Microscope on Washington
DHHS Proficiency Examination Faces Repeal
This could be a hot summer in Washington for allied health, beginning with a victory for
certified medial technologists. The Senate Finance Committee voted on May 29, 1987, to repeal
Section 1123 of the Social Security Act, which provides authority to the Secretary of the Department of Health and Human Services (DHHS) to conduct proficiency examinations for a
number of allied health professions, including medical technologists. Senator Malcolm Wallop
(R-WY) offered the repeal as an amendment to S. 1127, a bill to provide catastrophic coverage
for Medicare beneficiaries. The effective date of the repeal, however, is October 1, 1987, so the
August administration of the examination for medical technologists will proceed as scheduled.
ASCP and a coalition of 16 other allied health professions organizations had sought to stop the
August examination, but concerns from committee members over the disruption this would
cause at this late date convinced Senator Wallop to delay the effective date. Removing Section
1123 from the books will make reinstatement of the authority much more difficult and essentially
prevent extensions of the DHHS Examination for medical technologists.
To date, the DHHS Proficiency Examination for medical technologists has been offered six times.
Of the 58,000 who took the examination, 27,000 passed. The federal government has never
conducted a follow-up study to determine how these individuals are performing or to see if
they have remained in the clinical laboratory field.
Section 1123 was included in the 1972 Social Security Act as a temporary measure to prevent
staffing disruption when the Medicare personnel standards were introduced. Another concern
was the health manpower shortage in the early 1970s. Additionally, Congress wanted to take
advantage of the significant number of Vietnam Veterans who had received health professions
training in the military but did not meet the private sector certification requirements. Congress
intended that the private sector eventually take over the certification of these individuals and
provided a sunset clause for the law. Under Section 1123 authority, proficiency examinations
have been given for licensed practical nurses, clinical laboratory technologists, cytotechnologists, and psychiatric technicians. The examination for medical technologists is the only one
that has been given during recent reinstatements of the authority.
Section 1123 was reinstated as part of the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA). The authority of Section 1123 expires September 30, 1987. An examination for
medical technologists is scheduled for August 28, 1987. May 22 was the cut-off date for applications and only approximately 6,000 had signed up. The Professional Examination Service had
expected up to 20,000 applicants based on previous experience. The pass rate for previous
DHHS medical technologists examinations averages 44%.
The ASCP and the coalition must now press Congress to preserve the Senate repeal amendment
when it goes to a conference with the House. The reinstatement of Section 1123 originated in
the House so it will not be an easy task. The strength behind the issue is the numbers. The 17
organizations calling for repeal represent over one million health professionals. DHHS itself
has asked Congress to repeal Section 1123. In letters to the Hill, DHHS officials pointed out
that the connection between examination success and laboratory performance had not been
established and that they shared many of the concerns expressed by the laboratory community
about the wisdom of continuing the administration of the examination. Senator Wallop, in a
recent speech, stated that the original rationale for the statute has long since passed. The private
sector has education and certification programs in place, so there is no need for the examination.
LABORATORY MEDICINE • VOL. 18, NO. 8, AUGUST 1987 5 0 5
Medicare Pass-Through for Allied Health
Congress may provide another challenge for allied health in the budget reconciliation process.
The future of Medicare payments to hospitals to support schools of medical technology is again
at risk in this session of Congress. Medicare has always supported allied health education
through payments to hospitals for clinical education for nurses and allied health professionals.
When hospitals came under the Prospective Payment System in 1983, these payments were
kept separate from the DRG and continued to "pass-through" to the hospital. The amount of
Medicare support is based on the hospital's cost of maintaining these programs and the proportion of Medicare work in the hospital. The Reagan Administration has proposed that these
"pass-through" payments to hospitals for nursing and allied health education be eliminated
beginning October 1, 1987.
In response to a similar Reagan Administration proposal last year, Congress asked DHHS to
conduct a study on the benefits to Medicare of these "pass-through" payments to hospitals.
The study is being conducted by the Health Resources and Services Administration (HRSA)
and is due in October of this year. The ASCP is working with HRSA in their research for this
report to Congress. Organizations representing allied health and nursing concerns, such as the
American Society of Allied Health Professions (ASAHP) and the American Nurses Association
(ANA), have written to Congress in opposition to the President's proposal.
ASAHP has stated that "it is incumbent upon the government to maintain financial support for
these very important programs." Citing recent legislation mandating studies "addressing allied
health professions and funding," as well as studies conducted by ASAHP, the Society recommends that no changes in funding be made until these studies are completed and received.
Due to pressure to reduce the federal deficit and the ever-increasing Medicare program costs,
payments for the direct and indirect costs of medical education will be considered for substantial
cuts this year. The debate is over what part of medical education support should be reduced.
Besides nursing and allied health education, this Administration recommends elimination of
subsidies for classroom and other medical education program costs.
Congress seems disposed to cutting payments to hospitals for the indirect costs (ie, overhead,
etc) of medical education by as much as 50%. The fate of direct medical education payments
"pass-through" is less certain.
Registration of Health Professionals Revisited
Once again, we are faced with legislation to register health providers for the selective service.
The initiative moving through Congress is significantly different from legislation opposed by
health professionals last year. During the last Congress, Representative Sonny Montgomery (DMS) promoted legislation requiring the registration of all health care professionals between the
ages of 18 and 46. The measure was offered as an amendment but was defeated in Committee
with the understanding that alternatives would be considered to solve the shortage of qualified
health care providers in the military. A new look at the issue has resulted in H.R. 913, calling
for a post-mobilization registration of health care providers. This legislation now has been
included in the 1988 Department of Defense (DoD) reauthorization bill with concurrence by the
American Medical Association (AMA) and the ANA.
The AMA and ANA did have concerns, however, over the scope of the measure and worked
out committee report language that specifically states that names will not be collected. The
provision is aimed only at developing a computer system and the necessary forms to facilitate
registration during a national emergency. In addition, it will take new action by Congress before
Selective Service will be able to go any further in the development of this system. The DoD
Reauthorization bill will now be considered by the House and Senate.
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