AANA Federal Government Affairs
 THE HOTLINE
 Number 2009-18 -- Week of Monday, August 3, 2009

 In This Issue:

 *   Key House Committee OKs Health Reform (HR 3200) on 31-28 Party-Line Vote,
     Including Moratorium on Pain Care Payment Cuts
*   House Boosts Nurse Funding, Maintains Level Funding for Advanced Nursing
     Education
*   Administration Releases Over $200 Million in Economic Recovery Funding Sought by
     AANA and Nurse Groups for Nurse and Other Healthcare Workforce Development
*   Medicare Inspecting 125 Ambulatory Surgical Centers by Sept. 30, Focusing on
     Infection Control
*   Senate Bill Introduced to Reverse Harmful Medicare Rural Anesthesia Cuts
*   Graduate Nursing Education Bill Backed by AANA Introduced in Senate
*   CBO Estimates Independent Medicare Panel Would Save $2B Over 10 Years
*   Amendments




>> Key House Committee OKs Health Reform (HR 3200) on 31-28 Vote, Including
     Moratorium on Pain Care Payment Cuts

 Late Friday evening (July 31st), the final day before the chamber’s August recess, the House Energy and Commerce Committee voted 31-28 to approve the House reform bill (HR 3200) (New York Times, 88/1).  In addition to promoting CRNA interests in patients’ access to care, fair reimbursement of CRNA services, and reauthorization and funding of nurse workforce development programs in this letter, AANA worked with Reps. Ed Whitfield (R-KY) and Bart Stupak (D-MI) to include an amendment placing a moratorium on interventional pain management payment cuts. 

Five Democrats joined every Republican member of the panel in voting against the bill (The Hill, 7/31).  The Democrats who opposed the legislation, mostly members of the fiscally conservative Blue Dog Coalition, were Representatives John Barrow (D-GA), Rick Boucher (D-VA.), Jim Matheson (D-UT), Charlie Melancon (D-LA) and Bart Stupak (D-MI)Four of the seven Blue Dogs on the panel supported the bill, but only after two weeks of rigorous negotiations with committee Chair Henry Waxman (D-CA) (CQ Today, 7/31).  Last Wednesday (July 29th), Waxman made an agreement with the Blue Dogs to reduce subsidies to low- and middle-income U.S. residents, require the HHS secretary to negotiate reimbursement rates for the public plan with hospitals and physicians and increase the number of small businesses that would be exempt from an employer contribution mandate, among other proposals (American Health Line, 7/30).  The committee-passed changes in public health plan payment likely mean higher reimbursements for CRNA services than did earlier versions of HR 3200.

 Much more work remains to be done on health reform legislation, both in the House and the Senate.  Not only have three committees completed versions of HR 3200 that must be merged into one bill for full House consideration, the Energy and Commerce Committee still has over 60 amendments to address when it returns to work after August break.  Among those possible amendments: an AANA-backed provision to prevent federal preemption of state laws prohibiting health plans from discriminating against health providers like CRNAs.

Read more, click here  
 Also see, click here 
Read more, click here
Also see, click here 
View the bill, http://thomas.loc.gov
     Click “Bill Number”
     Enter “HR 3200”




 >> House Boosts Nurse Funding, Maintains Level Funding for Advanced Nursing
     Education

 On Friday (July 24th), the House passed a $730.5 billion fiscal year 2010 Labor-HHS-Education spending bill (HR 3293) by a 264-153 vote.  The legislation gives a historic boost for Title VIII nurse workforce development programs, and level funding for the Advanced Education Nursing (AEN) program that helps expand and establish CRNA educational programs.  At the request of the AANA, the explanatory report language associated with the bill (HR 3293, H. Rept. 111-220) advises the Division of Nursing to allocate funding specifically for nurse anesthetist education. 

