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In the May 18 Federal Register, Health and Human Services (HHS) Secretary Tommy Thompson announced the decision to delay until November a final Medicare rule that would allow CRNAs to provide anesthesia without physician supervision.
HHS said it would propose a new rule that would continue to require physician supervision "generally." However, a governor could exempt a state from this requirement after proving that the exemption is in the best interest of the state's citizens.
Proving the need for the exemption would involve consulting with the state's boards of nursing and medicine and verifying that state law and regulation permit independent CRNA practice. Thompson also proposed that HHS compare patient outcomes with different models of anesthesia care.
On Jan. 18, the Clinton administration published the final CRNA supervision rule in the Federal Register. The rule was set to take effect March 19, but was suspended 60 days by a Bush administration moratorium. The May notice delayed the rule for another 180 days, or until Nov. 14. This will allow time for the Thompson rule to go through all the required scrutiny and replace the now-suspended Clinton rule.
"Anesthesia services are a crucial part of modern medicine, and the Medicare program has always been attentive to both the safety and availability of these services for our beneficiaries," Thompson explained in a prepared statement. "At the same time, however, states have encountered increasing challenges in providing access to anesthesia services to all their citizens, particularly residents of rural
areas or other areas with few anesthesiologists."
Anesthesia providers and Anesthesia coders must keep updated on the national rule's status and determine their state and local governments' positions on physician supervision of CRNAs so cases can be coded appropriately and conducted in accordance with federal and state laws and regulations.
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