lioce alabama legislative workshop

Dr. Lori Lioce, CRNP September 30, 2010

Alabama State Nurses Association Legislative Workshop

Update: Alabama’s Health and Legislation

Alabama Statistics Alabama Legislature Overview

State Health Authority Overview Strategies/Issues/Recommendations

Letter Writing NP Update

The question is: Are you concerned about the following issues?

  Safe nurse staffing standards

  Scope of practice

  Prohibition of mandatory overtime

  Safe patient handling – no manual lifting

  Malpractice reform

  Reimbursement

  Nursing education funding

  Public health funding

  Continuing education

  Funding for uninsured

  Monetary/scholarship support for nursing education, certification, and training

  Licensure issues

  Nurse retention/shortage

  Health care access

  Safe work environment

ALABAMA OBESITY (49th/32.2%)

ALABAMA LACK OF INSURANCE (18th/11.9%)

ALABAMA CHILDREN IN POVERTY (47th/27.3 %)

ALABAMA SMOKING (41st/22.2%)

Alabama Medicare Patients w/ ICU stay in last 6

months: AL 38%

AL Health

Rankings (-0.546)

States with

+ Changes 2008-09

Alabama’s Infant

Mortality 2009

48th

Alabama All

Determinants vs. US

43rd

ALABAMA OVERALL (48th)

Alabama vs. U.S.

All Outcomes 2001-09

49th

Alabama Legislature Facts Quadrennium (4-year period)

1st Year: 1st Tuesday in March 2nd Year: First Tuesday in February 3rd Year: First Tuesday in February 4th Year: 2nd Tuesday in January

Regular Annual Session   No more than 30 Legislative (meeting) days, within a

105 Calendar day period   Tuesdays/Thursday Sessions   Committee Meetings on Wednesdays.

Alabama House & Senate   Standing Committee Meetings – open to public   Call ahead to meet with Legislators   ALISON   Galleries: Senate 8th & House 6th Floor

Alabama State Legislature   11 South Union Street

Montgomery, AL 36130 Senate: (334) 242-7800 House: (334) 242-7600

Alabama State Senate (7th Floor)

Secretary of the Senate & Senate Staff (7th Floor)

Senate Gallery (8th Floor)

Senate Committee Meeting Rooms (6th & 7th Floors)

Lt. Governor (7th Floor)

House of Representatives (5th & 6th Floors)

Clerk of the House & House Staff (5th Floor)

House Gallery (6th Floor)

House Committee Meeting Rooms (6th Floor)

Speaker of the House (5th Floor)

Legislative Reference Service (6th Floor)

Legislative Fiscal Office (6th Floor)

Legislative Reapportionment Office (8th Floor)

Joint Briefing Room (8th Floor)

Governor's Legislative Office (2nd Floor)

State Budget Office (2nd Floor)

Attorney General (3rd & 4th Floors)

State Representatives (House)   105 Members each represent ~40K   4 year term (no limit)   Must be 21 and citizen for 3 years   Lived in their District for 1 year   Revenue raising matters must originate in the House (like US

Congress).   Quorum of 53 members to conduct business   Majority of quorum can pass any bill except a constitutional

amendment, which requires 63 votes   Appropriation to a non-government organization such as a private

college requires a two-thirds vote of those elected   Exclusive power to originate revenue bills, such legislation can be

amended and/or substituted by the Senate

House Districts

Alabama Senate 35 Senators representing 125,000 Alabamians

  Must be 25, Citizen for 3 years and lived in their District for 1

  4 year term (midnight day elected)

  Governor fills vacancy

The Senate is considered to be the "deliberative body", rules concerning length of debate are more liberal than those of the House of Representatives.

Alabama Senate is precisely one-third the size of the House of Representatives

Lieutenant Governor of Alabama is ex officio President of the Senate

Elects President Pro-Tempore (for a time)

Article IX, Sections 197 and 198

ALABAMA LEGISLATURE PASSAGE OF A HOUSE BILL

Introduction in the House, first reading, and referral to appropriate

committee.

Committee hearings, discussion, etc. Bill may die in committee from

lack of action or by vote.

