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News December 10, 2014

Government Funding Bill Announced - ASA-Supported VA Handbook Language Included

Update: On December 16, President Barack Obama signed this legislation into law.


A government funding bill introduced late December 9 would avert a government shutdown and includes ASA-supported language on the VHA Nursing Handbook.  The proposed VHA Nursing Handbook threatens the physician-led, team-based model of anesthesia care for Veterans within VA, but ASA has worked with Congressional supporters for language that calls for greater stakeholder input from organization such as ASA and requests that any new handbooks “do not conflict with other handbooks already in place within the VHA,” a direct reference to the consensus Anesthesia Service Handbook.

During the course of 2014, Congress has worked to advance funding for all the government’s federal agencies through a series of 12 appropriation bills.  One of these bills, the Military Construction and Veterans Affairs, and Related Agencies (MilCon-VA) Appropriations Act, included report language addressing the proposed VHA Nursing Handbook.  The MilCon-VA appropriation bill passed the House of Representatives on April 30, 2014.  In the Senate, the bill and relevant report language passed in the Appropriations Committee on May 22, 2014, however, due to Congressional gridlock, this and other appropriations bills were never advanced to full passage. 

In the absence of agreement on the 12 individual bills, Congressional leaders introduced a bill combining them into a single package, referred to as a “Cromnibus” that would fund most departments through September 2015.  This larger legislation included the ASA-supported MilCon-VA Report Language addressing the VHA Nursing Handbook.  Specifically, the report language reads:

Nursing Handbook.-The Committee understands that the VHA Nursing Handbook is currently under review. The Committee encourages the VHA to seek input from internal VA program offices and external professional stakeholders prior to possible regulatory action and submission to the Under Secretary for Health for final approval. The Committee believes all possible outreach efforts should be used to communicate the proposed changes, to gather public comment, and to collaborate with Congress, stakeholders, VA nursing staff, and external organizations. The Committee also requests that the VHA ensure that any changes to handbooks within the VHA do not conflict with other handbooks already in place within the VHA.

ASA is pleased to see Congressional language that supports physician-led care within VA, and will continue to push for approval of this provision. ASA remains hopeful that VA will comply with the letter and spirit of the language. ASA will continue to engage both internal and external stakeholders in the effort to assure physician-led anesthesia care in VA.  It is still expected that VA will move forward with their plans to place their initial VHA Nursing Handbook into the Federal Register.  At that point, grassroots action by ASA will be required. Sign up for the ASA Grassroots Network to be involved and informed throughout this process. 

This legislation passed in the House of Representatives on Thursday, December 11.  ASA staff continue to read and evaluate the 289,861-word, $1.013 trillion “Cromnibus” bill for elements that could impact physician anesthesiologists and will provide updates as they become available.