Competitive Bidding comment to CMS

June 16, 2006

Centers for Medicare and Medicaid Services
Department of Health and Human Services
Attention: CMS-1270-P
P.O. Box 8013
Baltimore, MD 21244-8013

We are writing to you on behalf of the Wound, Ostomy and Continence Nurses Society, a professional specialty nursing organization of healthcare providers who manage the care of patients with wounds, ostomies and incontinence-all chronic health problems. The populations that we care for are consumers of durable medical equipment, prosthetics, orthotics and supplies; therefore we have an interest in the proposed rule for competitive bidding for providers who dispense DMEPOS under Medicare Part B. We would like to take this opportunity to comment on this proposed rule.

Our first concern is the very short time frame proposed to implement this projected rule. Because of the short timeframe, we are concerned that many important details have been overlooked. The proposed rule is not very detailed or thorough, so it is difficult for clinician and consumer groups to really anticipate what the true impact of this proposed rule will be, much less to adequately comment on it. We would start by asking for CMS to extend the 60-day comment period for more thought and comment.

The second issue that we have comment on is the expanded "gap-filling" methodology that CMS will use to price new technologies. This is a serious concern that has huge ramifications for manufacturers, clinicians and consumers. One recent example is the preliminary denial for antimicrobial dressing codes using this expanded criterion. We believe this decision will result in sub-optimal management of critically colonized or infected wounds. With increases in drug resistant organisms, antimicrobial dressings provide a cost-effective treatment option. Without adequate reimbursement of this technology, these dressings will not be available to many Medicare recipients. The result will be increased hospitalizations and higher costs to the Medicare program. We are also concerned that the significantly expanded criteria proposed for future coding decisions will have the unintended effect of reducing the research and development of new medical devices and technology.

As taxpayers and healthcare consumers, our members support the idea that Medicare should get the best prices for goods and services along with the best clinical outcomes. Unfortunately, the cost savings to CMS will come from the profits of the retail sector. The retailers most adversely affected will no doubt be the smaller retailers, many who serve rural and underserved Medicare recipients. The small retailers serve a smaller volume of clients and have much slimmer profit margins on which to operate. If these small retailers are forced to close, many consumers will have less access to the supplies necessary to treat and prevent a variety of medical conditions.

The rule also proposes that Medicare suppliers be accredited by a CMS-approved accreditation organization to meet quality standards. Suppliers will incur a significant cost in order to participate in the bidding process as well as maintaining their accreditation. There will be additional costs, such as modifying systems software and administering the program that have not been considered. While many of these costs have not been well identified, we know one thing for certain - the costs to the retailers will be considerable. This will be especially burdensome to small retailers, many who serve rural and underserved areas. These costs will be ultimately passed on to the consumer resulting in an additional burden to an already overburdened healthcare system.

Our last concern is that of quality clinical outcomes. While there seems to be much focus on bidding for a product code, there is no mention or consideration of maximizing clinical outcomes. As clinicians, we believe that healthcare providers are best at making clinical decisions about the appropriate durable medical equipment and supplies that the consumer will need to achieve optimal outcomes. We would recommend that CMS have a tracking method, such as a consumer hotline, where clinicians and consumers can report adverse clinical outcomes resulting from the inability to access the most appropriate medical therapy. Many of the patients that we serve have health conditions associated with significant costs and complications, especially when the care provided is inappropriate, incomplete or sporadic. CMS should be tracking any complication or adverse effect that results from competitive bidding.

Thank you for the opportunity to comment on this proposed rule. We can be reached at 888-224-9626 for further dialogue.

Margaret Goldberg, MSN, RN, CWOCN
President, WOCN

Lee Ann Krapfl, BSN, RN, CWOCN
Chair, WOCN Public Policy

Government Affairs Report 2006

Marilyn Magoffin G/A chair

What has the Government Affairs Committee been up to?

The purpose of the Government Affairs Committee (GAC) is to monitor legislation that is pertinent to WOC nurses and inform the Pacific Coast Region membership of these issues to allow them to contact congressional members to influence their support and votes on these issues. Issues that are pertinent to the nursing profession as a whole are also supported.

So how does this happen?

Committee members monitor newspapers, nursing newsletters and news list serves for articles on pending legislation that could benefit or negatively impact our practice. Periodically CMS will issue proposed regulatory changes and request public comment. When the GAC determines the membership should be notified about a particular bill or a public comment an email is sent to the support group leaders who then pass this information onto their members. The same email is also posted on the PCR web page under the Government Affairs banner. The GAC works closely with the WOCN Society via the Public Policy Committee which also monitors legislation via our lobbyist, Bill Applegate. We also receive and pass on, as appropriate, American Nurses Association "Stat" alerts which impact our membership. The following were the significant events that occurred in 2006:

1. Competitive bidding for DME: Under a new proposed rule that will take effect over the next 2 years, DME suppliers will submit bids to CMS for selected items. The CMS would use this information to select winning suppliers. This new rule would potentially have an impact on type, quality, availability of DME utilized by WOC nurses
   
   What happened: WOCN Society via the Public Policy committee sent a letter to CMS expressing WOCN Society concerns including the short time frame for implementation, the denial of antimicrobial dressings and the impact of the proposed rule on the quality of dressings and small volume providers
   
   
2. Healthcare Truth and Transparency Act: Legislation that would potentially mean fines for advance practice nurses practicing as such.
   
   What happened: Notice via the ANA Stat Alert was sent to PCR membership via the support groups, PCR web page and the WOCN Professional Practice forum advising members to contact their representatives about this legislation.
   
   
3. Pandemic Flu letter: requests that fit testing for N-95 respirators for nurses and other health care providers who could potentially be exposed to pandemic flu be mandated by OSHA. Currently the only mandate is for respirator masks that protect against TB.
   
   What happened: Notice via the ANA Stat Alert was sent to the membership via the support groups, PCR web page advising members to contact their representatives about this legislation.
   
   
4. Increased Funding for Nursing Work Force Development: No increase in funds for the Nursing Workforce development legislation was approved for 2007. Some Senate and House members have submitted a letter requesting increase to address the nursing shortage
   
   What happened: Notice via the ANA Stat Alert was sent to the membership via the support groups and the PCR web page advising members to contact their representatives about this legislation. In addition, WOCN members who were attending the Nurses in Washington Internship program (NIWI) conference (including our own Mary Anne Dilloway) met with Congressman Carnahan (D-MO) which resulted in his signing and the subsequent passage of the Congressional joint letter of support for increased nursing program funding in FY 2007. He had not been planning on signing this amendment. This amendment incorporated an additional $25 million dollars into the Nurse Reinvestment Act/Nursing Programs and is now a provision in the FY2007 Budget Resolution.
   
   
5. Oncology Nurse Society (ONS) Letter Sign on. Data on care provided by advance practice nurses is not being collected by CMS. It currently only collects data on care provided by MDs. ONS is very concerned that CMS is not taking the steps necessary to get its payment database system to a place where nurse practitioners will have equal opportunity as physicians to participate in demonstration and pay-for-performance/value-based purchasing programs.
   
