AANA Federal Government Affairs
HOTLINE
Number 2007-24 -- Week of Monday, December 17, 2007


In This Issue:


* Omnibus Appropriations Bill Includes Increase for APN Education Funding
* Senate Looks to “Bare-Bones” Medicare Fix, Might Not Include Teaching Rules Fix
* New GAO Report Shows Shortage of CRNAs in VA System, Encourages Changes in Pay
* Senate Committee Passes Pain Legislation for Veterans
* Lt. General James Peake Confirmed as New VA Secretary
* Amendments



>> Omnibus Appropriations Bill Includes Increase for APN Education Funding


An end-of-Congress Omnibus Appropriations Bill includes a modest increase in Title VIII nursing education funds, rather than a substantial cut as was requested in the Administration’s 2008 budget. Most of the increase goes to advanced education nursing, the program to which nurse anesthesia educational programs apply and compete for nurse education and practice grants and traineeships funds.

The package appears likely to be cleared by the Congress and signed by the President by late this week, with the funding “top line” for the whole appropriations omnibus measure coming in at the President’s FY08 budget request. The package includes:

* $156 million for Title 8 nursing workforce development programs represents a $6.4 million increase over 2007 levels, and about $51 million over the President’s budget request.
* $61.8 million for Advanced Education Nursing within that total for Title 8 represents a $4.8 million boost over 2007 levels. The President’s 2008 budget requested $0 for Advanced Education Nursing.

Throughout the year both AANA President Wanda Wilson and Past President Terry Wicks submitted written testimony to the appropriations committees of jurisdiction. Nurse anesthetists, educational program directors, faculty and student nurse anesthetists advocated for CRNA educational funding at AANA Mid-Year Assembly 2007 and throughout the year in CRNAdvocacy grassroots action projects.

Currently, programs funded by the Labor-HHS-Education bill, including CRNA educational funds, continue to be financed by temporary stopgap spending called a “continuing resolution.”

Visit the Rules Committee to read the bill, http://www.rules.house.gov/110_fy08_omni.htm. See the portions relating to “Labor-HHS-Education.”




>> Senate Looks to “Bare-Bones” Medicare Fix, Might Not Include Teaching Rules Fix


The end of the Congressional session appears inclined to yield a “bare-bones” fix to the pending 2008 Medicare Part B payment cut, pending final action on Capitol Hill.

Lawmakers are crafting legislation that aims to reverse a 10% physician fee cut, scheduled to go into effect January 1st, 2008 (CongressDaily, 12/14). With the Medicare agency having published a final rule increasing anesthesia payment 10% already, adoption of a fix to the “sustainable growth rate” formula affecting Medicare Part B would yield a 20% boost to CRNAs’ Medicare payments per service.

However, the route to a fix is not easy, even at this late date. On Friday (December 14th), Senate Minority Leader Mitch McConnell (R-KY) said that any Medicare bill coming to the chamber floor this week must pass by unanimous consent – meaning that zero of 100 Senators could object to either the fix or its financing mechanism. Lead Senate negotiators say that a bill should be completed before the end of this legislative session, but the measure likely will contain only the bare essentials, CQ HealthBeat reports (CQ HealthBeat, 12/14). Senate Finance Committee ranking member Chuck Grassley (R-IA) said that Republicans would only accept a package that alters current policy and will oppose any measure creating new policy. Other reports indicated the fix would provide six months of relief from the cuts, bringing Congress to address the Part B issue again come summer 2008.

A bare-bones Medicare fix would appear to exclude a fix for the Medicare anesthesia payment teaching rules because it may be considered a new policy item and not an extension of current policy, though that outcome is not certain. AANA and CRNAs have been working to fix the teaching rules for both CRNAs and anesthesiologists. A teaching rules fix for both CRNAs and anesthesiologists was included as part of a discussion document between the House and the Senate.

