John H. Fullerton, MD, CMD, MRO, CFP, FACP, AGSF, FAAHPM | Policy & Professional Services Committee Chair

According to CALTCM's current Bylaws: "The Policy & Professional Services Committee (PPSC) shall review and recommend policy issues and positions to the CALTCM's Board of Director's. They shall represent CALTCM at long-term care (LTC) industry, public policy, and government meetings, monitor legislative trends and actions, and act as a forum to set medical director and LTC practice guidelines." CALTCM's PPSC also collaborates whenever appropriate with AMDA's "parent" Public Policy Committee (PPC).

In the recent past, CALTCM's PPSC's range of agenda items has encompassed strategically supporting the California state-wide POLST Initiative-with James Mittelberger, MD, CMD, FACP, MPH and Karl Steinberg, MD, CMD-taking the "reins" from our committee [along with help from our valuable strategic partners from the California Coalition for Compassionate Care who lead the California POLST Project in the Long-Term Care (LTC) industry] to presenting a unanimously received Resolution by AMDA's House of Delegates, alerting the profession to issues surrounding the projected release of aging criminals into our nursing home systems. This high profile "Position Paper" was crafted by members of CALTCM's PPSC including Robert Gibson, PhD, JD, and presented by AMDA Past President James Lett, MD, CMD [entitled: "Addressing an Expected Increase in Long Term Care Continuum Residents with Criminal/Correctional Histories" (E 11)]. E 11 was originally presented at AMDA's Annual Symposium in March 2011 in Tampa, FL; moreover, E 11 was subsequently also unanimously approved by the AMA's HOD's later in 2011-ably presented by AMDA's widely-respected Delegate in the AMA's HOD's-Eric Tangalos,MD,CMD. More recently, CALTCM's PPSC has been reviewing and analyzing Psychoactive Agent use in Title 22-Governed California LTC Facilities. The Committee has been "spreading the word" (with CAHF) from April 2011 to the present regarding the strict rules governing the requirement for more comprehensive, physician-driven, well-documented informed consent from the NH attending "in advance" of administering any psychoactive medication (or dose adjustment) to every skilled nursing facility (SNF) patient (or from the patient's designated representative). The corresponding role of the NH medical director as well as the role of any associated non-physician practitioners (NPPs, e.g.: NP's/PA's) is also being explored. Our committee has also been proactive in "spreading the word" regarding "where we are now" with respect to DEA's "narrower" enforcement of" The Controlled Substances Act with the concomitant loss of the "Nurse as Agent" for the fulfillment of Schedule II Controlled (C-II) prescriptions in SNF's at the time of transfer. An ongoing update on the respective role(s) as well as pragmatic mechanism(s) for the SNF attending physician as well as the SNF medical director in procuring all C-II prescriptions in the LTC Facility (and continuing to prevent diversion of medications) is highlighted.

The PPSC has also been charged with evaluating the pros and cons of adhering strictly to the "Consultant Pharmacist Proposal from CMS (Preamble II.B.5)": regarding the recent CMS proposal for the strict "independence of LTC clinical pharmacists" from the contracted fulfillment pharmacy"; consequently, our committee has been attempting to calculate the impact and "aftershocks" of this CMS-driven proposal to the resultant systemic functional pharmacy reorganization & respective pharmacist's roles in Title 22-governed LTC facilities. The PPSC also successfully presented to our BOD's a request for organizational sponsorship for SIRUM, the Stanford-incubated, Not-For-Profit co-founded by Kiah J. Williams: "Supporting Initiatives to Redistribute Unused Medicine". SIRUM's mission is to compassionately assist in repackaging and supplying essential medications to under-insured, under-served LTC residents.

Lastly, the PPSC is forging relationships with other industry leaders whose strategic "partnerships" produce synergy. We now possess key representation within our key facility-based counterpart society-CAHF. Karl Steinberg, MD, CMD (who is also CALTCM's Immediate Past President) provides frequent invaluable "waves of updates" on timely CAHF-related issues that are "on our horizon".

Respectfully submitted.

John H. Fullerton, MD, CMD, MRO, CFP, FACP, AGSF, FAAHPM CALTCM B.O.D-Member Chair-CALTCM Policy & Professional Services Committee

Member-AMDA's Public Policy Committee Chief Medical Officer-Hampton Health, LTD. (SF, CA)