AANA Federal Government Affairs
HOTLINE
Number 2005-09, Week of Monday, May 02, 2005


In This Issue:

* Following AANA Request, CMS Issues Changes to Problematic Medicare Part A Guidelines
* Mid-Year Assembly: CRNAs and Lawmakers Meet to Discuss Issues
* Congress Approves Budget With $10B in Medicaid Cuts
* CMS Administrator Pushes Committee for Medical Liability Damage Caps
* Amendments




>> Following AANA Request, CMS Issues Changes to Problematic Medicare Part A Guidelines


Following intervention by AANA, the Centers for Medicare & Medicaid Services (CMS) issued changes April 29 to Medicare Part A Hospital Conditions of Participation interpretive guidelines that had raised barriers to CRNA practice, clarifying that individual operating practitioners need not be specifically privileged to supervise CRNAs.

Issues raised by CMS' guidelines and recommendations for change had been brought to CMS' attention at the request and involvement of AANA President Frank Maziarski CRNA MS CLNC. Previous interpretive guidelines from CMS posed problems for CRNAs by calling for hospitals to specifically privilege practitioners for supervising CRNAs, and tightly defining the degree to which operating practitioners were "immediately available" to supervise CRNAs. The issues had posed particular difficulties in some states. Because the guidelines relate to hospital compliance with CMS' Part A supervision requirement (42 CFR Sec. 482.52(a)), the guidelines appeared to leave alone the 13 states which had opted-out of CMS' physician supervision mandate. CMS uses the guidelines to ascertain hospitals' compliance with the Conditions of Participation (CoP) in the Medicare program, through random surveys conducted by state agencies (SAs) and surveys of hospitals not accredited by other entities such as the Joint Commission on the Accreditation of Hospital Organizations (JCAHO).

Interim guidelines issued by CMS April 29, now in effect, include new language which states, "Individual operating practitioners do not need to be privileged to supervise a CRNA." The new language further states, "CMS does not require a second 'operating practitioner' whose function is to supervise the CRNA."

The interim guidelines were addressed in the American Hospital Association's AHA News May 2: "The agency said it has issued interim changes to the guidelines (Tag A-0417) to clarify wording that had confused many hospitals and surveyors until the guidelines can be updated on its Web site. CMS also clarified that physicians do not need
to be specially privileged to supervise someone administering anesthesia, but that the hospital need only spell out in its statement of privileges the type and complexity of procedure that each category of practitioner may supervise. 'We appreciate the clarification,' said Nancy Foster, AHA vice president for quality and patient safety policy. 'This is one of many issues on which hospitals are seeking clarification.'"

AANA federal affairs and practice staff are continuing to analyze CMS' new interim language, and to address Medicare issues that affect CRNA practice. Additional information will be provided to AANA members in
the near future. Further, if issues arise in your state relating to the Medicare interpretive guidelines, please contact the AANA Federal Government Affairs office at info@aanadc.com.




>> Mid-Year Assembly: CRNAs and Lawmakers Meet to Discuss Issues


The AANA held its annual Mid-Year Assembly at the Capitol Hilton in downtown Washington. From April 24-27, 2005, nearly 500 CRNAs (including a record of approximately 100 student nurse anesthetists) stormed Washington, DC, and Capitol Hill. Meeting with over 400 different congressional offices, CRNAs educated legislators and their
staffs on issues relevant to nurse anesthesia including patient safety reporting, nurse anesthesia education, medical liability reform, and keeping Medicare strong.

To notify Capitol Hill of the CRNAs' arrival in Washington, the AANA placed a full-page advertisement in the Roll Call newspaper April 25th.

Senator Blanche Lincoln (D-AR), the 2005 AANA Health Leadership Award Winner, addressed the Mid-Year Assembly. She spoke of issues currently before the 109th Congress. She praised the AANA and asked that CRNAs
continue to work diligently in helping her ensure that healthcare is available to all those in rural areas that are in need. Members of AANA also heard from US Representative Phil English (R-PA). Congressman English praised the AANA and CRNAs for the service they provide to those in need of anesthesia not only here in the United States but also serving abroad.

The Monday evening reception and silent auction received a special surprise when former Senate Minority Leader Tom Daschle (D-SD) made an appearance welcoming all CRNAs to Capitol Hill. Also speaking was Fred Barnes, co-host of Fox News' "The Beltway Boys."




>> Congress Approves Budget With $10B in Medicaid Cuts


On Thursday (April 29th), Congress approved a $10 billion reduction in Medicaid funding over five years as part of a $2.6 trillion fiscal year 2006 budget resolution. The savings amount to about 0.7 percent of the estimated $1.3 trillion in total federal and state Medicaid spending over the affected five-year period. Further, states, not the federal government, determine most Medicaid benefits eligibility and reimbursement.

