May 26, 2000
WEEKLY UPDATE for May 26, 2000
***LEGISLATIVE UPDATE Patient
Protections—Conference Committee Quality Health Care
Coalition Act (HR 1304) Cardiac Arrest Survival Act
(HR 2498)
***REGULATORY UPDATE OIG Issues Proposed
Anti-kickback Safe Harbor for Ambulance
Restocking HCFA Moving Forward to Allow Nurse
Anesthetists to Work without Physician Supervision
LEGISLATIVE UPDATE
Patient Protections—Conference Committee
A compromise on the outstanding contentious issues –
liability, the right to sue and scope – continues to
elude conferees. Informal meetings with Conference
Chairman Nickels (R-OK) failed to break the ongoing
impasse. This week, House Speaker Hastert (R-IL) met
with Senate Majority Leader Lott (R-MS) in an attempt to
smooth the way for compromise. The meeting was said to
have been cordial but did not result in a plan to move
the bill. On Tuesday, Conference Democrats sent a
proposal to Chairman Nickles, which they hoped would
"jump-start" the stalled negotiations. The proposal
clarified the Democrats position on employer liability,
scope and an appeals process. Chairman Nickles called
the proposal a "non offer."
In addition to the three issues, post-stabilization
remains a discussion item. ACEP understands that many of
the conferees have questioned the logic of the tentative
agreement described in previous reports. Since an
overall agreement has not yet been reached, there is
still time to convey your concern to your Representative
and Senators.
CALL OR VISIT YOUR LEGISLATORS
The House and Senate will be in recess until June 6.
Since many Members will return home, we encourage
members of the 911 Network to contact their legislators.
Continued pressure from constituents can help break the
logjam during the current recess. Tell your legislators
that the "three-hour limit must go." Although we need to
reach out to all legislators, we must target the
following Republican members of the Conference:
House of Representatives--
Reps. Bill Archer (R-TX), Mike Bilirakis (R-FL), Tom
Bliley (R-VA), John Boehner (R-OH), Dan Burton (R-IN),
Ernie Fletcher (R-KY), Porter Goss (R-FL), Nancy Johnson
(R-CT), Jim McCrery (R-LA), Joe Scarborough (R-FL), John
Shadegg (R-AZ), Jim Talent (R-MO), Bill Thomas
(R-CA).
Senate--
Sens. Mike Enzi (R-WY), Bill Frist (R-TN), Phil Gramm
(R-TX), Judd Gregg (R-NH), Tim Hutchinson (R-AR), Jim
Jeffords (R-VT), Don Nickles (R-OK), John Ashcroft
(R-MO), Chuck Hagel (R-NE), Rod Grams (R-MN), Spencer
Abraham (R-MI), Bill Roth (R-DE), Jon Kyl (R-AZ), John
McCain (R-AZ), Rick Santorum (R-PA).
Quality Health Care Coalition Act (HR 1304)
The Campbell bill (HR 1304) was schedule to go to the
House Rules Committee on Wednesday May 23rd and to the
House floor for a vote on Thursday May 24th. On
Wednesday, 86 members of the Republican caucus voted to
pull the bill and it was subsequently pulled from the
schedule without notice or explanation. The Republican
leadership staff indicates that the bill may be taken up
in June when the House returns from Memorial Day recess.
The outcome of the bill in the House remains
unclear.
Cardiac Arrest Survival Act a.k.a. CASA (HR 2498)
The CASA bill (HR 2498) calls on the Secretary of the
US Department of Health and Human Services to establish
guidelines for the placement of automated defibrillators
in federal buildings. The bill also establishes Good
Samaritan protections for individuals using the devices
from civil liability. H.R. 2498 cleared the House on a
415-2 vote on Tuesday night. The bill now goes to the
Senate.
REGULATORY UPDATE
OIG Issues Proposed Anti-kickback Safe Harbor for
Ambulance Restocking
The Office of Inspector General (OIG) published a
proposed rule on May 22 that would establish a safe
harbor to the anti-kickback statute for ambulance
restocking. The safe harbor would protect certain
arrangements involving hospitals that replenish drugs
and medical supplies used by ambulance providers when
transporting emergency patients to hospitals. Comments
on the proposed safe harbor must be submitted to the OIG
by July 21.
Over the past two and a half years, there has been
some confusion regarding the applicability of the
anti-kickback statute to ambulance restocking. The OIG
issued an advisory opinion in late 1997, stating that an
ambulance restocking arrangement potentially violated
the anti-kickback statute. In 1998, the OIG issued three
advisory opinions approving ambulance restocking
arrangements. The OIG stated that the facts of those
opinions differed significantly from the facts of the
1997 case. In proposing to establish a safe harbor for
ambulance restocking, the OIG stated that these
arrangements serve a significant public interest by
providing a means of ensuring that ambulances are fully
stocked with current medications, sanitary linens and
other supplies that are compatible with equipment used
in local emergency departments.
Under the proposed rule, safe harbor protection would
be established for ambulance restocking arrangements
that meet the conditions in one or two categories. Both
categories pertain only to emergency ambulance services
– the safe harbor would not protect ambulance restocking
following routine ambulance transports.
The first new proposed safe harbor would protect
ambulance restocking where an ambulance provider pays
the hospital fair market value for the replenished drugs
or supplies used for the transport of an emergency
patient.
The second category would protect arrangements where
a hospital contemporaneously restocks drugs and supplies
used during the transport of an emergency patient, even
if restocking is for free or reduced prices. The OIG
proposed seven criteria to be met to qualify for this
safe harbor:
- Hospitals must restock on an equal basis for all
ambulance providers who bring emergency patients to
the receiving facility.
- Restocking arrangements must be part of a
comprehensive and coordinated effort to improve the
EMS delivery system in the relevant service area; must
be open to all emergency ambulance providers and
hospitals in the area; and must be implemented with
and monitored by a regional EMS Council or equivalent.
- The restocking arrangements must be in writing.
- The hospital must not bill any federal health care
program or beneficiary for the restocked drugs or
supplies or write off the cost of the drugs or
supplies as bad debt.
- Ambulance providers may not bill any federal
health care program or beneficiary separately for the
replenished drugs or supplies.
- The hospital and ambulance supplier must maintain
records of the restocked drugs and supplies and make
the records available to the Secretary of the
Department of Health and Human Services upon request.
- The hospital and ambulance supplier must otherwise
comply with all federal, state, and local laws
regulating emergency medical care and the provision of
drugs and medical supplies, including laws relating to
the handling of controlled substances.
The proposed safe harbors are available on the OIG's
web site at: http://www.dhhs.gov/progorg/oig/oigreg/ambulancepr.pdf.
HCFA Moving Forward to Allow Nurse Anesthetists to
Work without Physician Supervision
In a recent letter from HCFA Administrator Nancy-Ann
Min DeParle to Senator Arlen Spector (R-PA), HCFA
indicated that it is moving forward with plans to allow
Medicare payment for nurse anesthetists who work without
immediate supervision of anesthesiologists. The letter
stated that HCFA is planning to finalize the policy,
proposed in December 1997, by June. The letter stated,
"We propose the change because the clinical evidence
supports that anesthesia outcomes have improved
substantially in recent years such that anesthesia is a
relatively safe procedure." The American Society of
Anesthesiologists (ASA) is continuing its effort to
persuade the agency not to make this policy change. ACEP
has signed on to letters supporting ASA. |