us for a while, it pales in comparison to the health care bills that will eliminate the health care for millions.  I continue to encourage conversation with your local and state representative on changes to healthcare that can improve outcomes for our patients.
Lessons learned:

  • I still have a lot to learn.
  • Conversations with nurses are encouraged.
  • You are not always going to get what you want, but your voice is still important.
  • Have opinions, but discuss facts.
  • Open your mind to others and hear them out.  Your opinion may not change but you at least get to hear someone else’s perspective.
  • Read the paper, or at least some version of print news.

ANA will focus this year on a Culture of Safety. This will reflect Nurse to Nurse as well and violence toward health care professionals. Virginia:

  • Medicaid Expansion proposed; no changes at this time.
    • Increased access to care
    • Save state money over time

WOCN: Medicare Contractors Propose Big Changes to Wound Care Payments

  • First Coast Option & Novitas Solutions addressed, as well as comments through the Alliance of Wound Care Stakeholders.
  • concerned with the draft LCD, encouraged “scrap this draft”
  • work with stakeholders who follow clinical evidence and best practices.
  • lack of relevant literature citations, reexamine the current literature to understand of current practices.
  • Other concerns

Highlights from League of Women Voters

  • Voter enhancements to improve how we vote and making it “easier for more to vote
    • No excuse voting
    • Auto with DMV transaction
    • Additional eligibility and valid photo ID
    • Additional days and hours for absentee ballots
    • Shorter interval b/w regular deadline and election day
  • Public Safety
    • If protective order against, no firearms
    • Back ground checks for all firearm purchases
    • ED for safe handling, especially around children
    • Sex trafficking to have increase regulation and measures
  • Criminal Justice
    • Increased funding for mental health programs in jails and prison
  • Restoring voter rights of felons
  • Fair redistricting –create increase bipartisan districts, decrease gerrymandering
  • Environmental Protecting
    • Appropriate fracking regulations
    • Oppose repeal of VA’s moratorium on uranium minimum
    • Support resources to protect air/water/natural resources
  • Women
    • Protect reproductive rights
    • Oppose defunding Planned parenthood
    • Ratification of ERA/legislative advancement
    • Equal pay for equal work
    • Oppose changes to the US Constitution
  • Support Medicaid expansion
  • Support measures and program to reduce school suspension
  • Support transparency of general assembly and increased rights of all to know what is going on and choices made by legislators/bill introduction

April: Appointed Government Relations Rep of HR VNA, began work on legislative reception for 2017.

  • Invite HR legislation at state and local level as well as challenges.  This was an eye opening experience in planning with politicians.  My work was extremely superficial, but I was able talk with legislators and their aides.
  • WOCN call for help:

Requested “help”:

Appointed to WOCNCB Public Policy Committee.
Lymphedema Treatment Act: Amendments to be reintroduced to 115th Congress. This would amend Medicare statute to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. Compression therapy is considered the gold standard for the treatment of lymphedema and the treatment and prevention of venous leg ulcers (VLUs), also known as stasis ulcer. Please show continued support and keep in touch with your member of Congress. Follow link
Nursing Workforce: Title VIII programs bolster nursing education at all levels, from entry-level preparation through graduate study, and provide support for institutions that educate nurses for practice in rural and medically undeserved communities. 

Earlier this year, Rep. Joyce (R-OH) introduced H.R. 959, "Title VIII Nursing Workforce Reauthorization Act of 2017," and over 25 Members have signed on as co-sponsors to the Bi-partisan bill, which aims to amend Title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs, and for other purposes.

Other WOCN agenda items:

  1. Bladder health month H. Res. 67 to be recognized in November
  2. Palliative Care Meeting to be held in May
  3. Access to care
  4. Technical expert panels
  5. Disposable NPWT payment: Jan 2017 HHA can bill for per CMS

First meeting of WOCNCB public policy committee.  Lots of great ideas to promote and support WOC RN practice.  Working closely with WOCN to collaborate on ideas and information.


WOCN® Advocacy and Policy

WOCN"The WOCN Society works diligently to shape legislation that protects and strengthens the profession. The WOCN Society is committed to advancing legislative activity that promotes the benefits of WOC nurse involvement related to pressure ulcers, acute and chronic wounds, ostomy and continence (WOC) care." ~ excerpt from the WOCN® website

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