CARE Act H R 1214 Rad CARE Act

CARE Act H. R. 1214 Rad. CARE Act S. 1197 Presentation Prepared by the Society of Nuclear Medicine Technologist Section Government Relations Subcommittee

What is CARE & Rad. CARE? The CARE Act and the Rad. CARE Act are proposed legislation in the House and Senate which will require that every state enact a program of minimum standards for the education and certification of Radiologic and Nuclear Medicine Technologists as well as Radiation Therapists.

The Bill Specifically States: “it is unlawful for an individual in the State to intentionally administer or plan medical imaging procedures or radiation therapy procedures to or for another individual for medical or chiropractic purposes unless the individual has obtained from the State a license, certificate, or other document that authorizes the individual to administer or plan such procedures in the State (referred to in this section as a `medical radiation license'). ”

What does CARE stand for? Consumer Assurance of Radiologic Excellence

The CARE Act (H. R. 1214) is a bill which was introduced in the US House of Representatives by Representative Heather Wilson (R-NM) on March 11, 2003.

The Rad. CARE Act (S. 1197) is a virtually identical bill which was introduced in the US Senate by Senator Mike Enzi (R-WY) on June 3, 2003.

What will the CARE Act do? The CARE Act would require that in order for nuclear medicine and other diagnostic imaging and radiation therapy procedures to be eligible for Medicaid payments, they must be performed by licensed individuals who have met the federal minimum standards for education and certification.

Isn’t there already a similar law? The CARE Act is designed to amend the Consumer-Patient Radiation Health and Safety Act of 1981 (“Randolph Bill”). This law established minimum education and certification standards of radiologic technologists. However, compliance was voluntary.

Isn’t there already a similar law? There was no mechanism attached to the Consumer Patient Radiation Health and Safety Act for enforcing this law. Several states did pursue licensure, but many did not.

Non Compliant States There are currently no regulations governing the education and/or competence of imaging/therapy personnel 17 jurisdictions - no regulations for RTs t 23 jurisdictions - no regulations for RTTs t 30 jurisdictions (incl. D. C. & Puerto Rico) no regulations for NMTs (2 jurisdictions with pending regulations for NMTs) t

NMT licensure Pending NMT licensure No NMT licensure

States Without Licensure for NMTs Alaska Georgia Kansas* Minnesota New York* Oregon South Dakota Wisconsin Alabama Idaho Kentucky Montana North Carolina Pennsylvania Tennessee District of Columbia Colorado Iowa Michigan Nevada North Dakota Puerto Rico Virginia **Arizona & South Carolina licensure effective 2004 *New York and Kansas have licensure bills pending Connecticut Indiana Missouri New Hampshire Oklahoma South Carolina West Virginia

How is this bill different? The CARE Act links Medicaid reimbursement with licensure. This will give the CARE Act the necessary “teeth” which will require compliance at the state level.

Who will be affected by the CARE Act? t t t Patients will be provided with the best possible care administered by licensed imaging professionals. Imaging Technologists* will need to maintain the set standards. Institutions will be required to hire only licensed imaging personnel. *Not including ultrasound and echocardiography

Who will be licensed by the CARE Act? • Nuclear Medicine Technologists • Radiologic Technologists • CT Technologists • Vascular and Interventional Radiographers • MR Technologists • Radiation Therapists • Dental workers • Chiropractic imaging personnel • NOT Ultrasound or Echocardiography Technologists

Why are we doing this? Health care quality depends upon adequately trained professional caregivers. In many states, nuclear medicine technologists are not required to maintain certification or possess a license to administer/dispense radiopharmaceuticals and operate imaging equipment.

The proposed minimum Federal standards will: t t Ensure that quality information is presented for diagnosis leading to accurate diagnosis and treatment. Reduce health care costs by decreasing the number of repeated studies due to improper positioning or poor technique. Improve the safety of diagnostic imaging/treatment procedures. Reflect the professional standing of imaging technologists.

Who supports this effort? The SNMTS and ASRT are founding members of the Alliance for Quality Medical Imaging and Radiation Therapy.

What is the Alliance for Quality Medical Imaging and Radiation Therapy? Presently, the Alliance is comprised of 17 organizations representing diagnostic imaging and radiation therapy, dedicated to the provision of safe, high-quality radiologic care. This Alliance is progressively growing.

The Alliance for Quality Medical Imaging and Radiation Therapy The Alliance members agree that the personnel who perform medical imaging procedures as well as plan and deliver radiation therapy treatments should be required to demonstrate competency in their area of practice.

Who does the Alliance represent? This Coalition represents over 250, 000 allied health professionals in thirteen disciplines in the field of Diagnostic Imaging and Radiation Therapy.