   What happened: WOCN joined many other professional nursing organizations in signing onto the letter to CMS by the Oncology Nurses Society.
   
   
6. WOCN (and PCR) are fortunate to have William (Bill) Applegate as our lobbyist in Washington DC. In Nov 2005 he arranged for the WOCN Society in conjunction with the Pedorthic Foot Assoc. (PFA) to conduct an educational briefing on the care of the diabetic foot for invited members of congress. We were invited to present this briefing by Congresswoman Carolyn McCarthy, who has been a nurse for over 30 years prior to coming to congress and she was the lead sponsor of H.R. 1416, the Medicare Diabetic Footwear Quality Restoration Act of 2005. This bill amended the Medicare Prescription Drug Law of 2003 that reduced the Medicare payment for orthopedic shoes and inserts furnished to individuals with diabetes. Because of the extremely favorable response to the presentation by WOCN, Bill believes a follow up to this presentation will be welcomed by those congressional members who attended and he plans to set this up in 2007. Diabetes is "hot" because of its far reaching impact on US citizens.

In addition, several notices were sent out to support group leaders containing news articles and stories about healthcare issues that were "FYI"s

So what's next?

2007 looks to be a year that potentially will be labeled the "Year of Healthcare Reform" The new 110th Democratic controlled congress has already submitted legislation that raises the minimum wage (impacts non skilled care providers of our patients), supports stem cell research and a bill which allows Medicare to negotiate with pharmaceutical companies to reduce drug prices. The passage of these bills will be determined by the support of the Republican Party and their influence on President Bush who could potentially veto any of theses measures. In California, Governor Schwarzenegger is preparing to unveil a new plan to address the problem of the non insured.

Being part of a large network supports our membership by providing a larger voice for the issues that concern us. Anyone who has participated in the Nurses in Washington Internship program (NIWI) quickly realizes that the almost 3 million nurses in the United States are a powerful constituency that any legislator will take seriously if they believe they are being approached by this group. That is why organization is so important and why participation is crucial. Change occurs at a snails pace via the legislative process. But the legislative process is one of the main venues available to citizens where change does occur. Patience and vigilance will always pay off.

The GAC understands that PCR members are busy. No one feels as though they have the time to do all the things they'd like to in order support our patients and our profession. The GAC tries to limit our communications to those that are most pertinent while providing adequate information to those who are interested. Congressional members are more likely to respond to a constituent than to a non constituent. Knowing this, we hope that you do respond to our communications by sending an email or calling your representative. We always try to include the information to help you do so.

FOR IMMEDIATE RELEASE

Sunday, May 07, 2006

NURSING ORGANIZATIONS ALLIANCE ANNOUNCES 2006 NURSE IN WASHINGTON INTERNSHIP (NIWI) SCHOLARSHIP WINNERS

(Lexington, Ky.) - The Nursing Organizations Alliance (The Alliance) is pleased to announce the scholarship winners for the Nurse In Washington Internship (NIWI) program. NIWI provides nurses the opportunity to learn how to influence health care through the legislative and regulatory processes. Participants learn from health policy experts and government officials, network with other nurses, and visit members of Congress. NIWI will be held March 12-15, 2006 in Washington, DC.

The recipient of the full scholarship to NIWI is Robert Carroll, Seattle, Washington. He is a member of The Alliance member organization, the Association of Nurses in AIDS Care (ANAC). Mr. Carroll is the Washington State Education Coordinator for the Northwest AIDS Education and Training Center (AETC). In addition to his duties at the AETC, he is also heading up ANAC's new policy initiative. He has been active in many other professional associations and councils including a National Advisory Council member for the Health Action AIDS project; a grant reviewer for the Centers for Disease Control and Prevention; and a member of the International AIDS Society and International Association of Physicians in AIDS Care. He has provided more than 100 training seminars, presentations and workshops in venues across the US and around the world.

The recipient of the registration scholarship is Christina Foushee, San Francisco, California. She is a member of The Alliance member organization, the American Nurses Association\California (ANA\C). Ms. Foushee serves on the ANA\C Legislative Committee which is responsible for reviewing upcoming legislation, regulation and elections as well as monitoring and examining media coverage. During her time as a graduate student at the University of California, Ms. Foushee served as an intern in the Washington D.C. office of Congresswoman Nancy Pelosi. As an intern, her responsibilities included attending health-related hearings and briefings, compiling policy briefs, and the gathering of pertinent, updated health statistics from the Centers for Disease Control and National Institute of Health for the intent of resubmission of an environmental health tracking bill. This fall, Ms. Foushee was accepted to the PhD Occupational and Environmental Health and Policy Nursing program at the University of California, San Francisco.

The Nursing Organizations Alliance™ (The Alliance) is a coalition of nursing organizations united to create a strong voice for nurses. Membership in The Alliance is open to any national nursing organization whose focus is to address current and emerging nursing and health care issues. The mission of The Alliance is "to increase nursing's visibility and impact on health through communication, collaboration and advocacy."

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For more information please contact Tracy Tucker, The Alliance Account Executive at (859) 514-9157 or at

WOCN GOVERNMENT RELATIONS
STRATEGIC PLANNING - PREPARING FOR THE FUTURE
2006
2ND SESSION - 109TH CONGRESS

I. Overview & Background

The Wound, Ostomy and Continence Nurses Society (WOCN) concluded the first session/year of the 109th Congress by hosting a very successful Congressional staff briefing on Capitol Hill. On November 2, 2005, WOCN partnered with the Pedorthic Footwear Association (PFA) to convene an afternoon educational briefing for more than 30 Congressional health care aides. The Society utilized this opportunity to disseminate and discuss the organization's position statements on several policy issues of concern to the membership (focusing primarily on treating and preventing lower limb amputations as a result of diabetes). These position statements were developed and updated by WOCN leadership and the Public Policy Committee during the months prior to the Congressional briefing. The briefing also served to garner the support of Members of Congress for H.R. 1416, the "Medicare Diabetic Footwear Quality Restoration Act of 2005".

The Capitol Hill briefing, "Improving Care for Medicare's Diabetic Beneficiaries", was chaired and sponsored by Congresswoman Carolyn McCarthy (NY), a practicing nurse for more than 30 years. McCarthy addressed the educational forum with opening remarks and an overview of the current political landscape on Capitol Hill. Following the educational briefing, WOCN and PFA hosted a small political reception for McCarthy. The reception provided an opportunity for WOCN's President, Margaret Goldberg, to discuss nursing and WOCN community priorities with the Congresswoman. McCarthy invited WOCN to work closely with her during the Second Session of the 109th Congress (2006) to advance the organizations public policy goals in the areas of patient care, work force shortages, education, etc. The Congresswoman also specifically discussed her intention to work with WOCN on nurse workforce development program funding (Title VIII of the Public Health Service Act) in 2006.

The WOCN Capitol Hill briefing proved to be very successful in generating interest and raising the overall visibility of the Society among key Congressional staff decision-makers. The forum also assisted the WOCN government relations team in identifying specific Congressional offices that have been active and interested in the organization's public policy agenda.

