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North Carolina Emergency Nurses Association

ENA Government Relations Washington Update

Posted 6 months ago by Karen Drum

July 15, 2018 

ENA Government Relations

Appropriations Committees Advance Spending Bills, ENA Priorities Included

Both the House and the Senate continue to work to approve spending levels for fiscal year 2019. On June 28, the Senate Appropriations Committee approved spending levels for health programs that included a number of ENA priorities. Under the proposal, the National Institute for Nursing Research would see a $5 million increase, compared to just $1.9 million currently proposed by the House. Additionally, Title VIII Nursing Workforce Development programs would be level-funded at around $250 million under the Senate proposal, while the House proposal would cut the program by $8 million.

Regarding other ENA priorities, the House and Senate are more closely aligned. Under both bills, the Emergency Medical Services for Children program would receive $22.3 million, an increase of around $2.3 million. Likewise, poison control centers under the House and Senate proposals would receive an additional $2 million. This would bring total federal support for the nation's 55 regional poison control centers to approximately $23 million. Neither bill has been approved by the full House or Senate, and both chambers must agree on identical spending levels before they can be signed into law. Congress and the President have until September 30 to act or face another government shutdown.

House Opioids Package Addresses ED Treatment, Poison Control

On June 22, the House of Representatives approved a package of more than 50 bills as the latest effort to fight an opioid overdose epidemic that took more than 42,000 American lives in 2016 alone. The SUPPORT for Patients and Communities Act (H.R. 6) includes three ENA-supported measures to address treatment in the ED and provide continued support for our nation's poison control network.

The Preventing Overdoses While in Emergency Rooms Act (POWER Act, H.R. 5176) would authorize federal funds for facilities to develop protocols for discharging patients after a non-fatal overdose that improve coordination of community-based treatment for those patients. The Alternatives to Opioids in the ED Act (ALTO ED Act, H.R. 5197) would establish a demonstration program in which grants would be awarded to hospitals and EDs to develop, study and improve alternative pain management protocols with the goal of reducing opioid use in the ED. Finally, the SUPPORT Act includes language from H.R. 5329, the Poison Center Network Enhancement Act, that calls for continued federal funding to maintain and support the national poison control hotline, as well as the nation's 55 regional poison control centers. All three bills previously passed the House of Representatives by voice vote on June 12.

ED Overcrowding Indicative of Systemic Issues, Study Says 

Emergency department overcrowding causes increased waiting times, increased ambulance diversion, longer lengths of stay, increased medical errors, increased patient mortality and a negative financial impact to hospitals due, a study published in Revista Médica Clínica Las Condes states. Medicaid expansion was predicted to lead to fewer Medicaid patients accessing EDs for primary care. Instead, the opposite has occurred. In the states that expanded Medicaid coverage under the Affordable Care Act, EDs have seen an increase in Medicaid patients, according to a study published in the Annals of Emergency Medicine. That is a contributing factor to ED overcrowding, but certainly not the only factor.

The Revista Médica Clínica Las Condes study concluded that ED overcrowding is created primarily by institutional overcrowding-that when beds are not available for patients in other parts of the hospital, ED boarding of admitted patients becomes inevitable. The study has several recommendations for institutions to rectify the overload, but also has suggestions for EDs. Among them are: perform patient registration at the bedside rather than in the front of the ED, add a hospitalist to focus on bed management, analyze throughput and ensure staff is scheduled appropriately.

ENA President-Elect Joins Other Experts for D.C. Panel on Opioids

On June 28, ENA President-Elect Patti Kunz Howard, PhD, RN, CEN, CPEN, TCRN, NE-BC, FAEN, FAAN, participated in a panel discussion on "Modernizing Opioid Addiction Treatment Protocol: Emergency Departments As a Point of Care," that centered on the role of the emergency department in addressing the opioid epidemic. This included the concept of "warm-handoff," whereby patients who are discharged from the ED following a non-lethal overdose are linked to critical community resources for additional care, counseling and support. Establishing these links and providing a seamless transition to further care can significantly improve the likelihood of patients of adhering to a treatment plan.