Reported from committee, second

reading, and placement on calendar.

Amendments, debate, third reading and vote on

passage.

If bill passes, it is sent to the Senate. If not, bill may

receive no further consideration, unless

reconsidered.

SENATE BILL PASSAGE

First reading and referral to appropriate committee in the

Senate.

Committee hearings, discussion, etc. Bill may die in committee from lack of action or by vote.

Reported from committee, second reading, and placement on

calendar.

Amendment, debate, third reading and vote on passage. If it

fails to pass, it may receive no further consideration, unless

reconsidered.

If Bill passes… In identical form by both houses, it is returned to House, enrolled, signed by presiding

officers of both bodies, and sent to the Governor.

With a Senate amendment and the House concurs, it is enrolled, signed by presiding officers of both bodies, and sent to the Governor.

With a Senate amendment and the House does not concur, bill may be sent to conference committee composed of members of both bodies.

And Conference committee agrees to a compromise, report of conference committee is sent to both bodies. If not, bill dies from lack of action or another conference committee may be appointed to try to resolve differences.

And both bodies accept compromise, bill is enrolled, signed by the presiding officers of both bodies, and sent to the Governor.

BILL BECOMES LAW

If Governor signs;

If Governor fails to sign while Legislature

is in session, as provided by the Constitution; or

If, having been vetoed by Governor, it is re-passed by a majority

vote of both bodies. If not re-passed, bill is

dead.

Alabama Statistics Alabama Legislature Overview

State Health Authority Overview Strategies/Issues/Recommendations

Letter Writing NP Update

Nursing

Association

•  ASNA •  NPAA •  ALANA •  Coalition •  Black Nurses Association •  Schools Nurses •  ENA •  AANS •  NLN

Medical Association

•  MASA •  ALAPAC

AL Health

Regulation

•  BME •  Dept. of Public Health •  MASA •  ABON •  Joint Committee

Nursing 65,000 <3%

1500

Medicine 7,000 >90%

6200

DPH

BME

MASA

Legislature

NPAA

ASNA

Coalition

"The Board functions through the State Committee of Public Health as constituted by Code of Ala. 1975, §2224, which is composed of 12 members of the Medical Association of the State of Alabama and the chairman of each of four councils provided for by statute. The 16 members function under the leadership of a chairman and a vice chairman elected by the membership for a term of four years.” [2]"The State Committee of Public Health meets monthly. Agendas are available to any interested persons not less than seven days in advance of the meeting, if available, in accordance with the Alabama Open Meetings Act. All meetings will be open to the public unless closed in accordance with the Alabama Open Meetings Act." "Minutes of the Committee meetings are prepared and are available at the Board of Health offices for inspection during regular business hours."

Duties of the Board: Certify that initial applicants meet the statutory requirements for a license to practice medicine or osteopathy or as assistants to physicians in Alabama. Issue Alabama Controlled Substances Certificates and annually renew. With the Alabama Board of Nursing, approve applications for collaborative practice in Alabama. Investigate and review complaints against practitioners and pursue disciplinary action when appropriate. Establish and review compliance with continuing medical education requirements for physicians and assistants to physicians. Duties of the Commission: Issue licenses for physicians to practice medicine or osteopathy in Alabama and annually renew licenses. Adjudicate formal charges brought by the Board against physicians and determine appropriate disciplinary resolution.

MASA ALAPAC

Understanding the State Legislative Process

How a Bill Becomes Law

Development of an Effective Chapter Legislative Program

Interacting With Your State Legislators

How to Introduce Legislation

Key Contact Program

Working With a Professional Lobbyist

Working With Your State Medical Society

Building Successful Coalitions

Campaign Involvement

State Political Action Committees

Legislative Receptions

Nurse-of-the-Day Programs

Nursing Resolutions and Proclamations

Regulatory Agencies

The Mini-Internship Programs

The Legislative Seminar

Media Relations

Alabama Statistics Alabama Legislature Overview

State Health Authority Overview Strategies/Issues/Recommendations

Letter Writing NP Update

Let’s Write! Structure of the letter should include:

  The focus of your letter (preferably an action statement informing your legislator what you want done).

