Looking back on 2002, looking forward to 2003

AORN Journal,  Dec, 2002  by Frederick P. Franko

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Most of AORN's legislative activity in 2002 was related to the priorities in place before the AORN Board of Directors approved a new legislative agenda in August 2002. The 2001-2002 priorities included the following.

* Ensure the supervisory presence of the professional RN in the perioperative arena and promote AORN's position that every surgical patient deserves a perioperative nurse. AORN will ensure that all state laws and regulations require only RNs in the circulator role.

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

* Supervision to and regulation of assistive personnel. AORN supports the establishment of basic educational standards for surgical technologists (STs). In addition, AORN suspends opposition to the registration or certification of STs as long as it is under the state nursing board or equivalent.

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

AORN's updated and expanded legislative priorities for 2002-2003 are listed in this article following the recap of the 2002 legislative session.

KEEPING THE RN IN THE OR

At the federal level, AORN continues to oppose any change to the prescriptive language requiring RNs in the OR in the Centers for Medicare and Medicaid Services (CMS) hospital conditions of participation. The Centers for Medicare and Medicaid Services first announced the proposed elimination of the prescriptive language in December 1997. AORN followed this announcement with an aggressive campaign to retain the prescriptive language. (1) There has been no indication from Tom Scully, CMS administrator, or anyone at CMS that this issue will be considered further at any time in the near future. AORN will continue to monitor this issue. AORN's Department of Government Affairs followed some activity at the state level on the issue of the RN in the OR during the 2002 legislative session.

California. In 1999, California became the first state in the nation to require broad nurse-to-patient ratios with the signing of AB 394. Before AB 394, California already had regulations in place requiring an RN in the circulating role. Although the wording has changed slightly in the proposed regulations implementing AB 394, it still requires one RN assigned as circulating nurse for each patient-occupied OR. (2) The comment period for the regulations proposed to implement the law ends Dec 6, 2002.

Florida. Two sets of companion bills were introduced in Florida during the 2002 legislative session. All four bills (ie, HB 1827/SB 2230, HB 1799/SB 2326) would have set standards for staffing health care facilities. Specifically, they would have required a ratio of one RN to one patient in the OR. All four bills died in committee.

Rhode Island. House Bill 7219 would have required health care facilities' staffing plans to incorporate a 1:1 direct care nurse-to-patient ratio (ie, one perioperative circulating nurse to one patient). The bill did not make it out of the House Committee on Health, Education, and Welfare when the session ended.

Virginia. A member-initiated bill that would require a ratio of one perioperative nurse to one patient in the OR was introduced in Virginia. Although the bill did not pass in 2002, it has been carried over to the 2003 session.

On July 27, 2001, the Virginia Board of Nursing issued a guidance document (ie, 90-42) stating that the RN may not delegate circulating duties to unlicensed personnel. (3) AORN and its members also are following closely the work of the Virginia Board of Nursing concerning a proposed amendment to the regulations governing the practice of nursing. The proposed amendment, which has not yet been approved for public comment, adds "circulating duties in an operating room" to the tasks that shall not be delegated to any unlicensed person. (4)

Washington. Through the hard work of AORN volunteers in Washington, in May 2002 the Washington State Nursing Care Quality Assurance Commission adopted a draft position statement on the RN as circulating nurse in the OR. The statement affirms that it is the RN's role to function as the circulating nurse in the OR. It further states that it is not within the scope of practice of the licensed practical nurse or ST to function as the circulating nurse. (5)

REIMBURSEMENT FOR CRNFAS AND RNFAS

Rep Mac Collins (R-Ga) continues to champion CRNFAs through his ongoing support for CRNFA reimbursement. Rep Collins introduced the Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2001 (ie, HR 822) in March 2001. If passed, HR 822 would mandate reimbursement of CRNFAs at the same rate as other nonphysician providers of first assistant services, who currently are reimbursed at 13.6% of the surgeon's fee. As of Oct 29, 2002, HR 822 had 105 cosponsors. (6) The bill has broad bipartisan support and significant support from two committees with jurisdiction over Medicare.

On Dec 21, 2000, President Bill Clinton signed into law HR 4577 (ie, Public Law 106-554), which includes a provision that directed the General Accounting Office (GAO) to conduct a study on the coverage of surgical first assisting services of CRNFAs. The study is to focus on the impact of quality of care, appropriate education and training requirements, and appropriate rates of payment. Though the legislation requires the GAO to submit the report to Congress no later than one year after the bill's passage, as of press time, the report had not been submitted. Should HR 822 fail to pass during the 107th Congress, the CRNFA Medicare reimbursement legislation would have to be reintroduced during the next Congressional session.