Visit the Senate Finance Committee, http://www.senate.gov/~finance/
Visit the House Ways and Means Committee, http://waysandmeans.house.gov/




>> New GAO Report Shows Shortage of CRNAs in VA System, Encourages Change in Pay
On Thursday (December 13th), the Government Accountability Office (GAO) released, Many Medical Facilities Have Challenges in Recruiting and Retaining Nurse Anesthetists, a report stating that many Veterans Affairs medical facilities have had to temporarily close operating rooms or delay elective surgeries due to a shortage of certified registered nurse anesthetists. CRNAs provide the majority of anesthesia services in VA medical facilities. While demand for their services is increasing, 26% of the CRNAs are projected to retire or leave the department in the next five years. GAO said the recruitment and retention challenges are caused primarily by low salaries compared with local market areas, and recommended the VA train staff on its locality pay system policy to ensure salaries are adjusted as needed to be competitive. The GAO recommends the Department of Veterans Affairs train VA facilities on better use of the agency’s existing locality pay system, so that nurse anesthetists in the VA can be recruited and retained with pay that is closer to market levels.

Read the Report, http://www.gao.gov/new.items/d0856.pdf




>> Senate Committee Passes Pain Legislation for Veterans


On Wednesday (November 14th), the Senate Veterans’ Affairs Committee approved four bills aimed at improving healthcare services for veterans (CongressDaily, 11/15). One bill, the Veterans Pain Care Act of 2007 (S 2160) would require all VA facilities to have a pain management initiative, under which patient pain would be assessed during an initial appointment and tracked during future appointments (CQ Today, 11/14). The VA system is one of the largest employers of CRNAs. The AANA and the AANA Federal Services Ad Hoc Committee continues to monitor the legislation as it makes its way through Congress.

Visit the Senate Veterans’ Affairs Committee, http://veterans.senate.gov/public/
Visit the Department of Veterans Affairs, http://www.va.gov/
View the Pain Management Initiative bills, http://thomas.loc.gov
Click “Bill Number”
Enter “S 2160”




>> Lt. General James Peake Confirmed as New VA Secretary


On Friday (December 14th), the Senate confirmed retired Army Lt. Gen. James Peake as the Department of Veterans Affairs Secretary (CQ Today, 12/14). The VA is one of the largest employers of CRNAs in the country. President Bush said one of Peake’s first tasks will be to implement recommendations of the presidential commission on veterans’ healthcare, led by former Senator Bob Dole (R-KS) and former HHS Secretary Donna Shalala. The recommendations include aggressively treating post-traumatic stress disorder and traumatic brain injury, as well as streamlining VA processes and improving support for families (Detroit News, 12/15). Lawmakers have indicated that they expect swift results from Peake, who comes to the agency “at a time when it faces unprecedented demand for health services from both new and old veterans,” in addition to a “looming backlog of veterans awaiting decisions on their disability claims.” Senate Veterans’ Affairs Committee Chair Daniel Akaka (D-HI) said, “Dr. Peake has a vast challenge before him and narrow time frame to get things done.” He added, “I look forward to working with him to improve the healthcare and benefits veterans have earned through their service, and to provide a seamless transition from military service to veterans’ status.” Bush in a statement said that Peake’s “decades of expertise in combat medicine and healthcare management have provided him with a thorough understanding of the department’s responsibility to care for America’s veterans” (CQ Today, 12/14).

Read more, http://www.detnews.com/apps/pbcs.dll/article?AID=/20071215/NATION/712150347/1022/POLITICS
Visit the Senate Veterans’ Affairs Committee, http://www.senate.gov/~veterans/public/
Visit the Department of Veterans Affairs, http://www.va.gov/
Visit the Department of Defense, http://www.defenselink.mil/




>> Amendments


* The House and Senate will be in session this week. Both the House and the Senate will be in session this week with the House considering the Omnibus Appropriations Bill (HR 2764). Meanwhile, the Senate will continue work on a fix to Medicare Part B reimbursement.

* AANA DC has Moved!! As of December 1st, 2007, our new street address is 25 Massachusetts Ave., NW., Suite 550, Washington, DC 20001. Our telephone, fax number, and email addresses will remain the same.

* How’s Your NPI? In addition to the resources available to CRNAs at www.aana.com, the Medicare agency has posted extensive information on applying for, testing, and using your NPI at www.cms.hhs.gov/NationalProvIdentStand/. Healthcare professionals can apply for the NPI online at https://nppes.cms.hhs.gov. Newly updated information about reliably using your NPI is posted by the Medicare agency at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf .

* Make Plans NOW to Attend the AANA Mid Year Assembly! This year the AANA Mid Year Assembly will be held April 13th-16th in Washington, DC! For more information visit the AANA website at http://www.aana.com.

o 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. © 2007 American Association of Nurse Anesthetists.