What will the CARE bill do?
The CARE bill will amend and enforce the Consumer-Patient Radiation Health & Safety Act of 1981 (42 USC 10001, et seq.), and charge the Secretary of the Department of Health and Human Services (HHS) to promulgate updated regulations specifying the certification requirements for people who perform medical imaging examinations and who plan and deliver radiation therapy treatments.
Why isn't the Consumer-Patient Radiation Health & Safety Act of 1981 enforceable?
The CPRHSA was lobbied by the ASRT for more than 15 years. When the bill was on the Senate floor for the final vote, a political bargain was struck to ensure the bill's passage. As a result, the enforcement mechanism was stripped out in an amendment. This law directed the HHS to develop regulations specifying the education and credentialing of radiographers, radiation therapists, dental radiographers, sonographers and nuclear medicine technologists, but there are no legally enforceable penalties for states that choose not to comply. In 1985, the ASRT initiated legal action requiring the HHS to promulgate the regulations (42 CFR 75); however, states face no penalty for not meeting the HHS regulations. The regulations are now considered to be "federally-recommended guidelines" for states to follow.
If there are federal standards in place, why don't states follow them?
Some states have chosen to follow the federal standards and have put state laws or regulations into place specifying the education and certification standards for medical imaging and radiation therapy personnel; however, many state laws set standards significantly lower than the federal recommendations. States that have not followed the federal guidelines cite many reasons, including impasses in the state legislative bodies, lack of evidence supporting a benefit, states rights and the nonapplicability of 25+ year-old standards in today's health care environment.
How will the CARE bill make the 1981 CPRHSA enforceable?
Looking at the bill, it may appear that there isn't much "meat" on it specifying what standards personnel must comply with. This is because the bill amends the 1981 CPRHSA to make the law enforceable. The CARE bill makes it a condition of payment in the Medicare program that medical imaging and radiation therapy personnel working in facilities receiving Medicare payments or working for physicians receiving Medicare payments must meet the federal certification requirements or the insurance claim for imaging or therapy services will not be paid. The end result is that medical imaging and radiation therapy professionals will have to meet the federal minimum standards set by the HHS.
Will radiologic technologists be required to get a federal license to practice?
No. Medical imaging and radiation therapy professionals either will have to get a state license to practice (and all states that license personnel will have to issue licenses based on the federal standards) or they will have to demonstrate that they meet the federal standards to have their services paid for by Medicare. There will be no federal license to practice.
Why don't we write standards into the bill/law?
Writing specific standards into the CARE bill, and ultimately into the 1981 CPRHSA, would require us to start from scratch. The CARE bill builds on the existing law and enhances it. Writing standards into law would require a complete rewrite of the 1981 CPRHSA. It is politically more feasible to amend the portion of the CPRHSA regarding enforcement and to keep the regulations specifying technologist and other personnel standards under the authority of the HHS. The HHS is more knowledgeable about the specific guidelines for medical professionals than the voting members of Congress.
If we don't write the standards in to the bill/law, how will we get what we want?
As evidenced by the 1981 CPRHSA, many times political bargains are struck and we don't always get the perfect outcome. However, developing strategic alliances, developing materials in advance and engaging professional representation on Capitol Hill will help us get as close to perfect as we can. Even if standards were written into the bill/law, they most likely would not be what we wanted after all was said and done.
How can we ensure that the HHS will write "good" standards?
Once the CARE bill is passed, the HHS is required by the Federal Administrative Procedures Act to publish in the Federal Register a notice called a "Notice of Proposed Rulemaking." This is an opportunity for the public to comment on what they think should be included in the standards. The ASRT, along with the Alliance for Quality Medical Imaging & Radiation Therapy, has been working on a comprehensive draft of updated technologist and personnel guidelines to provide to the HHS once the rulemaking process begins. This document most likely will be the document upon which the HHS will base the federal minimum standards. Other organizations also may make comments, but the majority of organizations who would normally make public comments on proposed regulations have already been working on the Alliance draft.
If we get "good" standards, how can we make sure they won't arbitrarily be changed by the HHS in the future?
The HHS must follow the Administrative Procedures Act before any regulatory changes can be made. This means that the ASRT and the Alliance will have the opportunity during the public comment period to bring any "bad" standards or inconsistencies to the HHS's attention before the standards are finalized. There also are legal remedies that can be pursued if the imaging and radiation therapy community feels strongly about the quality of the standards that are finalized.
Why are we updating the 1985 HHS educational and credentialing standards?
In the 25+ years since these standards were published vast changes in the imaging and radiation therapy sciences have taken place. New technologies and professions have emerged. Medical physics is playing a larger role in patient care, and radiologic technologists' duties have changed substantially. New educational methods need to be recognized along with expanded competencies, certification requirements and certification organizations. Ideally, we should look at the federal standards every 10 years and ensure that they are still applicable to the profession and the practice environment.
How will the CARE bill affect personnel staffing?
The CARE bill will ensure that all medical imaging and radiation therapy professionals meet federal standards. A generous timeframe will be specified for states, employers and individuals to comply. In addition, the CARE bill gives the Secretary of Health and Human Services some latitude to issue alternative regulations based on defined criteria if needed to preserve patients' access to care. As a historical perspective, a 1976 study conducted by the ASRT and the American College of Radiology showed that mandatory state licensure had no significant effect upon technologist manpower in terms of recruitment, availability or compensation.
Will radiologic technologists' salaries increase significantly because of the CARE bill?
The ASRT studied radiologic technologists' salaries in Arkansas and South Carolina (recent states to pass radiologic technologist licensure laws). Following the implementation of state licensure, salary levels did not increase above the national norm.