  If a bill, identification by name and number.   Your credentials or why you have special knowledge about

the issue.   Major consequences of the proposed legislation.   Rationales for your point of view (facts and statistics).   Observations, personal anecdotes, or concrete examples

supporting your rationales.   A reiteration of what you want the legislator to do (vote yes,

vote no, introduce legislation, encourage others to act).   The effects proposed legislation will have on constituents

(not just nursing).   A request for your legislator's response (you are entitled to

this information).

Alabama Department of Public Health C/O Dr. Donald E. Williamson

P.O. Box 303017 Montgomery, AL 36130-3017

Alabama State Legislature OR Alabama State House Senator ____ OR Representative _____

11 South Union Street   Montgomery, AL 36130

Where are

Alabama

Nurses

now?

FEDERAL SUMMARY The Affordable Care Act: Immediate Benefits for Alabama

Improved Access to Care   Patients’ choice of doctors will be protected   Strengthening community health centers   More doctors where people need them Consumer Protection   New consumer protections in the insurance market when families

renew or purchase coverage on or after September 23, 2010 Coverage Expansion   New Medicaid options for States   Support for early retirees   Extending Coverage to Young adults   Small Business Tax Credits   Affordable Insurance for pre-existing conditions Support for Seniors   Closing Medicare Part D donut hole (gaps)   Free preventative services (804,000 Alabama enrollees)

Political Candidate Endorsement Criteria

Alabama RN Legislators: April Weaver

(Bibb County 49th District) Focus on Healthcare   Protect healthcare rights for

seniors   Fight for lower prescription drug

costs   Work for choice for Healthcare

providers   Fight O’Bama-care   Continue her support of the

healthcare industry

Alabama Nurses Nationally

Paula Gasser, MSN, RN – ANA CNPE 2010-2012 Lori Lioce, DNP, CRNP – ANA PAC Board of Trustees

Donna Herrin, PhD, RN – Immediate Past President AONE Fay Raines, PhD, RN – Immediate Past President AACN Richard Brown, CRNP, JD - Alabama State Rep to AANP Cindy Cooke, MSN, CRNP - Region 11 Director AANP

Alabama Challenges 1.  How will the state adjust to changes in the federal rules? 2.  Will Alabama be able to expand managed care—in both the

private and public sectors—in a way that does not under- mine the safety net?

3.  Insurance Monopoly 4.  Will the state reduce reimbursement rates, and what will be

the consequences of doing so? 5.  Concierge Medicine 6.  Legislature 7.  Public Interest 8.  Nursing Advocacy - organization 9.  Scope of Practice

DID you know?   ASNA/NPAA members sent over ____ emails to

legislators in through our online email system?   Nearly _____ members participated online in

lobbying their elected leaders?   Over ____ nurses and nursing students flooded

Montgomery on Nurse Legislative Day?   Over ____ members connected to their legislators

through ASNA/NPAA phone call program?   WERE YOU ONE OF THEM?

Why should YOU get involved?

 Alabama is in a healthcare crisis  Nurses Make-up the largest number

healthcare providers in this state  Our job is to ADVOCATE for our patients,

families, friends  Public Policy priorities MUST include

ensuring full-scope of nursing practice and addressing the nursing shortage in our State.

How can you make a difference in Alabama?

1. Donate to NPAA or ASNA Political Action Committee 2. Participate: Calls, Emails, Letters 3. Please ask your physician to write a letter to Don

Williamson, Director of Public Health supporting Nurse Practitioners use in Public Health

*Send a copy to NPAA President: lorilioce@comcast.net

4. Please submit a story at www.alabamanp.com 5.  Set up a meeting for an NPAA Officer and you to meet with

any of the physicians on the BME or Committee on Public Health.

Participation Opportunities

ASNA District Committees ASNA Governmental Health Committee

Board of Directors local & national

ASNA Annual Legislative Day MARCH 9 Nurses Day at the Capitol

Letters and Connections Document patient issues www.alabamanp.com