Introduced in 2016 Legislative Session
Legislative Bill Number:
House Study Bill (HSB) 103 AA bill
Explanation:
On January 21, 2016 at 9 am,The House Sub-Committee hearing on HSB 103 AA legislature, the Representatives Rob Taylor, Lisa Heddens and Brian Best called the hearing to see if there was any new data on AA’s.
Introduced in 2015 Legislative Session
Legislative Bill Number:
House Study Bill (HSB) 103 AA bill and its companion bill Senate Study Bill (SSB) 1150 AA bill
Explanation:
Licensure of AAs. IANA opposes licensure and practice of AA’s in the State of Iowa.
Action
Contact your legislators immediately!
Result
HSB103 and SSB1150 were not passed out of subcommittee hearings.
Latest Legislation
Legislative Bill Number:
House Study Bill (HSB) 3 and its companion bill Senate Study Bill (SSB) 1055 deal with interventional pain management
Explanation:
An Act relating to the practice of interventional pain procedures, and providing a penalty
Status:
Not passed 2013 session
Find your Local State Senators and Representatives
Please utilize the following link to find your local state senators and representatives. In addition you will also find district maps and individual contact information for your personal legislator. These officials represent your voice in the legislative process, so be sure to let them know how they are doing and what they can do for you!
Click HereOpt-out of the Federal Supervision requirement
Iowa Governor Tom Vilsack signed a letter to make Iowa the first state in the nation to opt-out of the Federal Supervision requirement for hospitals to participate in Medicare and be reimbursed for Medicare patients in Dec. 2002. Since then, 16 other states have opted out of the supervision requirement. They are:
- Iowa (December 2001)
- Nebraska (February 2002)
- Idaho (March 2002)
- Minnesota (April 2002)
- New Hampshire (June 2002)
- New Mexico (November 2002)
- Kansas (March 2003)
- North Dakota (October 2003)
- Washington (October 2003)
- Alaska (October 2003)
- Oregon (December 2003)
- Montana (January 2004)
(Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.) - Montana Re-Opt-Out Letter
- South Dakota (March 2005)
- Wisconsin (June 2005)
- California (effective July 17, 2009)
- Colorado (September 2010) (For Critical Access Hospitals (CAHs) and specified rural hospitals)
- Kentucky (April 2012)
Requirements for Hospitals
The opt-out does not define how CRNAs may practice, but does define the requirements for hospitals using CRNA anesthesia services to receive payments as a Condition of Participation (CoP). The following is the part of the Federal statutes that defines the opt-out procedure and how to reverse it.
§482.52(a) Standard: Organization and Staffing
The organization of anesthesia services must be appropriate to the scope of the services offered. Anesthesia must be administered only by
- A qualified anesthesiologist;
- A doctor of medicine or osteopathy (other than an anesthesiologist);
- A dentist, oral surgeon, or podiatrist who is qualified to administer anesthesia under State law;
- A certified registered nurse anesthetist (CRNA), as defined in §410.69(b) of this chapter, who, unless exempted in accordance with paragraph (c) of this section, is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed; or
- An anesthesiologist’s assistant, as defined in Sec. 410.69(b) of this chapter, who is under the supervision of an anesthesiologist who is immediately available if needed.
§482.52(c) Standard: State Exemption
- A hospital may be exempted from the requirement for MD/DO supervision of CRNAs as described in paragraph (a)(4) of this section, if the State in which the hospital is located submits a letter to CMS signed by the Governor, following consultation with the State’s Boards of Medicine and Nursing, requesting exemption from MD/DO supervision of CRNAs. The letter from the Governor must attest that he or she has consulted with State Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the State and has concluded that it is in the best interests of the State’s citizens to opt-out of the current MD/DO supervision requirement, and that the opt-out is consistent with State law.
- The request for exemption and recognition of State laws, and the withdrawal ofrequest may be submitted at any time, and are effective upon submission.
