Congressman Mac Collins introduced HR 3911 which is a bill for reimbursement of CRNFAs. At this time there are 16 co-sponsors to the House bill. Please write your Congressman asking them to support HR 3911. HR 3911 is in need of a Senate sponsor. Please write your US Senator asking them to sponsor this bill in the Senate. The language reads as follows:
Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2000 (Introduced in the House)
HR 3911 IH
106th CONGRESS
2nd Session
H. R. 3911
To amend title XVIII of the Social Security Act to provide for coverage under the Medicare Program for surgical first assisting services of certified registered nurse first assistants.
IN THE HOUSE OF REPRESENTATIVES
March 14, 2000
Mr. COLLINS (for himself, Mr. NORWOOD, Mr. HOEKSTRA, Mr. GREENWOOD, Mr. ENGLISH, Mr. DEAL of Georgia, Mr. FOLEY, Mr. LEWIS of Georgia, Mrs. JOHNSON of Connecticut, Mr. WISE, Mr. GOSS, Mrs. CAPPS, and Mr. MCDERMOTT) introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide for coverage under the Medicare Program for surgical first assisting services of certified registered nurse first assistants.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2000'.
SEC. 2. MEDICARE COVERAGE OF SURGICAL FIRST ASSISTING SERVICES OF CERTIFIED REGISTERED NURSE FIRST ASSISTANTS.
(a) SERVICES COVERED- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended--
(1) by striking `and' at the end of subparagraph (S);
(2) by striking the period at the end of (T) and inserting `; and'; and
(3) by adding at the end the following new subparagraph:
`(U) surgical first assisting services (as defined in subsection (uu)(1)) furnished by a certified registered nurse first assistant (as defined in subsection (uu)(2)).'.
(b) SERVICES DESCRIBED- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
`Surgical First Assisting Services; Certified Registered Nurse First Assistant
`(uu)(1) The term `surgical first assisting services' means services consisting of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care (as determined by the Secretary) furnished by a certified registered nurse first assistant (as defined in paragraph (2)) which the certified registered nurse first assistant is legally authorized to perform by the State in which the services are performed.
`(2) The term `certified registered nurse first assistant' means an individual who--
`(A) is a registered nurse and is licensed to practice nursing in the State in which the surgical first assisting services are performed;
`(B) has completed a minimum of 2,000 hours of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care; and
`(C) is certified as a registered nurse first assistant by an organization recognized by the Secretary.'.
(c) PAYMENT AMOUNT- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking `and' before `(S)'; and
(2) by inserting before the semicolon at the end the following: `, and (T) with respect to surgical first assisting services (as defined in section 1861(uu)(1)) furnished by a certified registered nurse first assistant (as defined in section 1861(uu)(2)), the amount paid shall be 80 percent of the lesser of the actual charge for the services or 85 percent of the amount determined under the fee schedule established under section 1848(b) for the same services if furnished by a physician'.
(d) PAYMENTS TO EMPLOYERS-
(1) IN GENERAL- Section 1833(r) of the Social Security Act (42 U.S.C. 1395l(r)) is amended--
(A) in paragraph (1), by inserting `or section 1861(s)(2)(U) (relating to surgical first assisting services)' after `clinical nurse specialist services)'; and
(B) in paragraph (2), by striking `1861(s)(2)(K)(ii)' and inserting `1861(s)(2)(K)(ii) or 1861(s)(2)(U)'.
(2) APPLICATION OF MANDATORY ASSIGNMENT RULES- Section 1842(b)(18)(C)(i) of such Act (42 U.S.C. 1395u(b)(18)(C)(i)) is amended by striking `physician assistant, nurse practitioner, clinical nurse specialist' and inserting `physician assistant, nurse practitioner, clinical nurse specialist, or certified registered nurse first assistant'.
(3) EXCLUSION FROM BUNDLED PAYMENTS FOR COVERED SKILLED NURSING FACILITY SERVICES- Section 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting `surgical first assisting services of a certified registered nurse first assistant,' after `services of a certified registered nurse anesthetist,'.
(e) REDUCTION IN PAYMENTS TO AVOID DUPLICATE PAYMENT- Notwithstanding any other provision of law, the Secretary of Health and Human Services may reduce the amount of payments otherwise made to hospitals under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to eliminate estimated duplicate payments for historical or current costs attributable to surgical first assisting services furnished by certified registered nurse first assistants as described in section 1861(uu) of such Act (as added by subsection (a)).
