AANA Federal Government Affairs
THE HOTLINE
Number 2009-12 -- Week of Monday, June 1, 2009

 In This Issue:

 *   Senate VA Committee Votes to Lift Cap on Pay for VA CRNAs, Following AANA &
     AVANA Request
*   Medicare Agency Posts Online Its New Interpretive Guidelines for Ambulatory
     Surgical Centers
*   AANA Submits Further Comments to Senate Finance Committee on Healthcare
     Options
*   As Congress Returns, All Eyes on Healthcare Reform
*   Amendments




>> Senate VA Committee Votes to Lift Cap on Pay for VA CRNAs, Following AANA &
     AVANA Request

 On Thursday (May 22nd), the U.S. Senate Veterans Affairs Committee approved S 252 (Akaka, D-HI), a measure that among other things lifts the statutory cap on pay for VA CRNAs so that the agency will have a better shot at recruiting and retaining nurse anesthetists.  Developed with the support and involvement of the AANA and the Association of Veterans Affairs Nurse Anesthetists (AVANA), the important provision is:

 Title I. Department Personnel Matters

Sec. 101. Enhancement of authorities for retention of medical professionals.

(j) Exemption for Certified Registered Nurse Anesthetists From Limitation on Authorized Competitive Pay- Section 7451(c)(2) is further amended by adding at the end the following new sentence: `The maximum rate of basic pay for a grade for the position of certified registered nurse anesthetist pursuant to an adjustment under subsection (d) may exceed the maximum rate otherwise provided in the preceding sentence.'.

The measure has been a long project for AANA and AVANA.  A 2007 Government Accountability Office (GAO) study in which AANA and AVANA were deeply engaged showed in close detail how the agency’s compensation structure for CRNAs and other healthcare professionals was badly hindering its recruitment and impeding its ability to provide care for our Veterans.  There is a House companion measure, HR 919 (E.B. Johnson, D-TX).  The AVANA presented testimony to both the House and Senate Veterans Affairs health panels, most recently in 2008.   

The Legislation will now go to the Senate floor for consideration sometime during the 111th Congress.  Currently, there is no date for consideration on the floor calendar, although, the AANA expects the legislation to move sometime soon.  The House companion bill is still being considered in committee.

 Read the 2007 GAO Study, click here
Read the 2008 AVANA Testimony, click here
View the bill, click here
     Click “Bill Number”
     Enter “S 252”
     Enter “HR 919”




 >> Medicare Agency Posts Online New Interpretive Guidelines for Ambulatory Surgical
     Centers

 The Centers for Medicare & Medicaid Services (CMS) has now posted online its comprehensive update of the interpretive guidelines to the Medicare conditions for coverage of ambulatory surgical centers (ASCs).  The document, which is effective May 18 and will be used by Medicare surveyors inspecting ASCs in the U.S., includes many provisions critical to CRNAs providing care in ambulatory settings.  Addressed in a previous issue of the AANA Federal Government Affairs Hotline, the document is under detailed review by AANA for impacts on CRNA practice.

“This new document includes newly-effective provisions AANA and CRNAs had sought that will help lower barriers to ASCs’ use of CRNAs,” said AANA President Jackie Rowles, CRNA, MBA, MA, FAAPM.  “However, it also includes many pages of interpretive guidelines that were not available for advance public review and comment before they were published.  Some of these new guidelines certainly raise concern.  The AANA is evaluating each of them, and will be communicating with the Medicare agency to protect and advance the interests of CRNAs and our patients.”

Of specific interest to CRNAs within the 167-page document, pages 50-60 of the revisions address the conditions for coverage for surgical services (42 CFR §416.42), anesthetic risk and evaluation (§416.42(a)), administration of anesthesia (§416.42(b)), and application of the opt-out process from physician supervision of CRNAs (§416.42(c)).  Previous regulatory language had required that only a physician could examine ASC patients for recovery from anesthesia prior to discharge.  New provisions at §416.42(a) ensure that a CRNA can provide that service in an ASC, which the AANA had supported, lowering barriers to utilization of CRNAs in ASCs.

Read CMS’ comprehensive update to the Medicare conditions for coverage interpretive guidelines for ASCs, click here




>> AANA Submits Further Comments to Senate Finance Committee on Healthcare
     Options

On Friday (May 22nd), the AANA submitted comments to the Senate Finance Committee in response to the Senate Finance Committee’s May 11, 2009, paper entitled “Description of Policy Options: Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans” (the “Health Care Coverage Policy Paper”).

 AANA President Jackie S. Rowles, CRNA, MBA, FAAPM, submitted comments on the paper educating Congress of CRNAs’ contributions to patient safety and specific major health reform priorities.

In her written statement to the Senate Finance Committee, AANA President Rowles stated, “though the number of nurse anesthesia educational program graduates doubled from 2000 - 2008, the nurse anesthetist vacancy rate remained steady at around 12 percent, due to increased demand for anesthesia services in the aging population, growth in the number of clinical sites requiring anesthesia services, and CRNA retirements. Particularly in rural and medically underserved America, the availability of
CRNA care represents the difference between availability and absence of surgical care, trauma stabilization, invasive diagnostic procedures, labor and obstetrical care, and pain management services. The availability of CRNA services may also mean the difference between the existence or absence of a hospital in a rural community.”