What is the Alliance for Quality Imaging & Radiation Therapy?
The Alliance is a coalition of 26 organizations that support the need for federal educational and credentialing standards for medical imaging and radiation therapy professionals. Founding members of the Alliance are the American Society of Radiologic Technologists (ASRT) and Society of Nuclear Medicine-Technologist Section (SNMTS). Other members of the Alliance are the American Association of Medical Assistants (AAMA), American Association of Medical Dosimetrists (AAMD), American Association of Physicists in Medicine (AAPM), American College of Medical Physics (ACMP), American Registry of Radiologic Technologists (ARRT), American Society of Echocardiography (ASE), Association of Educators in the Imaging and Radiologic Sciences (AEIRS), Association of Vascular and Interventional Radiographers (AVIR), Cardiovascular Credentialing International (CCI), Joint Review Committee on Education in Cardiovascular Technology (JRCCVT), Joint Review Committee on Education in Diagnostic Medical Sonography (JRCDMS), Joint Review Committee on Education in Radiologic Technology (JRCERT), Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT), Medical Dosimetrist Certification Board (MDCB), Nuclear Medicine Technology Certification Board (NMTCB), Section for Magnetic Resonance Technologists (SMRT), Society for Radiation Oncology Administrators (SROA), Society for Vascular Ultrasound (SVU), Society of Diagnostic Medical Sonographers (SDMS), and the Society of Invasive Cardiac Professionals (SICP). Other organizations supporting the Alliance and attending Alliance meetings are the AHRA: the Association for Medical Imaging Management; Conference of Radiation Control Program Directors (CRCPD), American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO).
What other groups support the CARE bill?
Patient groups, social advocacy organizations and radiology industry support the CARE bill. Other supporters of the CARE bill include the American Cancer Society, American Organization of Nurse Executives, American Osteopathic College of Radiology, Cancer Research Foundation of America, Help Hospitalized Veterans, Imatron, Inc., International Society of Radiographers and Radiological Technologists, National Coalition of Cancer Survivorship, Medical Imaging Consultants, Inc. and Philips Medical Systems, Inc.
Why don't all professional/certification/accreditation organizations participate in the Alliance?
Many organizations participate in the Alliance as an "observer organization" and may be eligible to become a full Alliance member. In addition, all interested parties are encouraged to participate in Alliance discussions.
When did the ASRT and the Alliance start working on the CARE bill? How long has this been going on?
The ASRT and the Alliance have been working on the CARE bill since 1998. The first version of the CARE bill was introduced in 2000 in the last days of the 106th Congress by Rep. Rick Lazio (R-NY) as H.R. 5624. It was reintroduced in the 107th Congress in 2001 by Rep. Heather Wilson (R-NM) as H.R. 1011 and introduced again in the 108th Congress in 2003 by Rep. Wilson as H.R. 1214. The Senate version of the CARE bill (referred to as the RadCARE bill) was introduced in 2003 by Sen. Mike Enzi (R-WY) as S. 1197. The CARE and RadCARE bills were reintroduced in the 109th Congress as H.R. 1426 by Rep. Chip Pickering (R-MS) and S. 2322 by Senator Mike Enzi (R-WY) and in the 110th Congress as H.R. 583 by Rep. Mike Doyle (D-PA) and S. 1042 by Sen. Enzi. The CARE bill was introduced in the 111th congress as H.R. 3652 by Rep John Barrow (D-GA) and S. 3737 by Senator Enzi and in the 112th Congress as H.R. 2104 by Rep Ed Whitfield (D-KY) and S. 3338 by Senator Enzi.
Why does the CARE bill include ultrasound?
When we first started working on the CARE bill, the proposal required each state to license medical imaging and radiation therapy personnel. Ultrasound organizations determined that state licensure is not an appropriate regulatory approach for sonography and asked to be exempted from the legislation. They chose to pursue sonography-specific educational and credentialing standards that did not require state licensure. Ultrasound is now included in the CARE bill at the request of sonography professional organizations.
When can I get a copy of the draft educational and credentialing standards the Alliance is working on?
The Alliance is finalizing its work on the draft consensus education and credentialing standards.
When will the CARE bill be passed and enacted?
The ASRT and the Alliance believe that the CARE bill is an important piece of patient quality care legislation and are committed to seeing it enacted. We came very close in the 109th Congress when the bill was passed in the Senate and missed passing the House by mere hours before Congress adjourned.
Isn't the CARE bill just another MQSA?
The Mammography Quality Standards Act (MQSA) was comprehensive legislation that tied federal standards for the performance of mammography procedures to federal reimbursement. Although the MQSA has been shown to increase the safety and efficacy of mammography, these standards cover personnel qualifications, facility inspections, quality control and physician assessment of mammograms. The CARE bill speaks only to nonphysician technical personnel qualifications through certification for medical imaging and radiation therapy professionals.
How will the CARE bill help the federal government save money?
The CARE bill will reduce health care costs by lowering the number of medical imaging examinations that must be repeated due to improper positioning or poor technique by requiring that personnel who perform medical imaging examinations meet educational and credentialing standards. Repeated imaging examinations cost the U.S. health care system millions of dollars annually in needless medical bills. According to the Radiologic Sciences of North America journal Radiology, approximately 130 million diagnostic radiology procedures are performed on 30 million Medicare enrollees a year.1 Approximately $9.3 billion was spent by Medicare on medical imaging in 2003, according to the Medicare Payment Advisory Commission MedPAC.2 If the national repeat examination rate is between 4 percent and 7 percent, averaging 5.5 percent, and the CARE bill can lower the repeat rate from 5.5% to 4.5%, then education and credentialing standards could save Medicare more than $90 million a year.