December 2000
Volume 64 |
Number 12
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| Year
2000 in Review: Highlights of State Legislative and Regulatory
Activities |
S. Diane Turpin, J.D.
As of this writing,
all but a handful of state legislatures have adjourned for the
year. While there has been limited legislative activity this year,
there has been significant regulatory activity, primarily related
to office-based surgery and anesthesia. We expect continued advances
in this area in the coming year. Selected activity from the past
year is reported in this article.
Office-Based Anesthesia
CA – The California
Society of Anesthesiologists supported legislation to redefine
the threshold standard for accreditation of outpatient settings
and to charge the Medical Board with adopting regulations regarding
same. The legislation did not pass this session but is expected
to be reintroduced next year.
CT – The Office
of Health Care Access has proposed regulations to address office-based
surgery. The proposed regulations would require a certificate
of need for the office and limit surgery to only elective procedures
of less than two hours. The proposed regulations are under review,
and additional hearings are scheduled.
DC – The Department
of Health adopted the ASA Guidelines for Office-Based Anesthesia
as the accepted standard of care for the office setting.
FL – Portions
of the proposed rule relating to office-based surgery and anesthesia
were adopted and became effective in February 2000. Additional
refinements, including anesthesiologist participation in all general
anesthetics and major conduction anesthesia (Level III), subsequently
were adopted. Implementation of the provisions related to anesthesiologist
participation in all Level III procedures has been delayed due
to legal challenges. The Board of Medicine recently adopted a
three-month moratorium on all Level III procedures in offices
due to reporting data that showed 20 adverse incidents in offices
within a five-month period. All adverse incidents required transfer
of the patient to the hospital; five incidents resulted in the
patient's death. The deaths were reportedly anesthesia-related.
When the moratorium expired on November 8, the Florida Board of
Medicine issued several new rules, including the adoption of the
ASA "Standards for Basic Anesthetic Monitoring" in offices and
the mandatory, detailed reporting of outcomes for one year (see
Component Society News, ).
MD – The Board
of Physicians Quality Assurance is developing guidelines for minimal
standards of care for patients undergoing office surgeries, types
of equipment required and anesthesia standards.
NY – The Department
of Health approved Guidelines for Office-Based Surgery and Anesthesia
addressing qualifications of practitioners and staff, equipment,
facilities and policies and procedures for patient assessment
and monitoring.
OK – The Board
of Medicine adopted the ASA Guidelines for Office-Based Anesthesia
as the accepted standard of care for the office setting.
RI – The Department
of Health approved regulations for surgery and anesthesia in the
office setting. The regulations require offices to be licensed
by January 1, 2001, with accreditation within 24 months thereafter.
TX – Regulations
were adopted by both the Board of Medical Examiners and the Board
of Nursing regarding office-based anesthesia. The Board of Medical
Examiners has proposed additional regulations to clarify registration
requirements.
Scope of Practice
MD – Two bills
supported by the nurse anesthetists failed: H.B. 622 would have
required hospitals to provide staff privileges for nurse anesthetists;
H.B. 798 would have required hospitals, as a condition of licensure,
to establish a credentialing process for health care practitioners
and physicians who were employed by or had staff privileges at
the hospital. H.B. 1034/S.B. 328 passed, requiring a study of
hospital credentialing processes for nurse anesthetists, nurse
midwives and social workers.
MO – Legislation
was introduced in the House and Senate to allow nurse anesthetists
to prescribe and administer drugs and devices, including controlled
substances, within the perioperative setting period. The bills
would have allowed a nurse anesthetist to cause drugs and devices
to be administered by a nurse under a nurse anesthetist's direction
and supervision. The bills failed to pass. The nurse anesthetists
are expected to reintroduce the bills in the next session.
NH – Nurse practitioners,
including nurse anesthetists, sought to eliminate the Joint Health
Council (JHC), the entity authorized to add to or alter the list
of controlled substances on the formulary from which nurse practitioners
may prescribe. In New Hampshire, the JHC is the only body, other
than the Board of Nursing, with the authority to place limitations
on the scope of practice of nurse anesthetists. A compromise measure
was passed to change the composition of the JHC to include three
nurses, three pharmacists and three physicians.
NJ – The Board
of Nursing proposed regulations that would have permitted an applicant
nurse anesthetist to work under the supervision of a nurse anesthetist.
