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State Advocacy

Kathleen M. Wilson, PhDDirector of Government Affairs

Gaby GeiseGovernment and Clinical Affairs Representative

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AMDA’s State Advocacy Program

Why has AMDA renewed it’s state advocacy program?

• National associations can no longer be assured that a problem remedied at the federal level has been resolved.

• The laws still need to be interpreted and implemented on a state level.

• Issues that once flowed from Congress down to the state and local level are now percolating up from the grass roots.

• State chapters can get the support and expertise they need from the national office.

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State Laws Emerging

• AMDA successfully opposed provisions of the Long Term Care Quality and Modernization Act.– Provides a state option for supervision of SNF care by

a nurse practitioner, clinical nurse specialist, or physician assistant who is working in collaboration with a physician.

– Permits shared or split billing so that physicians and nurse practitioners could submit separate claims to Medicare for the services they provide to a resident, so long as the combined sum could not be greater than the amount that would be paid if services were billed together.

– Amends Medicare law to permit SNF-Employed NPs to certify skilled care.

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State Laws Emerging• Colorado—Two bills were introduced concerning

advanced practice nurses’ (APN) scope of practice. One concerns the procedure for determining whether an APN will be granted participating provider status for a health benefit plan and the other concerns signatures by APNs on specified documents (e.g., affidavits, authorizations to continue treatment or tests, and directives for end-of-life care) within the scope of practice of an APN.

• Missouri—Introduced a bill that would authorize a physician assistant or advanced practice nurse to prescribe a schedule V controlled substance under a collaborative practice agreement. Other bills included limiting the certificate of need program to long-term care facilities, as well as modifying the training and regulation of long-term care facility inspectors and surveyors.

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State Laws Emerging

• New York—Two bills were introduced that would allow nurse practitioners to sign death certificates. Currently, both bills are in the Senate Committee on Health. The Medical Society of the State of New York opposes the legislation.

• Pennsylvania —Several bills were signed into law in 2007 that made modest changes to the scope of practice of certified registered nurse practitioners (CRNPs), clinical nurse specialists (CNSs), and physician assistants (PAs) and do not authorize independent practice models.

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Working the State Chapters

• Assist state chapters with educating local legislators and regulators.

• Track emerging issues at the state level.

• Sharing information on what other states are seeing.

• Provide tips and suggestions to help you take advantage of your state’s legislative and advocacy resources.

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How does AMDA track state policy?

StateNet

• Full text of all bills

• Staff and committee analysis/reports

• Voting records

• Hearing times and locations

• Same-day status actions

• Private AMDA Bill Tracking File

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How we communicate with States...

• When bills are introduced, a memo is send out to the State Chapter President.

• Here is a sample of a typical memo sent out.

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How can you track your own legislation?

• State Chapter Fact Sheets– http://www.amda.com/governance/statechapters.cfm

– Fact Sheets include this information (using California as an example):• Governor

• General Information: 916-445-4251

• Link to state assembly members

• Link to state assembly committees

• Link to state senate members

• Link to state senate committees

• Senate Bill Status: 916-445-4311; Assembly Bill Status: 916-445-3614

• Legislative Information: www.assembly.ca.gov; www.sen.ca.gov

• Legislative Session: Convenes January 7, 2008; Adjourns August 31, 2008

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Contacting State Legislators

• Take the time to learn the who, what, and why of an issue before contacting your state legislator.

• Know the role of the legislature and legislator.– Is it a new law or do you seek to change the law?– Is the legislator on the committee that has jurisdiction

over the issue?• Justify why they should listen to you.

– Are you in their voting district?– How many members do you have?– Who else agrees with you?– Anecdotes work, especially ones with a local flavor.

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Make Yourself Known

• Expert Panels/Advisory Panels• Physician Advisory Boards• Coalitions• Develop and Distribute Position

Statements through state delegations: AMDA House of Delegates, AMA House of Delegates

• Attend Meetings Offered by State Agencies and Legislators

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Arrange a Face-to-Face Meeting

– Send letter outlining reason for meeting.– State your recommendation and back up your

argument with your “who, what, and why”.– In advance of your meeting, provide names of your

representatives and hand outs.– Remember “evidence” versus “anecdote” is tied to

your audience.– Don’t be demanding or insulting.– Get to the point. Don’t run long.

• Bring talking points to back up your argument.

– Send follow up letter re-affirming your points and thanking them.

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Avail Yourself of AMDA Resources

• Clinical Practice Guidelines – www.amda.com/tools/guidelines.cfm

• Position Statements and White Papers– www.amda.com/governance/papers.cfm

• Talking Points (e.g., Part D, Assisted Living, Quality Improvement, Culture Change, Liability, Medical Director Tag)– www.amda.com/members/managementtools/amda_talking_points.pdf

• State Chapter Fact Sheets– www.amda.com/governance/statechapters.cfm

• Government Affairs Team– (410) 740-9743– Kathleen Wilson, PhD: kwilson@amda.com– Gaby Geise: ggeise@amda.com– Alex Bardakh: abardakh@amda.com

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Additional Resources

• Role of States in Health Policy    – National Academy for State Health Policy– www.kaiseredu.org/tutorials/StateHealth/

player.html– www.kaiseredu.org/tutorials_index.asp

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What else can we do for you?

• Tell us what else we can do to assist you.

• Contact Kathleen at kwilson@amda.com or (410) 992-3120.

• Contact Gaby at ggeise@amda.com or (410) 992-3145.