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Are nursing boards losing control over RN licensure?
Legislation
Are nursing boards losing control over RN Iicensure? Jurisdictionover licensingof registered nurses is being discussed in an increasing number of states and has already been taken out of the hands of the ConnecticutState Boardof Examiners for Nursing under a new law effective Jan 1, 1979. In 5 mass reorganization of the Connecticut state government authorized by a bill rapidly passed by the legislature in two weeks, all health-relatedboards and commissions will lose their autonomy and function under the aegis of the commissioner of health. According to Anne F McGuigan, RN, chief nursing examiner, rules and regulations will be promulgated by the commissioner and the Board of Nursing Examiners will act in an advisory capacity only. No consultation was made with the Board before passageof the bill. Ambiguous wording in the bill has prompted many questions and contributed to postponing the effective date from the original July 1, 1978. The Nursing Board is now looking to see how it can maintaina certain amount of control and striving for answers to many questions such as will the change affect reciprocity with other states. A bill removing all regulatory powers from professional boards has been before the Assembly of the Wisconsin legislature for several months. Elaine F Ellibee, RN, administrator of the state’s Department of Regulation and Licensing, Nursing Division, stated that under the bill the Board of Nursing would function as an advisory group only and thus be relieved of its responsibility and accountability.
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Wisconsin nurses have joined other healthrelated personnel to lobby actively against the bill with the result that it has not yet been taken out of committee for action by the Assembly. The registered nurses in that state attended and testified at public hearings, personally contacted legislators by telephone and letters, and arranged political forums to inform the legislature of nursing’s concern. Their opposition and actions prompted the cochairmen of the Joint Committee on Administrative Rules to ask for input from registered nurses in restructuring the bill. The legislature will not convene until late January, and in the meantime, nursing groups and other health-related personnel are working together to oppose the bill. In Illinois, a “blue ribbon” committee appointed by the governor is reviewingthe licensing procedures in the state with the view to make recommendations for changes. In talking to Steve Perrigo, assistant to the director of the Illinois Department of Registration and Education, which has jurisdiction over nursing licensure, we were told that no change is anticipated in who is responsible for nursing licensure. The committee of nurse examiners has been enlarged to include members throughout the state, and it has been suggested that meetings be held in Springfield, the state capital, as well as in Chicago, where they have traditionally been held. Margaret Pavelka, RN, executive director of the Nebraska Board of Nursing, cautions nurses to be aware that the responsibilities of nursing boards throughout the country are being scrutinized. In Nebraska, one legislative hearing has already been held on the nursing board’s functions with a second planned in the near future. More than 100 nurses from vari-
AORN Journal, December 1977. V a l 26, No 6
ous disciplines attended the hearing with several giving testimony. HR 3, the MedicareiMedicaid Antifraud and Abuse Amendments bill sponsored by Representatives Dan Rostenkowski (D-Ill) and Paul Rogers (D-Fla),was passed by an overwhelming vote of the House (362-5). Its companion bill in the Senate, S 143, sponsored by Sen Herman Talmadge (D-Ga), was passed by a voice vote and the bill went to conference. A confidentiality section was deleted in the House bill's final form but included were provisions for Professional Standards Review Organizations (PSRO) to act as major monitors for detecting fraud and abuse in federal health programs. Information detected from this monitoring is to be transmitted to federal and state investigative agencies. HR 3 also requires the secretary of the US Department of Health, Education, and Welfare (HEW) to develop methods for ambulatory care review within two years for use by PSROs with conditional designation within six years. A review of services by a "competent" PSRO would be conclusive for federal payment if the PSRO had entered into a "memorandum of understanding" agreement with the state Medicaid agency. With the reorganization