President-Elect Howard provided an overview of the warm-handoff from the ED's perspective, describing the various community partners that should be involved, including social workers, substance abuse counselors and behavioral health specialists. "Emergency department professionals, no matter who you talk about, are all about linking patients to care," Howard said. However, she mentioned it is often the scarcity of community resources that prevents warm-handoff from occurring more consistently. Other panelists included the executive director of the Narcotics Overdose Prevention & Education (NOPE) Task Force, the Secretary of Pennsylvania's Drug and Alcohol Programs, an emergency physician, and a representative from a Pennsylvania-based insurer.

Federal Advocacy Update: ENA Priority Legislation

Here you will find monthly updates on the status of bills that are of priority concern or focus for ENA. We will utilize this section to provide basic information such as new cosponsors that have signed on in the last month or updates on the status of the bill's movement through Congress. When bills are first added, existing cosponsors will be listed. Following, you will see only new cosponsors listed monthly. You may review the legislation and a complete list of cosponsors by clicking the link provided.


Health Care Workplace Violence Prevention Act

House (H.R. 5223)

Sponsor:    Rep. Khanna, Ro [D-CA]

New Cosponsors                           Party/State/Dist.                 Date Added

Rep. Brown, Anthony                  [D-MD-4]                                   7/11/2018

Status:                      This bill currently awaits action in the House Energy & Commerce, Education & Workforce, and Ways & Means Committees



House (H.R. 880)

Sponsor: Rep. Burgess, Michael [R-TX]

Status:                      This bill was passed in the House of Representatives on February 26, 2018 by voice vote 

Senate (S. 1022)

Sponsor:     Sen. Isakson, Johnny [R-GA]

No new cosponsors since June 6, 2018

Status:                        A modified version of MISSION ZERO was approved by the HELP Committee as part of reauthorization of the Pandemic and All-Hazards Preparedness Act reauthorization bill on May 23, 2018.


Stop, Observe, Ask, Respond (SOAR) to Health and Wellness Act

House (H.R. 767)

Sponsor: Rep. Cohen, Steve [D-TN]

No new cosponsors since September 13, 2017

Status:                       This bill was passed in the House of Representatives on February 26, 2018 by voice vote

Senate (S. 256)

Sponsor:     Sen. Heitkamp, Heidi [D-ND]

No new cosponsors since June 12, 2018

Status:                        This bill awaits action by the Senate HELP Committee


Air Ambulance Quality and Accountability Act

House (H.R. 3780)

Sponsor:        Rep. Hudson, Richard [R-NC]

No new cosponsors since June 8, 2018

Status:                        This bill currently awaits action by the House Energy & Commerce and Ways & Means Committees

Senate:                       Please note there is currently no Senate companion for H.R. 3780


Good Samaritan Health Professionals Act

House (H.R. 1876)

Sponsor: Rep. Blackburn, Marsha [R-TN]

New Cosponsors                        Party/State/Dist.                        Date Added

Rep. Barr, Andy                          [R-KY-6]                                    6/13/2018

Rep. Graves, Tom                       [R-GA-14]                                  6/19/2018

Rep. Mooney, Alexander             [R-WV-2]                                   6/19/2018

Rep. Palazzo, Steven                   [R-MS-4]                                    6/19/2018

Rep. Walorski, Jackie                  [R-IN-2]                                     6/19/2018

Rep. Brady, Robert                      [D-PA-1]                                    6/25/2018

Rep. Tipton, Scott                        [R-CO-3]                                    6/25/2018

Rep. Cook, Paul                          [R-CA-8]                                    7/6/2018

Rep. Smith, Adrian                      [R-NE-3]                                    7/11/2018

Status:                        Passed by House Energy & Commerce Committee on February 14, 2018

This bill awais action by the House of Representatives

Senate (S. 781)

Sponsor: Sen. Cassidy, Bill [R-LA]

No new cosponsors since June 14, 2018

Status:                        This bill currently awaits action by the Senate HELP Committee