As well, on Tuesday (May 26th), the AANA submitted comments to the Senate Finance Committee in response to the Senate Finance Committee’s May 20, 2009, paper entitled “Description of Policy Options: Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options” (the “Health Care Financing Policy Paper”)

In her written statement to the Senate Finance Committee, AANA President Rowles stated, “With more than 45 million Americans lacking health insurance, expanding coverage must come with the assurance that patients have access to the quality healthcare services they need.  We believe that health reform legislation should promote consumer choice and provider competition, while reducing costs, by including “nondiscrimination” language … such “nondiscrimination” language would prohibit plans from discriminating with respect to the reimbursement of qualified licensed healthcare providers.”

The Senate Finance Committee’s proposal’s [papers] are meant to seek comment to help better shape the upcoming health reform debate.  The AANA will continue to work with Congress to protect and advance nurse anesthesia practice, in the interest of individual patients and the whole healthcare system. 

Read the AANA’s Coverage Comment, click here 
Read the Baucus/Grassley Coverage Options Proposal, click here
Read the Senate Finance Committee Coverage Options Press Release, click here
Read the AANA’s Finance Comment, click here 
Read the Baucus/Grassley Financing Options Proposal, click here
Read the Senate Finance Committee Financing Options Press Release, click here
Visit the Senate Finance Committee, click here




>> As Congress Returns, All Eyes on Healthcare Reform

 On Tuesday (June 2nd), House and Senate members will return to work on crafting health reform legislation that they hope will be ready for floor votes in July. The Senate Health, Education, Labor and Pensions (HELP) Committee will begin meeting to discuss proposals for expanding health insurance to all US residents, and the Senate Finance Committee later in the week will hold private talks to craft their own legislation.  House leaders also will meet this week to work on their plan, according to Stephanie Lundberg, spokesperson for House Majority Leader Steny Hoyer (D-MD).  Over the Memorial Day break, lawmakers participated in many events and discussions related to healthcare.  President Obama also held a conference where he asked supporters to call on lawmakers to reform the healthcare system (San Francisco Chronicle, 6/1).

The HELP Committee has expressed intentions to begin marking up a reform bill on June 16th, according to a copy of the panel’s timeline circulated last week.  As for the House’s schedule for health reform, Hoyer said, “We hope to pass healthcare reform by August,” adding, “That is a target, not a deadline” (CongressDaily, 6/1).

Senate Finance Committee Chair Max Baucus (D-MT) said, “I’m not blowing smoke, reform is coming together.”  He also said, “There are lots of moving parts here, and everything is on the table.  One challenge is education, getting people up to speed, and the other is keeping everybody together, talking together, working together.  Now the rubber is going to start meeting the road.” Baucus added, “We’re going to have to start making choices” (USA Today, 6/1).

 Read more, click here
Also see, click here




>> 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 Transportation Security
     Administration Authorization Act of 2009 (HR 2200).  Meanwhile, the Senate will
     continue work on the Railroad Antitrust Enforcement Act of 2009 (S 146).

*   Mid Year Assembly attendees, don’t forget!  For AANA DC to follow-up with
     legislators on issues you discussed with their offices at the Mid-Year Assembly,
     please ensure that at least one legislator office report has been filed online for each
     office that was visited.  To file and submit the report, please follow the steps below.

     You will need to use the latest version of Internet Explorer or Mozilla Firefox to
     access the online link.
          1. The link to file your 2009 Mid-Year Assembly Lobby report can be found at
              http://capwiz.com/aanadc/lrm/feedback.tt?event=15221.  If your link is pre-
              populated with profile data other than your own, simply overwrite it with your
              personal information.  Click “proceed.”
          2. Based on your login address on the previous screen, your legislator (s) will be
              shown.  If you visited legislators other than the ones from your own district,
              you will also have to add the other legislator names by clicking the link
              “elected official not shown”.  Follow the steps provided and click “add name”.
          3. Check the names of all legislators you want to file reports for and click
              proceed.
          4. Answer the questions on the screen based on the meetings you had.  You will
              need to do a separate report for each legislator.
          5. If you have any comments from your meeting, please write them in the
              comment section at the end of the online report form.
          6. Click “submit” and your report will be filed with the AANA DC office. 
     If you have any questions about filing your lobby reports, please contact Shari
     Dexter, AANA Political Affairs Manager at 202-741-9087 or sdexter@aanadc.com

*   Beat the Clock for CRNA-PAC!  The AANA’s CRNA-PAC is a separate fund, supported
     by AANA members’ voluntary contributions, that builds AANA and CRNAs’ strength in
     Washington by supporting legislators friendly and influential to CRNAs’ federal policy
     issues. Governed by CRNAs, the CRNA-PAC’s annual fundraising campaign is taking
     place right now!  For more information, see www.aana.com/crnapac.aspx, or email
     info@aanadc.com if you have any questions.

*   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 the Monday following 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.  © 2009 American Association of Nurse Anesthetists.