WOCN's government relations team is looking forward to capitalizing on these past successes and achieving a "running start" in advancing the Society's government relations goals in 2006.

II. Second Session (Year) of the 109th Congress - 2006

Although Congress currently remains in their respective home states and districts for recess, the US House of Representatives and US Senate will return for the second year/session of the 109th Congress on January 18th (Senate) and January 31st (House of Representatives).

Key dates that mark the "kick-off" of this session of Congress include:

• January 18, 2006 - U.S. Senate Convene
• January 31, 2006 - U.S. House of Representatives Convene
• January 31, 2006 - President Bush delivers the "State of the Union" Address
• February 6, 2006 - President Bush submits the Administration's Budget Request/Proposal for FY 2007 (marking the beginning of the FY 2007 budget/appropriations process)

In preparation for the new session of Congress, WOCN was recently represented at the "National Nursing Organization Meeting on FY 2007 Nursing Funding" in Washington, DC on January 12, 2005. The purpose of the meeting was to assemble the nation's nursing organizations to examine and discuss funding realities and opportunities impacting the collective nursing professions in the FY 2007 federal appropriations cycle. Specifically, the meeting focused on Title VIII of the Public Health Services Act - Nurse Workforce Development Program Funding. The meeting including discussions with past Congressional champions on nursing issues, including: Congresswoman Lois Capps (D-CA), Congressman Steve LaTourette (R-OH), Senator Barbara Mikulski (D-MD), and Senator Susan Collins (R-ME). This meeting of the national nurses societies provided a good opportunity for WOCN to discuss collective strategies to advance the overall goals of the nursing community on Capitol Hill and within the Administration.

Building on the early success of WOCN's government relations activities in the fourth quarter of 2005, the Society's government relations team would like to propose several strategic initiatives for implementation in 2006. These initiatives include:

• WOCN Congressional Briefing II

During the first quarter of 2006 (Jan - April), we would like WOCN to consider sponsoring or co-hosting its second Congressional staff briefing on Capitol Hill. Congresswoman McCarthy's office believes that the Society should capitalize on the November briefing's success and would like to assist the organization in developing a second briefing to further educate targeted Congressional staff on policy issues of importance to the Society's membership and the collective nursing community.

• Capitol Hill Day Fly-In

As discussed in 2005, the Society's government relations team would like to have two to three (or more) of the WOCN leadership "Fly-In" for a day of meetings with selected Members of Congress and senior staff (House and Senate) that serve on key health care Congressional Committees of jurisdiction. With regard to timing, we would like to accomplish this goal once in February/March and again in September of 2006.

• Grassroots Tours of Medical Institutions/Practices in Home States and Districts of Members of Congress

We believe that WOCN should utilize 2006 and the Second Session of the 109th Congress to activate a grassroots campaign of inviting and hosting Members of Congress and staff for educational tours/briefings during recess periods when Members of Congress leave Washington, DC and return to their local districts and states. The Society's government relations team and association headquarters will coordinate these visits and work closely with WOCN members to ensure that the events run seamlessly (Scheduling, talking points, materials, etc). Upcoming recess periods when Members of Congress will return to their home districts and states include:

• February 20th - 24th
• March 20th - 24th
• April 10th - 21st
• May 29th - June 2nd
• July 3rd - July 7th
• The Month of August

As you know, former Speaker of the House, Tip O'Neill (D-MA), once said, "All politics are local." This could not be more true and is a great way for WOCN members to deliver the Society's message to their local elected officials (thus connecting-the-dots between WOCN's national efforts and the home state constituents that elect or defeat Members of Congress).

• Direct Lobbying by WOCN's Government Relations Team

WOCN's government relations team of lobbyists in Washington, DC will continue to aggressively meet with those Members of Congress serving on the key House and Senate Committees of jurisdiction important to the Society's public policy agenda. The purpose of this ongoing initiative is to familiarize targeted Congressional offices with WOCN as a "go-to" resource on specific nursing public policy issues. This includes weekly meetings with Members of Congress and their staff serving on the:

House Ways & Means Subcommittee on Health (Medicare/Medicaid/Public Health);
House Energy & Commerce Subcommittee on Health (Medicare/Medicaid/Public Health);
House Appropriations Subcommittee on HHS/NIH (Annual funding for HHS, NIH, CMS, CDC, HRSA, etc).

Senate Health, Education, Labor and Pensions Committee (Public Health); Senate Finance Committee (Medicare/Medicaid);
Senate Appropriations Subcommittee on HHS/NIH (Annual funding for HHS, NIH, CMS, CDC, HRSA, etc).

• Continued WOCN Participation and Leadership Within the Nursing Community - Host Nursing Community Congressional Strategy Meeting

Although it is important for WOCN to continue its recent efforts to raise the organization's individual identity as an expert resource to federal decision-makers, it remains important for the Society to participate and continue its efforts working collectively with the broader nursing community coalition. Given that WOCN now has its own lobbyists and offices in Washington, DC, we would suggest that the Society host a breakfast or lunch strategy meeting (in the WOCN Wash, DC Offices) for the entire nursing community to discuss legislative and regulatory priorities, goals and progress in 2006. This may be an ideal initiative for the end of the first quarter of 2006 (April).

• Further Development of the WOCN Public Policy Statements and Key Messages - Dissemination on Capitol Hill

As the WOCN government relations program continues to mature, it is important for the Society to have a polished set of talking points and key messages for use in educating Members of Congress and senior health care staff on the issues of concern to the organization. These position statements proved very useful during WOCN's Capitol Hill briefing this past November. We would like to finalize these statements and have them delivered to targeted audiences on Capitol Hill by the end of the first quarter of 2006 (April).

Congresswoman Carolyn McCarthy has offered to partner with WOCN and assist the organization in working with the other nurse Members of Congress to provide these WOCN educational materials to Congress and federal decision-makers.

• Coordination and Communication - Streamlining

WOCN's government relations team would like to propose the establishment of regular (quarterly or monthly) telephone conference calls to brief the Society's leadership and Public Policy Committee on developing issues, legislation and regulation impacting the organization's membership. These regularly scheduled communications would also be effective in discussing the Society's (and overall nursing community's) progress in advancing key issues. We would also suggest the establishment of a select email group of WOCN leaders that we may periodically call upon for expertise and/or update on recent developments.

Note: We realize that everyone recieves entirely too much email traffic. Our goal would be to only send and report on those items that are imperative and require action.

• Respond to the "Fluid Nature" of Congress - Remain Flexible

Although we have outlined several initiatives that we believe are important for WOCN to achieve and further strengthen the organization's political tool kit, we also fully understand that Congress runs fluid and that we must remain flexible to respond to those initiatives and legislative vehicles that present themselves as opportunities to the Society. As a result, we will continue to serve as the WOCN's "eyes & ears" on Capitol Hill and within the Administration.

ANA Legislative Agenda 9/05

Oppose Medicaid Cuts

Funding for Nursing Workforce Development

Position
ANA urges Congress to appropriate at least $205 million in FY 2005 funding for nursing workforce development (Title VIII, Public Health Service Act).