Total funding for Advanced Education Nursing in the measure is $64.4 million for FY 2010, same as in FY 2009 and in the President’s budget.  The total bill represents a $58.9 billion increase from FY 2009 and $1.9 billion more than what President Obama requested.  In addition, $163.4 billion of the bill is discretionary spending, an $11 billion increase from FY 2009 and $1.8 billion more than what Obama requested.

Under the bill, HHS would receive $73.7 billion, $7.4 billion more than its current level and $2 billion more than what Obama requested.  The bill now goes to the Senate Appropriations Committee, where markup is scheduled to begin July 28th (CQ Today, 7/24).  Republicans have criticized the spending in the bill, arguing that it is too high, considering that many of the agencies and programs receiving the money also received funding from the $787 billion economic stimulus package in February.

 Read more, click here 
Read the Report, click here
View the bill, http://thomas.loc.gov
     Click “Bill Number”
     Enter “HR 3293”




 >> Administration Releases Over $200 Million in Economic Recovery Funding Sought by
     AANA and Nurse Groups for Nurse and Other Healthcare Workforce Development

 Some $200 million in federal funding was released July 27 for nurse and healthcare workforce development – funding that AANA and nurse organizations sought and secured through the economic recovery legislation enacted by Congress earlier this year.

According to HHS Sec. Kathleen Sibelius and HRSA Administrator Mary Wakefield PhD RN, $80 million is allocated to scholarships and loan repayments, with half of that for nurse workforce development and nurse faculty, and the other half for other students from disadvantaged backgrounds.  An additional $47 million is allocated for primary care workforce development of physicians, physician assistants, and dentists.  $10 million is provided for public health, another $10 million for healthcare workforce diversity, and some $50 million is provided for equipment for health professions training programs.

Nurse anesthesia educational programs should pay close attention for opportunities to apply for grants from this funding.  According to HHS, some of the funding will be allocated to recipients who had applied for FY 2009 Title 8 or other funds, but whose applications were not awarded money from underfunded programs.  Alternatively, new applications may be accepted for some of this economic recovery funding.

Read more … The Secretary’s news release announcing the funding is here. 
Further important information about funding allocations is here. 




 >> Medicare Inspecting 125 Ambulatory Surgical Centers by Sept. 30, Focusing on
     Infection Control

 Some 125 ambulatory surgical centers (ASCs) are slated for intensive Medicare state agency inspections through Sept. 30, focusing on infection control and including safe injection practice issues in which CRNAs and other anesthesia professionals will get very close looks, according to a statement from HHS July 30.  CRNAs in ASCs can get prepared in advance by being aware of this Medicare initiative, by reviewing their own safe practices to prevent healthcare associated infections (HAI), and also by reviewing Medicare’s detailed HAI prevention survey procedures.

The inspections will focus on factors driving healthcare associated infections, on 125 ASC facilities in the following 12 states:  Arkansas, Florida, Indiana, Kansas, Maine, Maryland, Michigan, New Jersey, North Carolina, Oregon, Utah and Wyoming.  A comprehensive update to Medicare’s conditions for coverage and interpretive guidelines for ASCs released late May 2007 included a detailed survey document for inspectors looking for evidence of practices prone to spreading healthcare associated infections.

Read the HHS statement outlining the initiative here.
Read the Medicare ASC conditions for coverage HAI prevention survey procedures in this 167-page document.  The Infection Control Surveyor Worksheet begins on p. 152 of the PDF (p. 150 of the printed document) and runs 16 pages.
See AANA’s Infection Control Guide and Position Statement 2.13, Safe Practices for Needle and Syringe Use




>> Senate Bill Introduced to Reverse Harmful Medicare Rural Anesthesia Cuts

 Legislation introduced in the Senate Aug. 5 with the support of the AANA would reverse recent Medicare decisions that are cutting Medicare rural hospital reimbursements for CRNAs’ standby or on-call services. 

The Rural Access to Nurse Anesthesia Services Act (S. 1585), was introduced by Asst. Sen. Majority Leader Richard Durbin (D-IL).  It is identical to a House bill (HR 3151) introduced July 9 by Reps. Phil Hare (D-IL) and Timothy Johnson (R-IL). AANA is working with the American Hospital Association to include its provisions in major health reform legislation, and help ensure patients’ access to rural healthcare and to safe anesthesia services.