Who are some other members of the Alliance? t t Nuclear Medicine Technology Certification Board Joint Review Committee on Education in Nuclear Medicine Technology American Registry of Radiologic Technologists Joint Review Committee on Education in Radiologic Technology

Additional Alliance members t t t Association of Vascular and Interventional Radiographers American Association of Physicists in Medicine Section for Magnetic Resonance Technologists of ISMRM Society for Radiation Oncology Administrators Association of Educators in Radiologic Sciences

Additional Organizations endorsing the CARE and Rad. CARE Acts t t t American College of Radiology American Cancer Society American Heart Association’s Council on Cardiovascular Radiology American Organization of Nurse Executives Cancer Research and Prevention Foundation of America International Society of Radiographers and Radiologic Technologists

Additional Organizations endorsing CARE and Rad. CARE Acts t t t National Coalition for Quality Diagnostic Imaging Services National Coalition for Cancer Survivorship Conference of Radiation Control Program Directors Help Disabled War Veterans Help Hospitalized Veterans Philips Medical Systems . . . and the list is growing

Who supports the bill in the House of Representatives? Representative Heather Wilson, (R-NM) has now become the champion supporter of this bill. She re-introduced the CARE Act, Bill HR 1214, on March 11, 2003. t As of September 9, 2003, there are 52 cosponsors from 24 states. t

Is my Representative a cosponsor? AL (Bachus) AR (Berry, Ross) AZ (Grijalva, Hayworth) CA (Eshoo) CT (Larson) IL (Gutierrez, Lipinski Rush, Shimkus) IN (Burton, Visclosky) MA (Frank, Markey) MD (Van Hollen, Wynn) MI (Conyers, Kildee, Knollenburg) MO (Clay, Emerson) MN (Peterson, Sabo) MS (Pickering) NC (Price, Watt) ND (Pomeroy) NE (Osborne, Terry) NJ (Pallone, Payne) NY (Engel, Israel, King, Mc. Carthy, Walsh) OR (Blumenauer, Hooley) PA (Doyle) TN (Cooper, Davis, Duncan, Gordon, Tanner, Wamp) VA (Cantor) WA (Dicks, Inslee, Nethercutt, George) WI (Baldwin)

Who supports the bill in the Senate? Senator Mike Enzi (WY) introduced the Rad. CARE Act to the Senate on June 3, 2003. t As of September 2003, there are five cosponsors: t Sen. Ted Kennedy (D-MA) Sen. Tom Daschle (D-SD) Sen. Frank Lautenberg (D-NJ) Sen. Byron Dorgan (D-ND) Sen. James Jeffords (I-VT)

Sen. Enzi’s comments “When it comes right down to it, it’s a big enough battle to fight the cancers or the injuries to our bodies that require such invasive treatments or diagnosis. We shouldn’t have to worry about the level of competence of those who are providing us with the services we so desperately require for the maintenance of our health. ”

CARE and Rad. CARE: FREQUENTLY ASKED QUESTIONS

Why are we doing this? Health care quality depends upon adequately trained professional caregivers. In many states: t Personnel using radiation, magnetic devices and/or radiopharmaceuticals for diagnostic and therapeutic procedures are not required to: – maintain certification – possess a license – or document training to plan, administer, dispense or treat patients

“What are those benefits? ” • • • Job quality Professional standing Support for Continuing Education

“So, this is more about adequate care than about radiation safety? ” t t t Yes. Of course, radiation safety plays an important role within the responsibilities of an NMT. But, we all know that a person can be well trained in radiation safety and still not be able to perform adequately as a technologist. The CARE Act addresses all aspects of technologist education and training.

“My state already has licensure. Will it change? ” It depends upon your state laws. State licensure laws that do not meet the minimum standards of the CARE Act will need to be revised.

“When will the change take place? ” It will take 2 -4 years after passage of the CARE Act for states to implement licensure.

“There is no licensure requirement in my state. What will I have to do? ” NMTs will be required to graduate from an accredited institution. t NMTs will be required to pass a certifying exam, such as the ARRT (N) or NMTCB. t NMTs will be required to participate in continuing education. t

“I was ‘grandfathered’ in and never took an exam. Will I have to take one now? ” t This licensure is not intended to “legislate people out of jobs”. State bills will be drafted to include appropriate “grandfather” clauses. t You will, however, be required to participate in continuing education.

“What will this cost me? ” It is possible that state licensing boards will require an annual fee. The benefits of professional licensure, however, outweigh the nominal costs.

“There is a tech shortage and I have solid job security right now. Why do I need licensure? ” Assurance of quality patient care in every state. t Assurance that you will not be replaced by someone who does not have the proper education and credentials to perform diagnostic or therapeutic procedures t

“Where can I get additional and timely information? ” www. snm. org UPTAKE newsletter JNMT www. asrt. org

“What can I do to help? ” t Participate in letter-writing campaigns. Write to your representatives in both the: Congress and Senate t Talk to fellow technologists and administrators about the importance of licensure and don’t forget to speak to your family & friends about writing letters - they have a right to high quality patient care

Questions? Thank you!