STATES ALLOWED TO SET STANDARDS FOR ANESTHESIA
The Centers for Medicare & Medicaid Services (CMS) today announced a new Medicare rule that will give states the flexibility to regulate the administration of anesthesia in hospitals, critical access hospitals and ambulatory surgical centers while protecting the health and safety of patients.
"This rule allows states to make the most effective use of nurse anesthetists while ensuring Medicare beneficiaries continue to receive safe, high-quality anesthesia services," said CMS Administrator Thomas A. Scully.
Under the new rule the current federal requirement that certified registered nurse anesthetists (CRNAs) must be supervised by a physician when furnishing anesthesia services will remain in place, but, consistent with state law, governors will be able to exempt their states from the federal rule.
This new rule permits a state's governor, after consultation with the state's board of medicine and nursing, and consistent with state law, to attest that it is in the best interests of the state's citizens to permit CRNAs to administer anesthesia without direct physician supervision. It allows CRNAs to practice without physician supervision when permitted by state law. However, it requires that CRNAs be supervised by a physician when required by state law or hospital policy.
"Our goal is to give states the flexibility to improve access to anesthesia services without the burden associated with duplicative regulatory oversight," said Jeffrey Kang, MD, director of the CMS Office of Clinical Standards and Quality and the agency's chief clinical officer. "This final rule will serve all Medicare beneficiaries in all regions of the country in the safest and best way possible."
The new final rule went on display today at the Office of the Federal Register. It was to be published in the Federal Register on Nov. 13.
Medicare has had a longstanding rule that nurse anesthetists work under physician supervision, but states have encountered increasing challenges in providing access to anesthesia services for all their citizens, particularly in rural areas or other areas with few anesthesiologists.
The Agency for Health Research and Quality (AHRQ) will support a study to evaluate and improve the quality of care in states that opt out of the federal supervision requirement.
A final rule that would have removed the federal requirement of physician supervision of nurse anesthetists was published on Jan. 18, 2001, but the effective date was delayed to allow additional study of implementation issues and ensure that safety issues had been fully addressed. This new rule rescinds the Jan. 18 rule.