Rationale
In order to meet the growing demand for nursing services, Congress must invest in nursing workforce development programs. Funding of at least $205 million would allow HRSA to implement programs designed to attract more students into nursing programs; improve the workplace for nursing; support schools of nursing to provide faculty and updated curricula; recruit a more diverse student population; provide assistance to students to enable them to complete nursing studies, and; ensure the collection and analysis of current nursing workforce data to guide the appropriate implementation of these programs. ANA applauds Congress for taking the visionary step of passing the Nurse Reinvestment Act. However, the important programs contained in this law will never become a reality without adequate funding.

Update on State Staffing Legislation

Market forces have not resolved the issues of patient safety and quality of care related to nurse staffing. Massive reductions in nursing budgets have resulted in fewer nurses working longer hours, while caring for sicker patients. Nurses have turned to legislators at both the state and federal levels to protect patients by holding hospitals accountable for the provision of adequate nurse staffing through legislative or regulatory means. Three general approaches to assure sufficient nurse staffing have been proposed. The first is to require and hold hospitals accountable for implementation of nurse staffing plans, with input from practicing nurses, to assure safe nurse to patient ratios are based on patient need and other criteria. The second approach is for legislators to mandate specific nurse to patient ratios in legislation or regulation. The third approach is a combination of nurse staffing plans and legislated nurse to patient ratios. Nurse Staffing Plans ANA and State Nurses Associations promote legislation to hold hospitals accountable for the development and implementation of valid and reliable nurse staffing plans.

These plans are based upon ANA's Principles for Nurse Staffing which provides recommendations on appropriate staffing and requires nurses to be an integral part of the nurse staffing plan development and decision-making process. This is not a "one size fits all" approach to staffing but instead provides hospitals with the flexibility of tailoring nurse staffing to the specific needs of patients based on factors including how sick the patient is, the experience of the nursing staff, technology, and support services available to the nurses. This flexibility does not negate the accountability of hospitals to ensure safe and effective nurse staffing. States are looking at enforcement measures ranging from termination or suspension of a facility’s license, to public disclosure of violations, to fees, penalties and private right of action suits. In addition to state legislation, ANA developed federal legislation, S 991, introduced by Senator Inouye (D-HI), and its companion bill, HR 3656, introduced by Rep. Lois Capps (D-CA), that requires hospitals to develop and implement staffing plans as a condition of participation in Medicare. ANA has also worked with Rep. Maurice Hinchey (D-NY) to introduce HR 4374 that requires Medicare providers to publicly disclose nurse staffing and patient quality outcomes measurements. This year, Florida, Hawaii, Illinois, Massachusetts, Rhode Island, and Washington have introduced legislation that would require health care facilities to develop nurse staffing plans. The bills contain a variety of components such as: requiring nurse administrators to adopt and implement a staffing plan with input from direct care registered nurses; daily posting of the numbers of nursing staff responsible for patient care; evaluation of the adequacy of the staffing plan through the collection of patient quality outcomes; requirement that ANA’s Principles for Nurse Staffing serve as a basis for development of a staffing plan; and use of civil penalties for enforcement purposes.

In 2003, Nevada enacted legislation that would require the Legislative Committee on Health Care to appoint a subcommittee to conduct an interim study on nurse staffing. 2002 regulations adopted in Texas require hospitals to (under the administrative authority of a chief nursing officer and in accordance with an advisory committee comprised of nurse members) adopt, implement, and enforce a written staffing plan. This plan must be consistent with standards established by the Texas nurse licensing boards and based upon the nursing profession's code of ethics. Patient outcomes related to nursing care will be evaluated to determine the adequacy of the staffing plan. Last year a Florida bill also passed that specified the establishment of a minimum staffing standards and quality requirements for a subacute pediatric transition care center to be operated as a 2-year pilot program. 2001 legislation enacted in Oregon requires hospitals to develop and implement nurse staffing plans and establish internal review processes. Random audits of hospitals for compliance are mandatory and failure to comply will result in civil penalties or revocation of licensure. In 1998, legislation was passed by Kentucky and Virginia to set appropriate staffing methodology and in 1995, regulations were developed in California calling for institutions to develop valid staffing systems. Nevada adopted regulations a few years later. Nurse to Patient Ratios Another legislative approach to address nurse staffing is to mandate specific nurse to patient ratio legislation. In 1999, legislation was enacted in California calling for the adoption of regulations that would define uniform, unit-specific nurse to patient ratios for utilization in all nursing units in all California hospitals. Currently, a few states now require specific ratios in specialty areas such as intensive care and labor and delivery units, but none require ratios in every patient care unit in every hospital as required in the California regulations.

Building on the 1999 California legislation, this year legislation has been introduced in California that requires hospitals to develop staffing plans for professional, technical and support staff. Another California bill requires the evaluation of the current nurse to patient ratio of one nurse to six patients in medical surgical units and calls for the evaluation of a ratio of one nurse to five patients. Legislation has been introduced this year in Hawaii, Iowa, and Tennessee that would require specific nurse to patient ratios in hospitals and/or other health care facilities. These broad-based bills assign a numeric nurse to patient ratio for specific patient care units such as pediatric recovery rooms, trauma, and psychiatric units. Connecticut legislation calls for the Commissioner of Public Health to adopt regulations establishing minimum nurse-to-patient ratios. Strict enforcement is another hallmark of these bills with violations leading to any combination of the following: loss of hospital license, fines, termination of Medicaid reimbursement, private right of action, and civil penalties. Nurse Staffing Plans and Nurse to Patient Ratios In 2004, Illinois, Massachusetts, Michigan, New York, Pennsylvania, Rhode Island, and Tennessee have introduced legislation requiring minimum nurse to patient ratios that would be augmented by hospital-based staffing systems. Maine enacted legislation this year that requires minimum nurse to patient staffing ratios as outlined in law that will be increased as patient needs demand as determined by an established patient staffing system. The ME Department of Human Services will adopt rules for establishing patient staffing systems.

Susan Whittaker
MS, RN

CDC Publishes Draft Guidelines for Isolation Precautions

The Centers for Disease Control and Prevention (CDC) has published a report, Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2004. The CDC is asking for public comments on the document which was developed for use by infection control staff, health care epidemiologists, health care administrators, and other people responsible for developing, implementing, and evaluating infection control programs for health care settings across the continuum of care. All healthcare personnel who need general information about infection control measures will find the guideline helpful. The 2004 guideline updates and expands the 1996 Guideline for Isolation Precautions in Hospitals. The revised guideline is designed to meet the following objectives

1. to provide infection control recommendations for all components of the health care delivery system, including hospitals, long-term care facilities, ambulatory care, and home health;
2. to reaffirm standard precautions as the foundation for preventing transmission during patient care in all settings; and
3. to provide epidemiology recommendations that are sound, and whenever possible evidence-based.

