The past year has been a busy and c...

The past year has been a busy and challenging time for nursing and health care issues. Given the continuing rise in health care richnesss and the shortage of foments and other health care workers, 2001 promises to bring equal or greater challenges. This array of less front than depth will review AORN's legislative priorities, federal and state legislative activity in the past year, and expectations for the future

AORN's restraint Affairs Department continues to focus onward the four priorities recommended by the agency of AORN's Legislative Committee and approved on the AORN Board of Directors in October 2000

* Ensuring the supervisory demeanor of the professional RN in the perioperative arena and promoting AORN's position that "Every surgical patient merits a perioperative nurse"; AORN will make secure that all state laws and regulations require an RN simply to circulate.

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

* Supervision and regulation of assistive personnel

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

KEEPING THE RN IN THE OR

At pres time, the Health Care Financing Administration (HCFA) had not made a decision about the propos authority change to remove prescriptive language requiring RN in the OR, which initially was propos in December 1997 This propos command change applies to hospitals and ambulatory surgery center that receive reimbursement from Medicare and Medicaid. AORN met with HCFA representatives in November 2000 to provide last-minute information that HCFA may ne to release the final authority See the July 2000 AORN Journal for a chronology of AORN activities.

Nurse-to-patient ratios. At the state on a level in October 1999, Gov Gray Davis (D-Calif) signed Assembly Bill 394 making California the first state to require nurse-to-patient ratios by dint of licensed nurse classification and hospital unit, including the OR. The legislation requires minimum staffing on a levels of RNs and licensed practical and vocational nurtures (LPNs and LVNs) for all patient care units in acute care facilities. The bill also prohibits hospitals from assigning unlicensed personnel in lieu of an RN to perform nursing functions or from allowing unlicensed personnel to perform certain functions subject to the direct supervision of an RN The bill instructs the California Department of Health (DOH) to adopt regulations that establish nurse-to-patient ratios from Jan 1, 2001. Assembly Bill 1760 signed by way of Gov Davis in July 2000 stretch outed the date for adoption of these ratios to Jan 1 2002 view the November 2000 AORN Journal for more information.

AORN's position. Based forward a charge from the AORN Board of Directors, an AORN task force comprising members of the Legislative and Nursing Practice Committees lately developed an official statement regarding nurse-to-patient ratios. The Board of Directors approved this statement in October, and it now will travel before the AORN House of Delegates at the 2001 Congres in Dallas. The statement affirms AORN's position that the same RN shall be assigned to each patient during surgery and that each patient undergoing surgery shall be provided with an RN in the circulator character More information about this statement will be available in the January 2001 AORN Journal.

REIMBURSEMENT FOR RNFAS

At the federal even on March 14, 2000, Rep Mac Collins (R-Ga) formally introduced HR 3911 the Certified Registered succor First Assistant Direct Reimbursement Act. This legislation provides Medicare reimbursement at 136% of the surgeon's absolute title [i]or[/i] posession to CRNFAs for their surgical first-assisting services. The bill has 22 cosponsors who continue to lobby for its inclusion in an appropriate health legislative vehicle. Rep Bill Thomas (R-Calif) prayered that the Congressional Budget Office "score" the bill (ie, assess its impact onward a budget). This is an important degree as only bills that are scored can begin moving in consequence of the legislative process.

Substitute bill. in succession Oct 3, 2000, a substitute bill, the Medicare Refinement and Benefits Improvement Act of 2000 unanimously passed in the health subcommittee of the US House of Representatives Ways and Means Committee. Rep Collins contacted Rep Thomas, subcommittee chair, up to the final minutes of its passage to master HR 3911 added to this substitute bill. Rep Thomas ended to its inclusion based in succession his belief that the substitute bill was not the appropriate vehicle for HR 3911 He did agree, however, to add language to the substitute bill--known as a Balanced store Act or "BBA giveback bill"--that directs the comptroller general of the United States, as the head of the general accounting office, to escort a study on how reimbursement of CRNFAs will affect the Medicare connected view and its beneficiaries. According to the bill, the comptroller general shall consider the following in the study:

* any impact upon the quality of care furnished to Medicare beneficiaries by dint of reason of CRNFA coverage,

* appropriate education and training requirements for CRNFAs who furnish first-assisting services, and