Legislation

State activity regarding advanced practice nursing, RN first assistants

his article primarily focuses on advanced T practice nursing regulations and RN first assistant legislation in various states. Members of the Legislative Committee provide informa- tion from states in their regions for this feature. If you would like to provide input on any of the bills addressed in this column, please send a letter to your senator, representative, or gover- nor. Addresses can be obtained from state gov- ernment offices.

Florida

enate bill 1296, which provides recognition S of and reimbursement for RN first assistants from managed health care agencies, state agen- cies, worker’s compensation carriers, and pri- vate insurance companies, has gained a House sponsor and will be introduced during the fall 1994 legislative session.

VIVIAN WATSON, RN, CNOR LEGISLATIVE COMMITTEE

REGION TIT

Georgia

urses in this state have helped repeal lan- N guage in SB 137 that would have given physicians authority to direct nursing practice. The original bill was drafted to rewrite licens- ing laws for social workers, counselors, and marriage therapists but had exempted nursing practice from the proposed bill. The Georgia Medical Association, however, successfully campaigned to change the bill’s language and

give physicians the right to direct nursing prac- tice. Intensive campaigning by the Georgia Nurses Association helped repeal the language before it passed to the House, where it now resides.

REGINA MILLS, RN, CNOR LEGISLATIVE COMMITTEE

REGION 11-A

Indiana

n May 5 , 1993, Gov Evan Bayh signed 0 into law HB 1564. One element of the bill permits the state board of nursing to create and use ad hoc subcommittees to help the board with its responsibilities, including making rec- ommendations on rules. This will enable R N first assistants to become involved in writing rules and regulations pertaining to them. The bill also requires the board to establish require- ments for granting prescriptive authority to advanced practice nurses.

DIANA SULLIVAN, RN, MSN, CNOR LEGISLATIVE COMMITTEE

REGION IV

Massachusetts

t press time, a bill (SB 473/HB 1811) that A would provide third-party reimbursement of services for certain health care providers, including nurse practitioners, is on hold pend- ing passage of President Clinton’s health care reform plan. If the state bill passes, reimburse- ment would be paid to nurse practitioners if the

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AORN Members, Health Care Workers Asked to Support Federal RN First Assistant Bill

ouse bill 1618, which permits direct H payment to RNs as first assistants at surgery under the Medicare program, was jointly referred to the Health and Environment Subcommittee of the House Energy and Commerce Committee and to the Subcommittee on Health of the House Ways and Means Cornmiltee.

Collins (D-Ill), also directs Secretary of Health and Human Services Donna Shalala to submit recommendations to Congress for adjusting the payment amounts created under the Social Security Act to ensure that they reflect the approximate costs of fur- nishing services, including compensation, overhead, and supervision that can be attributed to RNs. At press time, AORN was seeking a Senate sponsor for the bill.

House members who are serving on the Health and Environment Subcommittee include Michael Bilirakis (R-Fla), Thomas Bliley (R-Va), Sherrod Brown (D-Ohio), John Bryant (D-Tex), Jim Cooper (D-Tenn), Gary Franks (R-Conn), James Greenwood (R-Pa), Ralph Hall (D-Texj, Dennis Hastert (R-Ill), Scott Klug (R-Wis), and Mike K reidler (D- Wash).

Also serving on the committee are J. Alex McMillan (R-NC), Frank Pallone, Jr (D-NJ),

The House bill, introduced by Rep Cardiss

Bill Paxon (R-NY), Bill Richardson (D- NM), J. Roy Rowland (D-Ga), Jim Slattery (D-Kan), Gerry Studds (D-Mass), Mike Synar (D-Okla), Edolphus Towns (D-NY), Fred Upton (R-Mich), Craig Washington (D- Tex), and Ron Wyden (D-Ore).

Subcommittee on Health include Michael Andrews (D-Tex), Benjamin Cardin (D- Md), Fred Grandy (R-Iowa), Gerald Kleczka (D-Wis), Sander Levin (D-Mich), Nancy Johnson (R-Conn), John Lewis (D- Ga), Jim McCrery (R-La), Jim McDermott (D-Wash), Fortney Stark (D-Calif), and William Thomas (R-Calif).