Reasons for the updating the 1996 guideline include: the transition of health care delivery system from primarily acute care hospitals to other health care settings; the emergence of new pathogens; the increase in multidrug resistant organisms; and threats of bioterrorsim. In addition, there is consistent evidence that organizational characteristics (such as nurse staffing levels and skill mix) as well as health care workers ’ levels of adherence to infection control practices, have led to a new emphasis on the importance of administrative involvement in the development and support of infection control programs.

The standard precautions approach to preventing transmission of infectious agents that the 1996 guideline established has been reaffirmed in the revised guideline. A new addition to the recommendations for standard precautions is Respiratory Hygiene/Cough Etiquette. The need for this recommendation grew out of observations during the SARS epidemic where failure to implement simple source control measures with patients, visitors, and health care personnel with respiratory symptoms may have contributed to SARS coronavirus transmission. ANA will review the 2004 Guideline document and provide comments to the CDC as needed. Deadline for comments is August 13, 2004.

Please Note:

New Evidence Report Summary on Monitoring of Diabetes

Medi-Cal will continue ostomy supplies

To: UOA Advocates in California
Subject: Medi-Cal will continue ostomy supplies

From Chico to Walnut Grove, from San Diego to Yreka, UOA members and WOC nurses across California responded to the early-2003 Medi-Cal threat by contacting their state senators and assembly-people. As a group, you educated them about what it means to live with an ostomy, and how ostomy supplies are NOT "optional", no matter how Medi-Cal defines them. You wrote letters in February and March and some went to Sacramento later that month, to meet face to face and testify at a hearing. In conjunction with UOA and it's collaborative efforts with WOCN and the California Association of Medical Equipment Suppliers, you kept up the campaign.

And we all held our breath though several rounds of budget negotiations...proposals and counter proposals, reported "compromises", failed agreements. Until finally the Assembly and Senate, in late July, passed a budget that retains coverage of ostomy and other medical supplies for the state's low-income elderly, disabled, and income-qualified families. It also contains some painful service cuts - it is not a great budget for everyone - but our objective was accomplished.

UOA thanks you for participating in this campaign. We hope you will pass the word along to others in your chapter who may have also taken part but whose names we do not know. Every one of you had a part in the victory.

We also hope you will continue the "conversation" - the learning process - that has begun with your elected officials. There will be a new budget next year, with potentially worse budgetary problems to confront and resolve. Every citizen must raise their voice so that our representatives and policy makers know what we need and know how strongly we feel about it.

Thanks again,

Linda

Nurses Convene In Washington For 2005 Nurse In Washington Internship (NIWI)™

NEWS RELEASE

February 10, 2005 -- Lexington, KY -- The Nursing Organizations Alliance (The Alliance)™ held its 3rd Annual Nurse In Washington Internship (NIWI)™ event February 6-9 in Washington, DC. Over 80 nurses came to D.C. to learn how to influence health care through the legislative and regulatory processes. Participants learned from health policy experts and government officials, networked with other nurses, and visited members of Congress.

With political boundaries being drawn on Social Security reform, a timely presentation by Lisa Maatz, director of public policy and government relations for the American Association of University Women, examined the issues surrounding the debate. Michael Hash, principal at Health Policy Alternatives and former deputy HCFA administrator at the U.S. Department of Health and Human Services (HHS), described the historical and current forces surrounding healthcare financing.

One of the highlights of the conference was the recognition of the 2005 NIWI™ scholarship recipients. The scholarships are given annually to help fund a nurse's travel to participate in the NIWITM conference. This year's recipients include:

Joyce Myers, a member of the American Society of Perianesthesia Nurses and the Pennsylvania State Nurses Association, who received the Alliance Full Scholarship for her legislative publications and activities on the local, state and national level.

Jodi Gunther, current president of American Association of Critical Care Nurses, received the Alliance Registration Scholarship. She co-presented "Advancing the Critical Care Nurse: Continuing Education in the 21st Century" at her local chapter and will be presenting at their national convention in May.

Sammi Jones Lawson, a member of National Association of School Nurses, the Epilepsy Foundation Executive Board, and the National Association of Female Executives, received the Policy and Politics in Nursing and Health Care Full Scholarship. She is involved with the formation of a policy on Diastat administration in the Louisiana schools.

Other sessions included presentations by Judith K. Leavitt, Med, RN, FAAN and Mary W. Chaffee, DSc (h), MS, RN, CNAA, FAAN, co-editors of Policy and Politics in Nursing and Health Care, who provided an overview for attendees about the political clout that nurses have to influence and the political arenas where nurses have traditionally been active. Sally Phillips, RN, PhD, director of the bioterrorism preparedness research program for the U.S. Department of Health and Human Services and former staff aide to Senator Tom Harkin (D-IA), presented an overview for a successful Hill visit. The conference concluded with individual meetings with members of Congress.

NIWI (Nurse in Washington Internship) program.

February 6-9, 2005

For those interested in an opportunity to learn how to work more extensively and effectively. The NIWI (Nurse In Washington Internship) teaches how to work with legislative staff to advance policy agendas. In doing this you can learn to influence health care through the key steps to effect change in the legislative and regulatory processes. Eligibility begins with completion of a brief Pre-Internship course as well as a sincere desire/interest in enhancing and understanding health policy and legislative/regulatory processes.

Please, submit your applications by the dates listed below. The PCR would like to help sponsor one of our ET/Wound, Ostomy, and/or Continence Nurse.

Schwarzenegger Expected to Withdraw Plan To Eliminate, Consolidate Some State Boards

February 17, 2005

Some State Boards Schwarzenegger Slated for Elimination Not Named by California Performance Review

January 10, 2005

Some of the state boards -- including several health-related commissions -- that Gov. Arnold Schwarzenegger (R) suggested eliminating during his State of the State address last week were not identified by the California Performance Review Commission, the Los Angeles Times reports (Rau, Los Angeles Times, 1/8).

In his speech, Schwarzenegger proposed consolidating or eliminating almost 100 state regulatory boards. His proposal included eliminating the Board of Registered Nursing and consolidating the responsibilities of the Medical Board of California to the state's consumer services agency.

Schwarzenegger also called for the consolidation of the Workers' Compensation Appeals Board, the Unemployment Insurance Appeals Board and the Occupational Safety and Health Appeals Board into a single, nine-member commission called the Employment and Benefits Appeals Board.

Schwarzenegger's proposal is subject to legislative approval and will undergo hearings later this month by the Little Hoover Commission, an independent state oversight committee. The commission within the next two months will present its recommendations to Schwarzenegger and the Legislature.

Schwarzenegger must formally submit his proposal to the Legislature within 30 days, and the Senate or Assembly will make a decision on the proposal within 60 days of receipt (California Healthline, 1/7).

According to the Times, health-related boards slated for elimination but not included in the CPR report include the following:

Acupuncture Board;

Dental Board of California;

State Board of Optometry;

California State Board of Pharmacy;

Physical Therapy Board of California;

Board of Podiatric Medicine;

California Board of Psychology;

Board of Registered Nursing,

Medical Board of California;

Board of Vocational Nursing and Psychiatric Technicians; and

Workers' Compensation Appeals Board. Schwarzenegger's plan is "expected to encounter resistance" after the commission presents its conclusions because the proposal would "wrest power away from the Legislature," the Times reports. Currently, board members are appointed to fixed terms by state officials and cannot be fired. Schwarzenegger's plan would "give the governor complete power" in appointing and releasing the state's board members, according to the Times.

