Nurse Training Act (1964), Public

Law 88-581,

provided enhanced funding for collegiate nursing programs.

Expanded university education for nurses, and laid the groundwork for the development of advanced practice nurses (APRNs).

Medicare program (1965) provided funding for health care services for older adults and the disabled.

Led to an increased number of hospitalized older adults and a greater need for nurses in acute care settings.

Renal Disease

Program (1972) provided funding for dialysis treatments and renal transplantation for individuals with kidney failure.

Led to the

development of a new area of nursing practice that is now a recognized specialty- nephrology nursing.

Diagnosis-related groups (DRGs) (1983) changed Medicare reimbursement to hospitals from a fee-for- service method

Forced hospitals to reduce patients' lengths of stay, cut costs, and initially reduced staff, including nurses; led to the development of new nursing roles-nursing case management

to a fixed-fee method.

and utilization review.

Balanced Budget Amendment (1997), Title 42,

provided for direct reimbursement of nurse practitioners (NPs) and clinical nurse specialists, regardless of geographic location, following state nurse practice act requirements for scope and practice.

Expanded the practice opportunities for APRNs, and further increased the importance of political action at the state level to remove barriers to APRN practice, such as medical supervision and other unwarranted limitations on scope and independence.

Medicare

Modernization Act (Medicare Part D) (2003)

added a prescription drug benefit for Medicare enrollees.

Provided needed access to medications for Medicare enrollees, and called attention to cost-and- effectiveness outcome from policymakers, requiring nurses to stay alert to proposed legislation and to advocate for appropriate benefits for the nation's older adults.

Mental Health Parity and Addiction Equity Act (MHPAEA)

(2008) removed discrimination in insurance coverage and benefits for mental illnesses and substance abuse disorders.

Greatly increased access to a continuum of mental health/substance abuse services, and put pressure on development of a nursing workforce with sufficient numbers and knowledge to address these illnesses as integrated with other chronic illnesses and as specialty services.

Patient Protection and Affordable Care Act (2010),

Public Law 111-

148.

Comprehensive health care reform legislation providing a health insurance program requiring U.S. citizens and legal residents to secure quality health insurance at reasonable rates with income-based subsidies while

also providing for provisions to improve the quality of health care and reduce costs.