The administration’s budget for fiscal year 2017 touched on a lot of Culture of Health themes: In announcing it early this month, President Obama spoke of the need to work to deliver to all a fair shot at opportunity, tackle poverty, boost education, help families move to safer neighborhoods, and revitalize distressed communities. Here are the proposed amounts for nursing and health:
Train More Nurses. $229 million (level funding with FY2016) is provided for the Nursing Workforce Development programs (Title VIII of the Public Health Service Act). This funding goes to train more nurses, advanced practice nurses, nursing faculty and to improve the diversity of the nursing workforce. Approximately $90 million of this will go to graduate-level nursing education. (Below are both a detailed chart of this proposal and key recent achievements of Title VIII programs).
Extend Home Visiting Program. The budget requests $1.3 billion to improve the health of mothers and children by extending and expanding the Maternal, Infant, and Early Childhood Home Visiting program for $15 billion in new funding over 10 years. This would expand access for at-risk families to voluntary, evidence-based home visiting services where nurses, social workers, and other professionals meet with and connect them to assistance to support their children’s health, development, and ability to learn.
Expand Basis for Beneficiary Assignment for Accountable Care Organizations (ACO) to Include Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialists. This proposal allows the Secretary of Health and Human Services to base beneficiary assignment in the Medicare Shared Savings Program on a broader set of primary care providers. Under the proposal, beneficiaries will be assigned to an ACO on the basis of primary care services delivered by nurse practitioners, physician assistants, and clinical nurse specialists (rather than just physicians). This could broaden the scope of ACOs to better reflect the types of professionals delivering primary care services to fee‐for‐service beneficiaries. Some Medicare beneficiaries, especially those in rural or underserved areas, receive most or all of their primary care from non‐physician practitioners. This proposal results in a greater number of Medicare fee-for‐service beneficiaries who rely on these practitioners for their care being assigned to ACOs and is therefore estimated to generate $150 million in savings over 10 years.
Reestablish the Medicaid Primary Care Payment Increase Through Calendar Year 2017 and Include Additional Providers. In an effort to boost primary care, in 2013 and 2014, states were required to reimburse qualified Medicaid providers at the rate that would be paid for the primary care service under Medicare. The federal government covered 100 percent of the difference between the Medicaid and Medicare payment rate. This proposal reestablishes the enhanced rate through December 31, 2017, expands eligibility to obstetricians, gynecologists, and non‐physician practitioners, including nurse practitioners and physician assistants and excludes emergency room codes to better target primary care.
Increase Access to Mental Health Services. Many areas of the country are experiencing a shortage of mental and behavioral services, especially in rural areas. An annual $25 million investment in FY2017 and FY2018 ($50 million total) is part of the $500 million initiative to increase access to mental health services, by investing in enhancing the behavioral health workforce. This includes psychiatrists, psychiatric physician assistants, psychiatric nurse practitioners, health service psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, and psychiatric nurse specialists. This funding will also address increased demands for health care services from an aging population, including mental and behavioral health services.
Continue Nursing Research. The president’s budget also proposes $146 million (level funding with FY2016) for the National Institute of Nursing Research within the National Institutes of Health, which funds the science necessary to improve practice across all communities.
Title VIII Funding Chart (in $millions))
Program FY2016 FY2017
(final) President's Budget
Advanced Education Nursing 64.58 64.58
Nursing Workforce Diversity 15.34 15.34
Nurse Education, Practice and Retention 39.91 39.9
Nurse Faculty Loan Program 26.5 24.6
NURSE Corps 83.14 83.14
TOTAL 229.47 229.47
Key Title VIII Program Accomplishments 2014-2015:
Advanced Nursing Education (ANE). Grantees trained 8,735 nursing students and this exceeded the program’s performance target of 6,255 by 40 percent. This program also produced a total of 2,148 graduates, thereby exceeding the program performance target of 1,485. In addition, 30 percent of students trained were underrepresented minorities and/or from disadvantaged backgrounds, exceeding the performance target of 24 percent. Further analysis showed that ANE grantees partnered with over 4,200 healthcare delivery sites to provide clinical and experiential training. Approximately 45 percent of sites used by ANE grantees were located in a medically underserved community, and 46 percent were situated in primary care settings.
Nursing Workforce Diversity. Trained more than 4,400 students in degree-bearing nursing programs, exceeding the FY2014 target of 2,500 by 56 percent. Approximately 46 percent of students were underrepresented minorities in their respective fields and nearly 82 percent were from educationally or financially disadvantaged backgrounds. This is particularly notable when looking at the current makeup of the nursing workforce, where 91 percent of registered nurses are female, and 79 percent are non-Hispanic white. Of the 999 students who graduated during the academic year, 18 percent intended to apply to advanced nursing degree programs.
Nurse Faculty Loan Program. Supported a total of 2,399 nursing students pursuing graduate level degrees as nurse faculty—exceeding the program’s performance target of 2,200. The majority of students (75 percent) who received loans during the academic year were pursuing doctoral-level nursing degrees (e.g., PhD, DNP, DNSc/DNS, or EdD). Further analyses showed that 20 percent of students who received a loan reported coming from a disadvantaged background, and nearly 25 percent students are considered underrepresented minorities in their prospective professions. A total of 605 trainees graduated and 91 percent of these graduates intend to teach nursing. Further analysis showed that of students who graduated in the previous academic year (2013-2014) for whom data were available, 74 percent obtained a full-time faculty appointment.
NURSE Corps. In FY2015, 55 percent of NURSE Corps Loan Repayment Program (LRP) participants extended their service contracts to commit to work at a critical shortage facility for an additional year, exceeding the 52 percent target; and in FY2014, 90 percent of NURSE Corps participants were retained in service at a critical shortage facility for at least one year beyond the completion of their NURSE Corps LRP/SP commitment.