2000-2001 legislative and regulatory update

AORN Journal, Dec, 2000 by Frederick P. Franko

The past year has been a busy and challenging time for nursing and health care issues. Given the continuing rise in health care costs and the shortage of nurses and other health care workers, 2001 promises to bring equal or greater challenges. This column will review AORN's legislative priorities, federal and state legislative activity in the past year, and expectations for the future.

AORN's Government Affairs Department continues to focus on the four priorities recommended by AORN's Legislative Committee and approved by the AORN Board of Directors in October 2000.

* Ensuring the supervisory presence of the professional RN in the perioperative arena and promoting AORN's position that "Every surgical patient deserves a perioperative nurse"; AORN will ensure that all state laws and regulations require an RN only to circulate.

* Medicare reimbursement for certified RN first assistants (CRNFAs) and third-party reimbursement for RN first assistants (RNFAs) in the states.

* Supervision and regulation of assistive personnel.

* Patient and personnel health and safety in the perioperative arena.

KEEPING THE RN IN THE OR

At press time, the Health Care Financing Administration (HCFA) had not made a decision about the proposed rule change to remove prescriptive language requiring RNs in the OR, which initially was proposed in December 1997. This proposed rule change applies to hospitals and ambulatory surgery centers that receive reimbursement from Medicare and Medicaid. AORN met with HCFA representatives in November 2000 to provide last-minute information that HCFA may need to release the final rule. See the July 2000 AORN Journal for a chronology of AORN activities.

Nurse-to-patient ratios. At the state level, in October 1999, Gov Gray Davis (D-Calif) signed Assembly Bill 394, making California the first state to require nurse-to-patient ratios by licensed nurse classification and hospital unit, including the OR. The legislation requires minimum staffing levels of RNs and licensed practical and vocational nurses (LPNs and LVNs) for all patient care units in acute care facilities. The bill also prohibits hospitals from assigning unlicensed personnel in lieu of an RN to perform nursing functions or from allowing unlicensed personnel to perform certain functions under the direct supervision of an RN. The bill instructs the California Department of Health (DOH) to adopt regulations that establish nurse-to-patient ratios by Jan 1, 2001. Assembly Bill 1760, signed by Gov Davis in July 2000, extended the date for adoption of these ratios to Jan 1, 2002. See the November 2000 AORN Journal for more information.

AORN's position. Based on a charge from the AORN Board of Directors, an AORN task force comprising members of the Legislative and Nursing Practice Committees recently developed an official statement regarding nurse-to-patient ratios. The Board of Directors approved this statement in October, and it now will go before the AORN House of Delegates at the 2001 Congress in Dallas. The statement affirms AORN's position that one RN shall be assigned to each patient during surgery and that each patient undergoing surgery shall be provided with an RN in the circulator role. More information about this statement will be available in the January 2001 AORN Journal.

REIMBURSEMENT FOR RNFAS

At the federal level, on March 14, 2000, Rep Mac Collins (R-Ga) formally introduced HR 3911, the Certified Registered Nurse First Assistant Direct Reimbursement Act. This legislation provides Medicare reimbursement at 13.6% of the surgeon's fee to CRNFAs for their surgical first-assisting services. The bill has 22 cosponsors who continue to lobby for its inclusion in an appropriate health legislative vehicle. Rep Bill Thomas (R-Calif) requested that the Congressional Budget Office "score" the bill (ie, assess its impact on a budget). This is an important step, as only bills that are scored can begin moving through the legislative process.

Substitute bill. On Oct 3, 2000, a substitute bill, the Medicare Refinement and Benefits Improvement Act of 2000, unanimously passed in the health subcommittee of the US House of Representatives Ways and Means Committee. Rep Collins contacted Rep Thomas, subcommittee chair, up to the final minutes of its passage to get HR 3911 added to this substitute bill. Rep Thomas objected to its inclusion based on his belief that the substitute bill was not the appropriate vehicle for HR 3911. He did agree, however, to add language to the substitute bill--known as a Balanced Budget Act or "BBA giveback bill"--that directs the comptroller general of the United States, as the head of the general accounting office, to conduct a study on how reimbursement of CRNFAs will affect the Medicare system and its beneficiaries. According to the bill, the comptroller general shall consider the following in the study:

* any impact on the quality of care furnished to Medicare beneficiaries by reason of CRNFA coverage,

* appropriate education and training requirements for CRNFAs who furnish first-assisting services, and