AORN and organized nursing strongly support this bill. AORN members are encour- aged to contact their representatives regard- ing the imbalance that exists between non- physician health care workers who are reim- bursed for first assistant services and RNs who are not paid for performing the same services. It is important that representatives understand the financial impact this disparity has on unreimbursed RN first assistants.

Nurses should address all letters to their representative at the US House of Rep- resentatives, Washington, DC 205 15, or call (202) 224-3 121 and ask for representatives by name and state.

House members serving on the

service provided was included in the scope of practice and if physicians and other licensed health care professionals already are reim- bursed for the same ccrvice.

Another bill (SB 457/HB 2795) that amends certain sections of the state’$ nurse practice act, including updating the definition of nursing to reflect current nursing practicc, if in commit- tee. This bill is significant because the state’s board of registration in nursing recently pub- lished a position statement affirming that it is within the scope of practice for an RN to be a

first assistant in surgery if certain conditions are met. These conditions include

developing institutional policies accepted by nurses, physicians, and administrators permitting nurses to act as RN first assis- tants; ensuring that RN first assistants function under continuous, on-site direction of sur- geons; instituting annual reviews of RN first assistants; keeping a current list of approved RN first

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REGION-IA

assistants on file at the facility; ensuring that nurses cannot function as both first assistants and scrub nurses dur- ing the same procedure; and

0 requiring a current state license and spe- cial training as indicated in the AORN Oflicial Statement on RN First Assistants. I

CAROLYN BARTLETT, RN, MS LEGISLATIVE COMMITTEE

REGION 1-B

New Mexico

ertified nurse practitioners now can prac- C tice independently in this state since Gov Bruce King signed SB 145 into law on Feb 3, 1993. The bill permits independent practice a well as giving nurses the authority to write pre- scriptions for medications subject to the Controlled Substance Act of 1970 (ie, cate- gories two through five).

ELIZABETH HUNT, RN, MBA, CNOR LEGISLATIVE COMMITTEE

REGION VI

New York

unibill (A 4075/S 2492) regarding third- A party reimbursement for nurses currently is in committee. The bill was introduced during the 1993 legislative session.

The bill says it would amend insurance laws that require certain third-party reimbursement coverage in health insurance policies and by medical expense indemnity corporations and health service corporations for any service within the lawful scope of practice of a licensed professional RN.

Current law, enacted in 1984, requires insur- ers who offer group health insurance policies only to “make available” direct reimbursement to RNs upon request of policyholders. If enact- ed, the new bill would mandate third-party reimbursement for covered services provided by RNs.

SHARON A. MCNAMARA, RN, BSN, CNOR LEGISLATIVE COMMITTEE

Rhode Island

t press time, SB 672, which addresses A third-party reimbursement for nurse prac- titioners, had passed the House and was sent to the Senate. If the bill does not pass the Senate before the legislature adjourns, the bill must be reintroduced during the January 1994 session.

CAROLYN BARTLETT, RN, MS LEGISLATIVE COMMITTEE

REGION I-B

Texas

ouse bill 2180, which addresses the state’s H board of nurse examiners, is awaiting the signature of Gov Ann Richards after passing both the House and the Senate. Significant aspects of the bill include

retaining the definition of a “public mem- ber” that will preclude anyone who works in health care from serving as a member, giving the governor the authority to appoint the board’s president, retaining the current provision that gov- erns continuing education, and requiring the board to establish time lines for creating a method for receiving com- plaints, including establishing a toll-free telephone number, and a method for keeping complaints on file.

ELIZABETH HUNT, RN, MBA, CNOR LEGISLATIVE COMMITTEE

REGION VT

Note 1. Association of Operating Room Nurses, Inc,

“AORN Official Statement on RN First Assistants,” quoted in H S Pashley, “RN first assistant statement, bylaws change, financial update, student chapter membership, and Project 2000 discussed at Congress,” AORN Journal 57 (June 1993) 1319.

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