California Opts Out of CRNA Physician Supervision Rule

A San Francisco Superior Court ruled Oct. 8 that California’s certified registered nurse anesthetists (CRNAs) do not require physician supervision when administering anesthesia. That makes California the 15th state to officially opt out of the federal requirement for physician supervision of anesthesia furnished to Medicare patients by CRNAs.

In June 2009, California Gov. Arnold Schwarzenegger submitted a letter to the Centers for Medicare & Medicaid Services (CMS) requesting that California be allowed to opt out of the regulation. In February 2010, however, the California Medical Association (CMA) and the California Society of Anesthesiologists sued Schwarzenegger on the grounds that opting out of the rule violated state law.

Whereas the California Association of Nurse Anesthetists considers the recent court ruling a major victory, the California Medical Association said it “is analyzing the opinion,” and “exploring all of its options, including appealing.”

Other states have opted out of the federal Medicare rule, including number 16, Colorado, just last month. Colorado Gov. Bill Ritter announced Sept. 27 his decision to opt out of the federal Medicare rule for critical access hospitals (CAHs) and specified rural hospitals.

The Colorado Society of Anesthesiologists and the Colorado Medical Association filed a lawsuit in Denver District Court one day later, according to The Denver Post, also on the grounds that opting out of the rule is not consistent with state law.

Besides California and Colorado, 14 other states have opted out of the federal supervision requirement since publication of the Nov. 13, 2001 CMS final rule permitting such opt-outs. They are:

  • Iowa – December 2001
  • Nebraska – February 2002
  • Idaho – March 2002
  • Minnesota – April 2002
  • New Hampshire – June 2002
  • New Mexico – November 2002
  • Kansas – March 2003
  • North Dakota – October 2003
  • Washington – October 2003
  • Alaska – October 2003
  • Oregon – December 2003
  • Montana – January 2004
  • South Dakota – March 2005
  • Wisconsin – June 2005

The Nov. 13 rule says that the request for an opt-out is effective upon submission.

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