of HEW announced months ago, the National PSRO Council would have been placed under the new Health Care Financing Administration. HEW Secretary Joseph Califano has reversed this and announced that the Council will continue under the Office of the Assistant Secretary for Health, a physician. Opponentsof the change felt placing the Council in the new authority would emphasize it as a cost control program and thus hinder future participation by physicians. m The Senate bill (S 708) providing for reimbursement to physician's assistants and nurse practitioners for services in rural clinics has passed. In a manipulative move to facilitate passage, it was tacked on to a House-passed tariff bill, HR 422. A jurisdictional dispute over control of the House reimbursement bill (HR 8422) was finally settled by the House Committees on Ways and Means and Interstate and Foreign Commerce. each having a health-related subcommittee. The bi\l was placed on the House "Suspense Calendar" meaning the bill could be called up for consideration but no amend-
1122
ments could be added. However, the entire Suspense Calendar was suspended before the Columbus Day recess. Supporters will press for consideration after the recess. Under certificate of need statutes enacted in 37 states, depending on the state law, health care facilities must show a need for equipment or expanded facilities and staff that exceed stated amounts. Wisconsin, the 37th state to enact such a law, is the first state to provide for "decertification of specialized services," ie, determining that no need exists for a service. The law states that after decertification, the institution must phase out the service in one year. An institution that violates the decertification provisions may be fined no less than $100 and no more than $1.000 for each day the violation continues. The Wisconsin Department of Health and Social Services "may decertify a specialized service if the service is clearly and demonstrably not needed by the community. being served or the resources of the institution are incapable of maintaining the service." Formal hearings and review procedures must be undertaken before decertification. Specialized services are defined as "the specialized facilities, equipment, and staff necessary: (a) to perform heart catheterization studies or cardiac surgery, (b)to perform radiation therapy treatment of cancer and other diseases, (c) for hemodialysis treatment of acute or chronic renal insufficiency, (d) to perform kidney transplants, (e) for the intensive care and management of high-risk maternal, highrisk fetal patients or high-risk neonatal patients, (f) to perform computed tomography." Payment for hospital charges in New York may now be made with credit cards. A 1977 law permits hospitals to institute such billing systems after seeking assistance from the state comptroller. In Ohio, an amendment to the law restricting smoking in public places states that no more than one-half the rooms for patients in a health care facility may be designated as smoking areas.
AORN Journal, December 1977, V o l 2 6 , N o 6
Dora B D'Amico Associate editor
Are nursing boards losing control over RN Iicensure? Jurisdictionover licensingof registered nurses is being discussed in an increasing number of states and has already been taken out of the hands of the ConnecticutState Boardof Examiners for Nursing under a new law effective Jan 1, 1979. In 5 mass reorganization of the Connecticut state government authorized by a bill rapidly passed by the legislature in two weeks, all health-relatedboards and commissions will lose their autonomy and function under the aegis of the commissioner of health. According to Anne F McGuigan, RN, chief nursing examiner, rules and regulations will be promulgated by the commissioner and the Board of Nursing Examiners will act in an advisory capacity only. No consultation was made with the Board before passageof the bill. Ambiguous wording in the bill has prompted many questions and contributed to postponing the effective date from the original July 1, 1978. The Nursing Board is now looking to see how it can maintaina certain amount of control and striving for answers to many questions such as will the change affect reciprocity with other states. A bill removing all regulatory powers from professional boards has been before the Assembly of the Wisconsin legislature for several months. Elaine F Ellibee, RN, administrator of the state’s Department of Regulation and Licensing, Nursing Division, stated that under the bill the Board of Nursing would function as an advisory group only and thus be relieved of its responsibility and accountability.