In introducing his measure, Sen. Durbin recognized the importance of CRNAs.  “For the majority of Critical Access Hospitals, Certified Registered Nurse Anesthetists are the sole providers of anesthesia services. The nurse anesthetists make it possible for these hospitals to offer surgical, obstetrical, trauma stabilization, interventional diagnostic and pain management capabilities. Critical Access Hospitals depend on the work of nurse anesthetists to deliver quality care, even while the hospitals are pressed for resources,” he said.

Read Sen. Durbin’s bill introduction statement here. 
AANA’s letter supporting the identical House measure is here. 




>> Graduate Nursing Education Bill Backed by AANA Introduced in Senate

 A bill to provide Graduate Nursing Education (GNE) funding to hospitals for clinical and other costs associated with education of Advanced Practice Registered Nurses including CRNAs was introduced in the U.S. Senate by Sen. Debbie Stabenow (D-MI).

The bill, S. 1569, is similar to a Graduate Nursing Education measure introduced in the House by Rep. Lois Capps (D-CA), HR 3185, which is also backed by AANA, a coalition of nursing organizations, and the AARP.

In her statement introducing the legislation, Sen. Stabenow said, “At a time when our country faces a shortage of healthcare professionals, funding for the clinical education of APRNs, including nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists, and clinical nurse specialists is vitally important to meet the demand for expanded health care, which is expected under a newly reformed delivery system.”

Read Sen. Stabenow’s introductory statement here. 




>> CBO Estimates Independent Medicare Panel Would Save $2B Over 10 Years

 On Saturday (July 25th), the Congressional Budget Office (CBO) released a report stating that an Obama Administration plan to create an independent advisory council to set Medicare payment rates would save just $2 billion over the next 10 years (Washington Post, 7/26).  Though that sounds like a lot of money, the projected savings is dwarfed by the U.S. healthcare economy that exceeds $2 trillion per year.  AANA is monitoring the prospects for such a panel closely and has raised concerns about aspects of current proposals, because CRNAs are reimbursed through Medicare Part B, just as their physician counterparts are. 

In the report, CBO Director Douglas Elmendorf states that the proposal does not go far enough to guarantee that Medicare costs would decrease, noting that it “does not explicitly direct the council to reduce” Medicare spending, “nor does it establish any target for such reductions.”  He added that the first savings would be realized in 2016 and amount to $2 billion between 2016 and 2019.

White House Office of Management and Budget (OMB) Director Peter Orszag said that the “point of the proposal was never to generate savings over the next decade;” rather, he added, “The goal is to provide a mechanism for improving quality of care for beneficiaries and reducing costs over the long term” (New York Times, 7/26).

Read more, click here
Also see, click here
Read the Report, click here




>> Amendments

*   The Senate will be in session this week, while the House Takes August Recess.  The
     House has adjourned for the Summer District Work Period.  Meanwhile the Senate will
     continue work on the Agriculture, Rural Development, Food and Drug Administration,
     and Related Agencies Appropriations Act, 2010 (HR 2997), sent over from the House

*   Schedule appointments with your legislators now!  Now is the time to make
     appointments with your legislators to educate them on nurse anesthesia issues. 
     Members will be working from their District Offices for the entire month of August …
     often right down the street from where you are now … contact their local office ..
     take them to lunch … go in and visit!

*   The AANA Federal Government Affairs HOTLINE will be on August Recess!!!!  The
     Hotline will next be published on Monday, September 14th,

*   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.

*   See you at AANA Annual Meeting in San Diego!  Come by the AANA Federal
     Government Affairs registration table, and our booth in the convention center, to
     learn about CRNA issues, take CRNAdvocacy action on anesthesia payment teaching
     rules, and support the CRNA-PAC!

*   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.