Medicaid funding is important to CRNAs, especially those working in obstetrical and childbirth settings, since the Centers for Medicare & Medicaid Services (CMS) estimates a third of US childbirths are paid-for by the federal-state joint funded program. In some areas, Medicaid pays a far larger share of childbirths. The approved budget resolution includes Senator Gordon Smith's (R-OR.) request to create a bipartisan commission that would "find ways to eliminate fraud and abuse in the state reimbursement component of Medicaid." President Bush would appoint the Commission members. The House voted 214-211 to approve the budget, which would essentially freeze domestic spending at $391 billion. Several hours later, the Senate passed the budget 52-47 (Washington Times, 4/29). Although the budget resolution is nonbinding, it sets "critical guidelines" for Congress, as it makes spending
decisions for FY 2006, which begins October 1st (Las Vegas Sun, 4/28). The FY 2006 budget would cut $35 billion in growth from entitlement programs (including Medicaid) making it the first budget since 1997 that would reduce entitlement spending (New York Times, 4/29).

Read more,
http://www.washingtontimes.com/national/20050429-124415-9959r.htm

Also see,
http://www.lasvegassun.com/sunbin/stories/bw-cong/2005/apr/29/042908860.html

And finally,
http://www.nytimes.com/2005/04/29/politics/29budget.html?hp&ex=1114833600&en=8d8f99910a27073c&ei=5094&partner=homepage




>> CMS Administrator Pushes Committee for Medical Liability Damage Caps


Medical malpractice lawsuits have contributed to increased healthcare costs, and Congress should pass legislation to cap damages in such lawsuits to help address the issue, Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan, MD, PhD, testified on Thursday (April 29th) at a Joint Economic Committee (JEC) hearing. AANA has backed medical liability reform, recognizing the impact the medical liability insurance crisis has had on patients' access to healthcare, and the impact it might have in the future on CRNAs' liability premiums.

Dr. McClellan said that malpractice lawsuits affect healthcare costs through damage awards, as well as the higher number of diagnostic tests that physicians order to avoid such lawsuits. According to Dr. McClellan, a $250,000 cap on noneconomic damages in malpractice lawsuits proposed by congressional Republicans would "have a direct effect on (malpractice insurance) premiums and would also have an effect on the cost to consumers." Dr. McClellan said that such a cap would result in "5% to 9% decreases in hospital expenditures within three to five
years." However, Senator Jack Reed (D-RI) questioned the relationship between damage awards in malpractice lawsuits and healthcare costs. Senator Reed stated, that based on a Congressional Budget Office (CBO) estimate, a 30% decrease in damage awards in malpractice lawsuits would result in only a 0.5% reduction in healthcare costs (CQ HealthBeat, 4/28).

Read the JEC Chairman's Press Release,
http://www.house.gov/jec/press/2005/04-28-05.htm




>> Amendments


* The House and Senate will be in session this week. The House will be taking up the Federal Deposit Insurance Reform Act of 2005 (HR 1185), while the Senate will be focusing on the Appropriations.

* Representative Tom Osborne (R-NE) will not seek re-election. Congressman Tom Osborne announced during a speech in Nebraska over the weekend that he will not seek reelection to the House of Representatives in 2006. Instead, however, he will be seeking the Republican nomination for the gubernatorial race in Nebraska.

* Nurse Anesthesia Program Recognized on Senate Floor. Senator Daniel Akaka (D-HI) singled out the U.S. Army Medical Department Center and School at Fort Sam Houston, TX, as one of the best nurse anesthesia programs in the country on Wednesday, April 27th in the Congressional Record.

Read Senator Akaka's Statement,
http://thomas.loc.gov/cgi-bin/query/D?r109:5:./temp/~r109zG1G85

Or, http://thomas.loc.gov, click on Congressional Record, click on Senator Daniel Akaka.

* We can report our most successful PAC Cruise ever! CRNA-PAC raised over $26,000 on the cruise and over $4,000 at the silent auction the following night. With yet another sold out cruise where we saw two Larry Hornsby's (or was that David Ware in a wig?) conducting the auction, everyone had a fantastic time bidding on their favorite items or enjoying the sights of Washington, DC at night cruising on the Potomac River. Thanks to everyone who participated and made another AANA PAC cruise memorable.

* For up-to-date Congressional floor & committee schedule information, see http://thomas.loc.gov/.




>> For More Information


The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA each week Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, 202-484-8400,
info@aanadc.com, Frank Purcell, Senior Director. Copyright (c) 2005 American Association of Nurse Anesthetists.

(posted 5-9-2005)