1. Alabama State Nurses Association
Legislative Workshop
Update: Alabama’s Health and
Legislation
Dr. Lori Lioce, CRNP
September 30, 2010
2. Alabama Statistics
Alabama Legislature Overview
State Health Authority Overview
Strategies/Issues/Recommendations
Letter Writing
NP Update
3. 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
14. 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.
15. 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
16. 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)
17. 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
19. 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
20. ALABAMA LEGISLATURE
PASSAGE OF A HOUSE BILL
Introduction in the Committee hearings, Reported from
House, first reading, and discussion, etc. Bill may committee, second
referral to appropriate die in committee from reading, and placement
committee. lack of action or by vote. on calendar.
If bill passes, it is sent to
the Senate. If not, bill may
Amendments, debate,
receive no further
third reading and vote on
consideration, unless
passage.
reconsidered.
21. SENATE BILL PASSAGE
First reading and referral to Committee hearings, discussion,
appropriate committee in the etc. Bill may die in committee
Senate. from lack of action or by vote.
Amendment, debate, third
reading and vote on passage. If it
Reported from committee, second fails to pass, it may receive no
reading, and placement on further consideration, unless
calendar. reconsidered.
22. 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.
23. ES LAW
BEC OM
B ILL
If, having been vetoed
If Governor fails to
by Governor, it is re-
sign while Legislature
passed by a majority
If Governor signs; is in session, as
vote of both bodies. If
provided by the
not re-passed, bill is
Constitution; or
dead.
24.
25. Alabama Statistics
Alabama Legislature Overview
State Health Authority Overview
Strategies/Issues/Recommendations
Letter Writing
NP Update
26. • ASNA
• NPAA
• ALANA
Nursing • Coalition
• Black Nurses Association
Association • Schools Nurses
• ENA
• AANS
• NLN
Medical • MASA
Association • ALAPAC
• BME
AL Health • Dept. of Public Health
• MASA
Regulation • ABON
• Joint Committee
27. Nursing 65,000 Medicine 7,000
<3% >90%
1500 6200
Legislature
Coalition
MASA
ASNA
BME
NPAA
DPH
28. "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."
29.
30. 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.
34. 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
35.
36. Alabama Statistics
Alabama Legislature Overview
State Health Authority Overview
Strategies/Issues/Recommendations
Letter Writing
NP Update
37. 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).
38. 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
40. 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)
45. 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
46. 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
47. 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
48. 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?
49.
50. 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.
51. 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.
52. 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