Administration officials have said they do not know if the proposed changes would reduce state costs. In addition, any savings would not be transferred to taxpayers because most boards are supported by licensing fees, according to the Times.

Response Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego School of Law and monitor of the medical board, said, "This is ill-advised on the part of the administration. A board has to meet in public; it has to respond to public comment. The only interest in Sacramento who's not a special interest is the public interest, and that's going to be blocked out. We're shoving public government into a private closet where only the special interests and the trade interests will be able to go."

Foundation for Taxpayer and Consumer Rights President Jamie Court said, "The whole reason we have professional boards with private citizens deliberating in open meetings is because political bureaucrats like [State and Consumer Services Agency Secretary Fred] Aguiar botched the job and were working for the professional industries that were supposed to be regulated." Court also called Aguiar a "political animal who, when he was in the Legislature, was fed and bred by the medical insurance complex."

California Medical Association President Robert Hertzka said that under Schwarzenegger's proposal there could be a "significantly dramatic change in how physician discipline was being managed and run" in the event of a "major partisan switch." He added, "In the present system, going from (Gov. Pete) Wilson to (Gray) Davis or Davis to Schwarzenegger didn't change the philosophy."

California Nurses Association Director Rose Ann DeMoro said that Schwarzenegger is "trying to appear as a populist, while he's promoting perhaps the worst corporate agenda we've seen."

Aguiar said that SCSA would continue to review disciplinary complaints and would be accountable to Schwarzenegger. He said, "This administration has had a priority of consumer protection. This does not change under this proposal. I believe this will be open government" (Los Angeles Times, 1/8).

Implementation of AHRQ Policy on the Inclusion of Priority Populations in Research Begins October 1

AHRQ Releases Clinician's Handbook Resources Update

Sample Letter Regarding Overtime Issue

> From ANA News:
Keeping Track: Reauthorization of the Higher Education ActIn the House of Representatives, the reauthorization of the Higher Education Act has been split into several small bills, leaving key issues including loan forgiveness for professions such as teachers and nurses, and increases in student grant aid unaddressed. One bill that the House has not yet voted on, H.R. 3180, "The College Opportunity for All Act" would allow loan forgiveness for nurses who are employed in a clinical setting or who serve as faculty members at an accredited school of nursing. This bill introduced by Rep. George Miller (D-CA) builds upon legislation developed by Rep. Carolyn McCarthy (D-NY) which would amend the Higher Education Act of 1965 to expand loan forgiveness and loan cancellations for nurses and other professionals. The House is expected to hold a hearing on student aid during the third week of June. Following this hearing, the House may take up a final higher education bill in the Education and Workforce Committee. The Senate has yet to fully engage in the reauthorization process and there is no definite time frame set for them to determine if they will consider a reauthorization bill.

Note: Please use this as an example only and please write your letters in your own words as that may be more effective. Thank you, PCR BOD

The NIWI Experience

Political action has always seemed to be the "right" thing to do but being a busy CWOCN [could you not just say "wound care nurse"?] in a small rural hospital. I wasn't sure I had the time I needed in order to be as effective as I wanted. Signing up to be on the Government Affairs committee two years I thought would be a way I could learn more about political work without a large time commitment. It was fairly easy to review my assigned news lists for items that pertained to WOC nursing and general nursing. Pretty soon I was hooked and set up my mail program so I could contact my legislators easily with the goal of developing relationships with them. Checking the news lists and communicating with my other committee members became part of my weekly routine.

When I first heard of the Nurses in Washington Internship program (NIWI) I thought it sounded like a great idea. It had never occurred to me to actually go and meet with my legislators face to face. A program that would teach you how to do this and provide support as you did it made sense. NIWI is a bit like WOC/ET school. You are provided with the knowledge and tools and then you get to use them. You share your experiences and listen and learn from your classmates' experiences as well. You leave with a network of peers and instructors whom you can utilize as you enter the political arena to make your voice heard.

The didactic portion was excellent. There were multiple speakers who were all experts in their fields and provided a variety of ways that we can effect political change. For example, we learned the role of media in influencing health policy from Diana Mason, Editor-in-Chief for of the American Journal of Nursing. Michael Hash, Former Acting Administrator of HICFA, spoke about the economic impact of the U.S. healthcare delivery system.

Most moving to me was the story of the Nurse reinvestment Act as told by Sister Rosemary Donley PhD, RN, FAAN, who was one of the main pioneers in the passage and funding of this legislation. She is one of those rare individuals who, though soft spoken, exudes that particular quiet strength that makes you happy she is on your side!

What I did not expect was the excitement of Washington DC. If the United States is the wheel, then DC is the hub. Watching our government work, shaking hands with my own Senators or Congressmen and meeting with them and their legislative assistants for healthcare was exciting and empowering. I felt well prepared as I presented the paper provided by WOCN. Our own Dianne Mackey was a participant and we were joined by Judy Dutcher, Kathleen Dean, Eileen McCann, Phyllis Kupsick and Mary Jo Soloman who are also WOC nurses. In addition, I met nurses from many other professional organizations and we shared our concerns and issues.

As it turns out, being a CWOCN is an excellent qualification for engaging in the political process. We chase down doctors (with only a few minutes to give us) to advocate for the dressing we want. We are the experts in our field and we have worked hard to establish our credibility by utilizing evidenced-based practice. At NIWI I learned that speaking to the point and offering information that is backed by fact are essential skills for having effective communication with your legislator.

I am exceedingly grateful to Pacific Coast Region for providing a scholarship to attend NIWI. It is an excellent investment in the future of WOC nursing. I would encourage anyone who is interested to discuss it with me or go to the PCR web page.

The Nurse Reinvestment Act

The Nurse Reinvestment Act is up for refunding for year 2005. The vote is scheduled for July 16.

N-STAT ALERT: Fight For RNs Right To Overtime Pay

On April 20, the U.S. Department of Labor (DOL) issued a revised Fair Labor Standards Act (FLSA) rule that, as currently written, threatens the rights of Registered Nurses to receive overtime compensation. Unless Congress intervenes, this new rule will go into effect on August 23, 2004.

Representative David Obey (D-WI) has proposed an amendment to the Labor, HHHS, and Education Appropriations bill that would protect nurses and other workers currently eligible for overtime pay. The Amendment prescribes that workers covered by the FLSA who are currently eligible for overtime pay cannot be denied this pay under the new rule.

It is imperative that the House take up the Obey Amendment, but it appears unlikely that the House Leadership will allow a vote on the amendment prior to the rules’ implementation in August.

ANA believes it is essential to preserve the right to overtime compensation for registered nurses, and has strongly supported past measures including the Harkin (D-IA) amendment in the Senates and a previous amendment in the House by Reps. Obey and George Miller (D-CA) to protect nurses and other workers from the DOL regulations.