The proposed regulation would have eliminated the requirement
that direct supervision shall mean the physical presence of said
supervisor within the immediately available area, unit or suite
in which anesthesia is being administered. As such, the proposed
rule would have given an applicant nurse anesthetist less supervision
than nurse anesthetists, as nurse anesthetists are required to
practice under the supervision of an anesthesiologist. Following
comments from the New Jersey State Society of Anesthesiologists,
the Board of Nursing did not adopt the proposed regulations.
NY – The New York
State Society of Anesthesiologists continues its efforts to pass
S.B. 2969, legislation to define the scope of practice of nurse
anesthetists. The bill would require nurse anesthetists to practice
under the supervision of and in the immediate presence of an anesthesiologist
or operating practitioner.
PA – The Pennsylvania
Society of Anesthesiologists continues with its efforts to defeat
legislation to expand the scope of practice of nurse anesthetists.
WI – The Board
of Nursing proposed a rule to allow advanced practice nurses (including
nurse anesthetists) to independently order laboratory testing,
radiographs or electrocardiograms to assist the nurse in issuing
a prescription order. The Wisconsin Society of Anesthesiologists
opposed the proposed rule and worked with the state medical society
and other specialty societies to require a documented relationship
with a physician. The collaborative relationship is defined as
a process in which an advanced practice nurse prescriber is working
with a physician, in each other’s presence when necessary, to
deliver health care services within the scope of the practitioner's
professional expertise.
Pain Management
CT – Legislation
was passed to require insurance companies and health maintenance
organizations (HMOs) to cover pain management treatments and access
to a pain specialist.
FL – The Board
of Medicine adopted a new rule on Standards for the Use of Controlled
Substances for the Treatment of Pain. The standards were developed
to clarify the Board's position on pain control, specifically
related to the use of controlled substances, to alleviate physician
uncertainty regarding potential disciplinary action and to encourage
better pain management.
Anesthesiologist's
Assistants
OH – The Ohio
Society of Anesthesiologists supported legislation to license
anesthesiologist’s assistants (AAs) following the Attorney General's
opinion that AAs had no authority to practice in the state pursuant
to the delegatory authority of an anesthesiologist. The legislation
was passed to license AAs. Their scope of practice is defined
in the law and requires that AAs must work under the supervision
of an anesthesiologist.
Reimbursement Issues
CA – Legislation
was passed providing a 16.7-percent increase in Medi-Cal reimbursement,
although it is yet to be determined how the increases will be
distributed among the specialties.
IN – The Indiana
Society of Anesthesiologists supported legislation to increase
Medicaid reimbursement rates. The bill passed but was vetoed by
the Governor due to budgetary constraints. It is possible that
an effort will be made to override the veto.
MD – Legislation
was passed to reimburse out-of-network hospital-based physicians
who treat HMO patients based on 125 percent of the HMO rate for
services rendered or the amount being paid for the service on
January 1, 2000, whichever is greater. This provision will remain
in effect until 2002. A study will be conducted to determine the
appropriate methodology for reasonable payment for nonparticipating
physicians.
NJ – Legislation
was introduced to require Medicaid to reimburse anesthesiologists
for services provided to Medicaid recipients who are not enrolled
in an HMO at 80 percent of the rate the HMO currently reimburses
anesthesiologists for services provided to its commercial clients.
The bill has not been reported out of committee.
PA – The Pennsylvania
Society of Anesthesiologists continues its work to increase reimbursement
rates under the workers' compensation program.
SC – The South
Carolina Society of Anesthesiologists is working to obtain an
increase in reimbursement rates from Blue Cross/Blue Shield (BCBS).
WI – The Wisconsin
Society of Anesthesiologists continues its efforts to increase
BCBS reimbursement rates.
Tort Reform
OR – The Oregon
Society of Anesthesiologists is part of a coalition effort to
secure a constitutional amendment to permit the legislature to
limit civil damages. The constitutional amendment is necessary
because of an Oregon court decision holding that the state legislature
has no jurisdiction over jury awards and, as such, cannot establish
caps on damage awards.
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S.
Diane Turpin, J.D., Assistant Director of Governmental Affairs
(State), rejoined the ASA Washington Office in September 1999
after completing a degree in law from St. Louis University,
St. Louis, Missouri. She previously was a member of the Washington
Office from 1990 to 1993. |
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