Opt Out History
In July, 2012, Frank Cassady, former ISA president, wrote an article in the ASA newsletter outlining a plan to reverse opt-outs in every state where they exist as one of the ASA’s main goals.
In September, 2012, Governor Branstad was asked directly by then-IANA President Mindy Miller whether he was, indeed, considering reversing the Iowa Opt-out. He stated that he was considering it, because he had “serious safety concerns.”
In October, 2012, a web-based commercial was found on the internet “Thanking Governor Branstad” for his reversal of the opt-out, even though he had not done so at the time. This commercial has since been taken off the web. An aggressive letter-writing, phone call and email grassroots effort went into action by the IANA and the Iowa Hospital Association to raise concerns to the Governor about the disruption in health care services that such a reversal would cause.
Governor Branstad then announced he has tasked Department of Public Health Director Dr. Miller-Meeks to form a “task force” to investigate the issue. The Governor will not be reversing the opt-out and Dr. Miller-Meeks and her review committee considered the following three factors:
- Safety: there is no basis of concern for safety of patients based upon the facts they have been provided and information regarding the care of patients.
- Accessibility: the current opt-out ensures accessibility of care for Iowans throughout the state and that reversing the opt-out would have a negative effect on accessibility.
- Cost: it is clear that CRNAs are cost effective and at the same time provide safe and efficacious care.
On considering those three factors the Governor has decided not to reverse the opt-out. There will not be a press release or any other type of public statement.
What Should IANA CRNAs Be Doing
What should iana crnas be doing as a result of the governor’s decision not to reverse the opt out?
- You should immediately thank all hospital administrators, physicians and legislators who stepped forward to communicate on your behalf with Dr. Miller-Meeks and the Governor regarding not reversing the opt-out.
- You must maintain a high quality of practice standards, continue to obtain continuing education and display a high degree of professionalism. You know that your adversaries will jump on any untoward event or negative outcome to argue that the Governor’s decision was incorrect.
- You should not in any manner brag about the Governor’s decision or inflame your adversaries who would naturally be disappointed with the Governor’s decision.
More information regarding the history of achieving the Opt-out rule can be found on the AANA website, under the State Government Affairs site.
Iowa CRNAs
The Iowa Board of Nursing (IBON) and Iowa Department of Public Health (IDPH) has been engaged in a long rule making and subsequent litigation course with the Iowa Medical Society (IMS) and the Iowa Society of Anesthesiologists (ISA) regarding supervision of fluoroscopy by Advanced Registered Nurse Practitioners (ARNPs) in Iowa. After rules were promulgated and placed into code by the IBON and IDPH, a litigation course ensued. The Iowa Association of Nurse Anesthetists (IANA) joined as intervenors in this case and became a party to the litigation in support of the IBON. On October 31, 2011, a decision of Summary Judgment was handed down at the district court level in favor of the IMS and ISA that invalidated these rules. The IBON appealed this Summary Judgment and oral arguments were heard before the Supreme Court of Iowa on Nov 14, 2012. On May 31, 2013, the Supreme Court published their decision on this case of first impression.
Conclusion
Their conclusion reads as follows:
For the foregoing reasons, we hold the district court erred in invalidating the agency rules that allow qualified ARNPs to supervise fluoroscopy. Accordingly, we reverse the summary judgment of the district court and remand for entry of an order lifting the stay and upholding Iowa Administrative Code rule 655—7.2(2) and rule 641—41.1(5)(n).
The Supreme Court decision has been attached to this email.
We would like to thank everyone who participated in these proceedings.
Sarah Tweedy, CRNA
IANA Government Relations Chair
History of the Case of IMS/ISA v. IBON/IDPH
June 2, 2009, the Iowa Board of Nursing (IBN) adopted an administrative rule authorizing ARNPs to provide “direct supervision” of fluoroscopy.