ANA has sent a letter to all members of the House asking them to support the Obey Amendment and to urge the House leadership to allow a vote on the provision before the August Recess.

We need your help to make sure this issue is a top priority for Congress. Contact your Representative TODAY. Make the Voice of nursing heard.

WHAT YOU CAN DO:

Vote Smart on November 2
Learn about Health Care Ballot Propositions

On November 2, Californians have a historic opportunity to affect the future of the state's health care system by casting their vote on five ballot measures.

Save the Date for Conference on Expanding Health Insurance in California

If anyone has time can they attend and give report?

"Expanding Employment-Based Health Insurance in California: Senate Bill 2 * Issues and Options" will be a one-day conference held on Friday, May 7, 2004, at the Century Plaza Hotel in Los Angeles.
Senate Bill 2 (SB 2) is the new California law that provides for expanded employment-based health insurance. Under SB 2, more employers would provide and/or pay for health insurance for their workers, potentially covering over one million workers and their dependents. Employers, union leaders, health care providers, advocates and policy makers will learn and share their concerns about:

• What SB 2 does and what it doesn't do
• Likely employment and labor market effects
• Potential ERISA challenge
• Effect on health care providers and other programs
• Effects on health care costs and how costs could be controlled
• Likely effects on California's health insurance coverage if SB 2 was repealed in November or was not implemented
• SB 2's implications for other states and national health policy

Funding for Nursing Workforce Development ANA Action

Proposed Revisions to California's Nurse Ratio Law

TALKING POINTS

07/01/2003

• In January 2002, Governor Davis announced proposed nurse staff ratios, as required by state law (AB 394, 1999). On September 29, 2002, the Governor followed up this announcement by releasing detailed proposed regulations as to the ratios and how they are to be implemented.

• Following Governor Davis' September 2002 announcement, the California Department of Health Services (DHS) held public hearings in three cities across the state (Los Angeles, San Francisco and Fresno) on the proposed nurse-to-patient ratios. Additionally, written comments were accepted by DHS through early December 2002.

• Based on the oral and written comments received during this public comment period, DHS today released several revisions to the proposed regulations.

• The revisions announced by DHS today include regulatory clarifications, enhanced definitions and phased-in changes to nurse-to-patient ratios in some units of the hospital.

• The most commonly referenced ratios ­ those in medical-surgical units and emergency departments ­ have not changed. DHS still proposes that the nurse-to-patient ratio in a medical-surgical unit will be 1:6 effective Jan.1, 2004. This ratio will drop to 1:5 effective Jan. 1, 2005. The proposed nurse ratio in an emergency department will remain at 1:4, although DHS has granted hospitals some flexibility in what duties triage and base radio nurses may perform when they are not needed to perform their primary duties.

• The revisions announced by DHS today will allow triage nurses in an emergency department to perform other nursing tasks when there are no patients needing triage. Similarly, the revised regulations will allow nurses assigned to the base radio in an emergency department to perform other duties when they are not responding to radio calls. In both cases, however, these nurses must be immediately available to respond to their primary duties whenever they are needed to triage patients or handle radio calls. And, neither triage nurses nor radio nurses can be counted as part of the overall 1:4 ED ratio.

• CHA is pleased that the Department of Health Services has recognized our concerns about the need to allow some flexibility in the duties performed by triage and base radio nurses in hospital emergency departments.

• The revised regulations also provide hospitals with some flexibility in how breaks are covered. DHS today announced that nurse administrators, nurse supervisors, nurse managers and charge nurses will be able to relieve floor nurses during breaks, meal periods and other routine absences as long as the supervisory personnel has demonstrated competency to provide care in that particular unit.

• CHA also is pleased that the 1:10 monitor technician ratios originally proposed in the nurse ratio regulations has been deleted. CHA strongly supported the elimination of this section because technology no longer requires such stringent ratios, and AB 394 required ratios for licensed nurses only.

• CHA is disappointed, however, in certain other changes made to the proposed nurse staffing ratios. Specifically, the revised regulations call for more restrictive nurse ratios in step-down units, telemetry and specialty care units effective Jan. 1, 2008. Under the revised regulations, staffing in step-down units would change from 1:4 to 1:3 in 2008; while telemetry unit and specialty unit staffing would both drop from 1:5 to 1:4 in 2008. CHA remains very concerned about the impact of California' s severe nursing shortage on hospitals' ability to meet these more restrictive staffing standards.

• Another change in the proposed regulations that is of concern to CHA is the staffing requirements in the " post-anesthesia recovery" units (recovery rooms). The proposed regulations announced today would mandate a nurse ratio of 1:2 at all times in the recovery room, regardless of the type of anesthesia the patient received. In those cases where patients are recovering from minor surgery and have had only local anesthesia, this staffing mandate seems excessive. Similarly, there will likely be cases when patients recovering from major surgery require 1:1 staffing. CHA would have preferred the ratios to reflect the actual needs of the patients, rather than setting this artificial ratio.

• The revised regulations released today are subject to a public comment period ending July 17, 2003. CHA will be providing DHS with written comments during this time period.

• Whatever staffing standards are ultimately adopted following the regulatory process, California' s hospitals will do their best to comply with the law.

• However, because we face the most serious nursing shortage in the nation, the nurse ratio law may have some serious unintended consequences (e.g. services closed, capacity reduced, access to patient care services compromised, etc.).

• California currently faces one of the worst nursing shortages in the nation. We rank 49th in the nation in terms of the number of RNs per capita. Only Nevada has fewer RNs that California.

GA Committee Update 3/03

Nursing Shortage Issues

H.R.501,

Referred March 3 to a House Committee on Education and the Workforce subcommittee, would forgive up to $17,000 in nursing student loans for registered nurses who work full-time in a health care setting.

Capps Introduces Cancer Treatment Legislation

3/13/2003

Bill would improve Medicare coverage of cancer medications

WASHINGTON, D.C. - Congresswoman Lois Capps today joined Congresswomen Deborah Pryce (R-OH) and Sue Myrick (R-NC), and Congressman Steve Israel (D-NY) to introduce the Access to Cancer Therapies Act, legislation that would update Medicare rules to cover the most up-to-date oral cancer medications. The four Members of Congress are the co-chairs of the House Cancer Caucus.

Currently, Medicare's outdated provisions require that covered medications be administered in a hospital or doctor's office. But because of so many groundbreaking scientific advancements, many medications are now available in oral form and can be taken by patients in their own homes. The bill would recognize that Medicare should cover the latest in technological advances, and that patients should not be penalized because of how they receive their treatment.

Last year, the Access to Cancer Therapies Act gained overwhelming bi-partisan support with 327 co-sponsors.

Congresswoman Capps, a registered nurse and co-chair of the House Cancer Caucus, delivered the following statement today:

"As co-chair of the Cancer Caucus and also a registered nurse, I'm proud to be here today to support the Access to Cancer Therapies Act - a bill that can truly change the lives of those living with cancer.