(f) EFFECTIVE DATE- The amendments made by this section shall apply to services furnished on or after the date of the enactment of this Act.
SEC. 3. STUDY OF PAYMENT RATES.
Not later than 180 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report containing recommendations for adjustments to the payment amounts established under part B of title XVIII of the Social Security Act for surgical first assisting services furnished by certified registered nurse first assistants (as described in section 1861(uu) of such Act (as added by section 1(a)) to ensure that the payment amounts reflect the approximate costs of furnishing such services, taking into account the costs of compensation, overhead, and supervision attributable to certified registered nurse first assistants.
STATE OF MISSOURI LEGISLATION
Our RNFA legislation was sponsored by Senator Ted House & Representative Joan Barry, RN. Our legislative goals were to recognize the RNFA in the Nurse Practice Act and for reimbursement. HB 1292 was defeated on the last day of session. Herb Johnson, lobbyist for the AFL-CIO said not to be discouraged. He will make us a "priority one" next year!
California Board of Medicine Rules on Assisting-At-Surgery
Unlicensed assistive personnel, including surgical assistants and technician, may not clamp, cut, or suture tissue per a ruling by the Medical Board in California. These activities may only be performed by physicians, physicians' assistants (PAs), or registered nurses; even licensed practical/vocational nurses may not perform them, as they are considered outside for their scope of practice. In its ruling, the Medical Board cited clamping, cutting and suturing tissue as medical acts which may not be delegated to or performed by unlicensed persons. The Board noted that nurse practitioners or RN first assistants, with demonstrated competency, may act as first assistants-at-surgery; California requires standardized procedures for specific delegated acts by RNFAs. PAs function under their standards for physician delegation and supervision. The ruling applies to all surgical settings, including ambulatory surgical center and physician offices.
The Association of Operating Room Nurses (AORN) position statement on UAPs states: "Perioperative registered nurses are accountable for patient outcomes resulting from the nursing care provided during the perioperative (before, during, and after surgery) experience. A perioperative registered nurse must plan and direct the care of every patient undergoing operative and other invasive procedures. A 1:1 perioperative RN to patient ratio is required for each patient during operative and other invasive procedures. To ensure that patients receive the highest quality and standard of care, the circulating nurse must always be a registered professional nurse."
The statement goes on to identify the core activities of perioperative nursing as assessment, diagnosis, outcome identification, planning, implementation, and evaluation. The perioperative RN may not delegate assessment, diagnosis, outcome identification, planning, and evaluation; however, depending on the patient's potential for adverse outcomes and need for complex interventions and teaching, the perioperative nurse may delegate appropriate patient care activities. The perioperative nurse uses judgment to decide to whom and under what circumstances to delegate these activities.
Factors that must occur before UAP assume responsibilities for patient care activities are as follows:
1. Nursing Practice Factors
The patient's risk for adverse outcome must be determined.
The patient's need for complex technology and complex intervention must be determined.
The patient's need for teaching must be determined.
2. Training and Education Factors
RNs must receive education and demonstrated knowledge and skills of delegation .
The level of preparation and education of UAP required to perform the delegated task must be determined.
UAP must receive appropriate didactic and psychomotor training.
UAP must demonstrate compentency for each patient care activity that will be delegated.
3. Management Factors
UAP position descriptions and job duties must delineate which patient care activities can be performed.
Perioperative nurses must participate in defining UAP position descriptions.
Perioperative nurses must assist in validating UAP competencies.
An appropriate number of perioperative nurses must be provided to perform core patient care activities that may not be delegated.
An appropriate number of perioperative nurses must be provided to supervise and coordinate the performance of patient care activities that may be delegated to UAP.
Regulation of Surgical Technologists (UAPs)
The Association of Operating Room Nurses (AORN) is opposed to state licensure or registration of STs. STs are not independent practitioners. STs always work under the direct supervision of a physician or registered nurse. Delegation of designated tasks to unlicensed care providers, with the accompanying responsibility for the public's safety related to care, is a part of the scopes of practice of physicians and nurses. Public safety will not be enhanced with the regulation of an additional class of provider that remains accountable to another professional provider. The educational preparation of certified surgical technologists (CSTs) does not include the nursing process and judgment about patient care needs and the evaluation of patient care processes and outcomes. AORN supports the delegation of nursing tasks as provided for in law and as implemented through guidelines developed by the nursing profession.
For further information regarding the AORN Government Affairs contact Candice Romig, AORN Health Policy Analyst/Legislative Program Coordinator, at cromig or x 8263#.
