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April
2002
Volume 66 |
Number
4
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STATE
BEAT
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Legislative,
Regulatory and Gubernatorial Actions:
AK, AL, FL, IA, ID, KS, MN, MO, NE, NM, ND, OR, TX |
S. Diane
Turpin, J.D., Assistant Director
Office of Governmental Affairs (State)
Opt
Out
Nebraska Governor Mike Johanns forwarded a letter to the
Centers for Medicare and Medicaid Services (CMS) on February 22,
2002, stating that Nebraska is opting out of the Medicare requirement
for physician supervision of nurse anesthetists. In his press
release, he referenced the fact that existing Nebraska law requires
nurse anesthetists to obtain the consent of a physician and to
consult and collaborate with a physician in all cases. Governor
Johanns claimed that his decision to opt out ensures affordability
and accessibility of health care. On March 8, 2002, Idaho
Governor Dirk Kempthorne forwarded a letter to CMS opting out
of the Medicare requirement. Idaho law requires nurse anesthetists
to practice in collaboration with a physician, dentist or podiatrist.
Collaboration is defined under state law as "the cooperative
working relationship with another health care provider, each contributing
his respective expertise in the provision of patient care, and
such collaborative practice includes the discussion of patient
treatment and cooperation in the management and delivery of health
care." Nebraska and Idaho join Iowa in opting out of the
requirement. In all of these states, a physician remains involved
in the anesthesia care of the patient. Opt-out efforts are under
way in Alaska, Kansas, Minnesota, Montana, New Mexico, North
Dakota, Oregon, Washington and Wyoming.
Anesthesiologist
Assistants
Florida Florida H.B. 599, providing for the licensure
of anesthesiologist assistants (AAs), passed the House by a vote
of 71 to 46. The bill was amended to allow an anesthesiologist
to supervise two AAs as opposed to four AAs as originally drafted.
The Board of Medicine may, by rule, allow an anesthesiologist
to supervise up to four AAs after July 1, 2006. "Direct supervision"
means supervision by an anesthesiologist who is present in the
same room as the AA or in an immediately adjacent room or hallway
such that the supervising anesthesiologist is able to monitor
the ongoing anesthetic and be immediately available to provide
assistance and direction while anesthesia services are being performed.
Direct supervision also requires the supervising anesthesiologist
to personally begin the patientıs preanesthetic assessment. Similar
legislation is pending in the Senate, although it is uncertain
whether the bill will move before the end of the session.
This legislation
has advanced in spite of the strenuous efforts by nurse anesthetists
to diminish the quality of AA education and training and to impugn
the motives of the anesthesiologists who support the legislation.
Texas
The Texas Board of Medical Examiners has amended its guidelines
regarding AAs to comply with the Medicare supervision rule, allowing
for supervision of up to four AAs. Previously, the guidelines
allowed for 1:2 supervision.
Pain Management
Alabama The Alabama Workers Compensation Medical Services
Board has proposed a rule relating to pain management. The proposed
rule states: "The administration of a block for pain management
is a physician or an on-site direct-physician supervised service.
The evaluation of the candidate to determine the appropriateness
of the invasive procedure and the technique for administration
is a physician service. It is considered the practice of medicine
and should be performed by a physician, medical doctor or doctor
of osteopathy, or under the on-site direct supervision of a medical
doctor or doctor of osteopathy." Testimony before the Board
by nurse anesthetists alleged that pain management is the practice
of nursing when performed by a nurse anesthetist. Hearings continue.
Office-Based
Surgery and Anesthesia
Florida The Florida 1st District Court of Appeals denied
a motion by nurse anesthetists and others to rehear the case regarding
the office-based surgery and anesthesia regulations. As you will
recall from my last column, the Florida court found in favor of
the Department of Health's regulations, which upheld the requirement
that a nurse anesthetist be supervised by an anesthesiologist
during all Level III office surgeries. The nurse anesthetists
may now ask the Florida Supreme Court to hear the case. In the
interim, the regulations are in effect. Nevertheless, an amendment
is expected to be proposed in the last days of the Florida legislative
session to prohibit the Department of Health and the Board of
Medicine from requiring that a nurse anesthetist be supervised
by an anesthesiologist in Level III cases as required by the existing
regulations. The amendment would require nurse anesthetists to
practice under the supervision of the operating surgeon.
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