"Groundbreaking scientific advances have brought many lifesaving and cost-effective medications to the forefront of the treatment of cancer. Patients now have access to oral therapies that can save their lives. Unfortunately, outdated Medicare rules have resulted in many cancer patients being left behind -- unable to benefit from these groundbreaking advancements simply because the treatments may be taken orally in one's own home rather than administered in a doctor's office. This is unacceptable.

"We all know that lack of coverage means that most people will resort to older, less effective drugs in order to obtain coverage through Medicare. As new, more effective medicines are developed, it's long past time for Congress to re-visit these rules and make the necessary changes that will help cancer patients gain access to the most up-to-date and effective treatments available.

"The Access to Cancer Therapies Act would recognize that we should not penalize cancer patients simply because of where and how their treatment is administered. This is an important quality of life issue for cancer patients, and it simply makes sense. Patients should not have to resort to treatment that is outdated or invasive when more effective oral medications are available.

"It is clear that we need a comprehensive Medicare prescription drug benefit for our seniors. But until we meet that goal, the Access to Cancer Therapies is a big step in the right direction. With broad bipartisan support, this is something we all can agree on right now. It's something we can do to improve the lives of patients living with cancer.

"I'm proud to stand with my colleagues and the brave patients and advocates who are here to tell us their stories today. Let's show them that Congress is truly listening, and that we can offer them a real solution. For them, let's pass the Access to Cancer Therapies Act."

$20 Million for Nurses

Mid-Year Budget Cuts Passed

01/31/2003

The Assembly on Tuesday and the Senate on Thursday passed their versions of the Mid-year budget cuts - $8.6 billion, short of what the governor requested. The resulting two bills will have to be melded into one and sent to the governor next week. These cuts will be effective for the next five months (current year). Many of the cuts are seen as bookkeeping changes ­ delaying payments from current year to budget year.

The governor wanted larger cuts as a signal to Wall Street. The state's bond rating is currently A, the highest rating is AAA. The lower the rating the more interest is charged when borrowing money. Davis is planning to borrow $5 billion in July to cover the deficit and because of the actions of the legislature, billions will be added to the amount borrowed and the borrowing may begin in May instead of July.

Both houses voted to cut $9 million from their house budgets - $8 million in the Assembly and $1 million in the Senate. The cuts involved catered meals, furniture purchases, freezing purchasing of office supplies, legal fees, outside consultants, travel and printing costs. However, these cuts are seen as largely symbolic and don't need to be approved by the governor.

Assembly Cuts
The Assembly approved $8.6 billion in cuts and $4 billion in tax increases. $3.5 billion in cuts, from universities, cost of living increases to welfare recipients, delay prison construction and work credits will be given to those prisoners eligible to work but for whom no prison jobs are available, were voted on. However, the Assembly linked their proposed cuts to the VLF, meaning if the increase doesn't occur the cuts don't take effect.

AB4x is the tax levy that will send $4 billion to cities and counties based on revenues from increasing the Vehicle License Fee (VLF). Autos costing less than $5,000 will be exempt; the estimated increase for cars over $9200 is $124. AB4x passed on a 45-33 vote with 2 Democrats voting no. The Republicans were and continue to be obstreperous about AB4x, they threatened to take it to the voters but the Democrats by making only 75% of cars affected nullified their ability to put it on the ballot. Because not all autos licenses will have increased taxes, this is called a "tax levy" and does not require the 2/3 vote necessary for a tax increase. Additionally, AB4x, if signed becomes effective immediately; sending $900 million to cities and counties.

Senate Cuts
The Senate approved $3.2 billion in cuts; over $2 billion short of what the governor wanted. The cuts approved included:

• $1.5 billion from K-12 schools - Cuts to K-12 will be $25/pupil/year.
• $ 238 million from Community Colleges
• $230 million from health & welfare programs
• $95 million from child care for CalWORKS recipients

The Senate has not taken action on the VLF increase, Senator Burton states this will happen next week. If the increase is approved, it will probably trigger a showdown with the governor. Governor Davis remains cool to the idea of increasing taxes on automobiles, as his budget would use these fees to plug the deficit.

ANA News Update - 1.23.03

Now accepting application:

Senate Budget Committee Rejects Proposed Mid-Year Budget Reductions for Medi-Cal

01/22/2003

The Senate Budget Committee yesterday "rebuffed" many of the mid-fiscal-year budget reductions for Medi-Cal proposed by Gov. Gray Davis (D), the Fresno Bee reports (Maxwell, Fresno Bee, 1/22). Davis last month proposed $2 billion in budget reductions for health care programs. Under the proposal, the state would reduce Medi-Cal income eligibility limits for parents who apply for the program to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the proposal would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The proposal also would reduce Medi-Cal reimbursement to physicians and other providers by 10% (California Healthline, 1/16). The committee approved $1.2 billion in mid-year budget reductions but rejected most of the proposed Medi-Cal reductions. Committee Chair Wes Chesbro (D-Arcata) said that "it was premature" to reduce reimbursement rates for Medi-Cal providers and eliminate coverage for optional benefits. "Our job is not to simply rubber stamp what the governor has proposed. This requires a lot more examination and discussion," Chesbro said (Fresno Bee, 1/22). Hilary McLean, a spokesperson for Davis, said that the governor proposed the Medi-Cal reductions to address the state's estimated $34.8 billion budget deficit over the next 18 months. "Each dollar we don't save now means more pain down the road," McLean said (Hill, Sacramento Bee, 1/22).

Nurse Reinvestment Act Funded for $20 Million in the U.S. Senate

New funds included in Senate version of omnibus spending bill
Washington, DC -- The American Nurses Association (ANA) today applauded the U.S. Senate for approving $20 million in new federal funds for the Nurse Reinvestment Act as part of the omnibus appropriations bill for fiscal year 2003. The funding package now goes to a conference committee with the U.S. House of Representatives, where the final version will be hammered out.

"We are very pleased that the Senate has approved these new funds and that the amendment received bipartisan support," said ANA President Barbara A. Blakeney, MS, APRN,BC, ANP. "It is a good first step toward getting the funds we need to implement the Nurse Reinvestment Act. However, we must ensure that the House also sees the importance of making this much-needed investment in nursing," Blakeney added. "We look forward to working with sponsors in both the House and Senate to make sure that the nursing shortage is addressed." The amendment appropriating the money was introduced by Sen. Barbara A. Mikulski (D-MD).

The Nurse Reinvestment Act was signed into law in August 2002. It authorizes scholarships and loan repayments for nursing students who agree to work in shortage areas after they graduate. The new law also authorizes public service announcements to promote nursing as a career, loan cancellations for nursing faculty, grants for geriatric nurse education, and grants to encourage nursing best-practices, such as those in the American Nurses Credentialing Center Magnet Recognition Program for excellence in nursing services.

"We thank Senator Mikulski for spearheading this effort, as well as the other senators who supported it," Blakeney said. "With predictions that we will be short more than 800,000 registered nurses by the year 2020, we need to act now."

Governor Davis' Proposed Budget