March 10, 2010, the Iowa Department of Public Health (IDPH) adopted an administrative rule authorizing ARNPs to provide direct supervision of radiologic technologists and radiologic students in the performance of fluoroscopy for purposes of localization to obtain images for diagnostic or therapeutic purposes.
June 21, 2010, Iowa Medical Society (IMS) and Iowa Society of Anesthesiologists (ISA) filed petitions in Polk County District Court for judicial review of the Iowa Board of Nursing and Iowa Department of Public Health’s adopted administrative rules pertaining to ARNP supervision of fluoroscopy.
The District Court granted the Motions to Intervene filed by the Iowa Nurses Association (INA), Iowa Association of Nurse Anesthetists (IANA) and the Iowa Osteopathic Medical Association (IOMA).
November 23, 2010, the District Court entered an order staying the enforcement and effect of the rules. Subsequently, petitioners and respondents filed motions and cross-motions for Summary Judgment.
October 31, 2011, Judge’s ruling on Motion for Summary Judgment is entered.
November 14, 2011, IANA files Motion for Clarification.
November 30, 2011, Board of Nursing files Notice of Appeal.
November 11, 2012, case heard before the Iowa Supreme Court, decision pending
Order Summary Judgment 3
What you need to know
There has been a lot of angst waiting for the decision of the Supreme Court in the Iowa Medical Society (IMS) – Iowa Society of Anesthesiologists (ISA) vs. Board of Nursing (BON). IANA appeared on behalf of the Board of Nursing as an Intervener to support the Board of Nursing’s position.
It is important to keep in mind what this decision, when it is rendered, will mean and what it will not mean. If IMS and ISA prevail in the lawsuit they will unquestionably put a spin on the decision that is favorable to them. Please keep in mind that if the Board of Nursing does not prevail, the decision will mean that the Supreme Court has determined that the Board of Nursing exceeded its authority in adopting rules regarding fluoroscopy or failed to properly adopt the rules for fluoroscopy for Advanced Registered Nurse Practitioners utilizing or supervising fluoroscopy. The case is about the Board of Nursing’s authority to adopt rules regarding fluoroscopy and nothing more.
An adverse ruling will not affect the practice of CRNAs in the performance of pain management procedures. It will not affect CRNAs’ practice in utilizing fluoroscopy being performed by radiologic technologists. As the district court stated in its decision, CRNAs’ practice is not affected. The whole issue before the Supreme Court relates to the authority of the Board of Nursing to adopt rules regarding fluoroscopy and/or whether it adopted rules on fluoroscopy in a proper manner.
We are anticipating that the decision will come down in the near future. The moment the decision is issued we will provide you with a summary of the decision and online access to the decision. Our attorney, Jim Carney, will keep you advised and will be available to answer questions after the decision is rendered. This is a case that is slightly different from the norm. Usually we think about practice “can and can’t do” in a court battle outcome and we are not the only ones who might have a difficult time understanding this concept, but please remember that this is only about the rule making process by the BON, not our ability to practice using fluoroscopy. This may be a very touchy subject depending on the court outcome and could spin out of control quickly due to our opponent’s views if the BON does not prevail, so it is a situation that needs expert explanation. If you, other CRNAs, or any other individuals have any questions or concerns, these need to be directed to Jim Carney. He is our lawyer and can speak fluently to the legal and practice applications of CRNA practice in regards to any decision. Please urge everyone to utilize our best resource. Misinformation will cause confusion and mayhem that we don’t need!
Thank you for your great support of IANA’s effort to support the Board of Nursing as an intervener in the case.
Jim Carney’s Contact Info:
James W. Carney
Carney & Appleby, P.L.C.
303 Locust Street, Suite 400
Des Moines, Iowa 50309
Telephone: (515) 282-6803
Cell Phone: (515) 689-3189
Facsimile: (515) 282-4700
Warmest Regards,
Sarah Tweedy, CRNA
IANA Government Relations Chair
[email protected]
(402) 612-7662