1120
3
Wisconsin nurses have joined other healthrelated personnel to lobby actively against the bill with the result that it has not yet been taken out of committee for action by the Assembly. The registered nurses in that state attended and testified at public hearings, personally contacted legislators by telephone and letters, and arranged political forums to inform the legislature of nursing’s concern. Their opposition and actions prompted the cochairmen of the Joint Committee on Administrative Rules to ask for input from registered nurses in restructuring the bill. The legislature will not convene until late January, and in the meantime, nursing groups and other health-related personnel are working together to oppose the bill. In Illinois, a “blue ribbon” committee appointed by the governor is reviewingthe licensing procedures in the state with the view to make recommendations for changes. In talking to Steve Perrigo, assistant to the director of the Illinois Department of Registration and Education, which has jurisdiction over nursing licensure, we were told that no change is anticipated in who is responsible for nursing licensure. The committee of nurse examiners has been enlarged to include members throughout the state, and it has been suggested that meetings be held in Springfield, the state capital, as well as in Chicago, where they have traditionally been held. Margaret Pavelka, RN, executive director of the Nebraska Board of Nursing, cautions nurses to be aware that the responsibilities of nursing boards throughout the country are being scrutinized. In Nebraska, one legislative hearing has already been held on the nursing board’s functions with a second planned in the near future. More than 100 nurses from vari-
AORN Journal, December 1977. V a l 26, No 6
ous disciplines attended the hearing with several giving testimony. HR 3, the MedicareiMedicaid Antifraud and Abuse Amendments bill sponsored by Representatives Dan Rostenkowski (D-Ill) and Paul Rogers (D-Fla),was passed by an overwhelming vote of the House (362-5). Its companion bill in the Senate, S 143, sponsored by Sen Herman Talmadge (D-Ga), was passed by a voice vote and the bill went to conference. A confidentiality section was deleted in the House bill's final form but included were provisions for Professional Standards Review Organizations (PSRO) to act as major monitors for detecting fraud and abuse in federal health programs. Information detected from this monitoring is to be transmitted to federal and state investigative agencies. HR 3 also requires the secretary of the US Department of Health, Education, and Welfare (HEW) to develop methods for ambulatory care review within two years for use by PSROs with conditional designation within six years. A review of services by a "competent" PSRO would be conclusive for federal payment if the PSRO had entered into a "memorandum of understanding" agreement with the state Medicaid agency. With the reorganization of HEW announced months ago, the National PSRO Council would have been placed under the new Health Care Financing Administration. HEW Secretary Joseph Califano has reversed this and announced that the Council will continue under the Office of the Assistant Secretary for Health, a physician. Opponentsof the change felt placing the Council in the new authority would emphasize it as a cost control program and thus hinder future participation by physicians. m The Senate bill (S 708) providing for reimbursement to physician's assistants and nurse practitioners for services in rural clinics has passed. In a manipulative move to facilitate passage, it was tacked on to a House-passed tariff bill, HR 422. A jurisdictional dispute over control of the House reimbursement bill (HR 8422) was finally settled by the House Committees on Ways and Means and Interstate and Foreign Commerce. each having a health-related subcommittee. The bi\l was placed on the House "Suspense Calendar" meaning the bill could be called up for consideration but no amend-
1122
ments could be added. However, the entire Suspense Calendar was suspended before the Columbus Day recess. Supporters will press for consideration after the recess. Under certificate of need statutes enacted in 37 states, depending on the state law, health care facilities must show a need for equipment or expanded facilities and staff that exceed stated amounts. Wisconsin, the 37th state to enact such a law, is the first state to provide for "decertification of specialized services," ie, determining that no need exists for a service. The law states that after decertification, the institution must phase out the service in one year. An institution that violates the decertification provisions may be fined no less than $100 and no more than $1.000 for each day the violation continues. The Wisconsin Department of Health and Social Services "may decertify a specialized service if the service is clearly and demonstrably not needed by the community. being served or the resources of the institution are incapable of maintaining the service." Formal hearings and review procedures must be undertaken before decertification. Specialized services are defined as "the specialized facilities, equipment, and staff necessary: (a) to perform heart catheterization studies or cardiac surgery, (b)to perform radiation therapy treatment of cancer and other diseases, (c) for hemodialysis treatment of acute or chronic renal insufficiency, (d) to perform kidney transplants, (e) for the intensive care and management of high-risk maternal, highrisk fetal patients or high-risk neonatal patients, (f) to perform computed tomography." Payment for hospital charges in New York may now be made with credit cards. A 1977 law permits hospitals to institute such billing systems after seeking assistance from the state comptroller. In Ohio, an amendment to the law restricting smoking in public places states that no more than one-half the rooms for patients in a health care facility may be designated as smoking areas.
AORN Journal, December 1977, V o l 2 6 , N o 6
Dora B D'Amico Associate editor