I 

110TH CONGRESS 

1ST SESSION H. R. 1932 

To amend title XVIII of the Social Security Act to provide for improved 

payments under the Medicare Program for academic anesthesiology programs for resident physicians and for academic programs for student 

registered nurse anesthetists. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 18, 2007 

Mr. STUPAK (for himself, Mr. BURGESS, Mr. ENGLISH of Pennsylvania, and 

Mr. POMEROY) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committee 

on Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for improved payments under the Medicare Program for 

academic anesthesiology programs for resident physicians 

and for academic programs for student registered nurse 

anesthetists. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Academic 

3 Anesthesiology and CRNA Payment Improvement Act of 

4 2007’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) Since 1992, the Medicare program has re8 duced reimbursements for anesthesia services pro9 vided to Medicare beneficiaries by 50 percent in cer10 tain instances when education of student nurse anes11 thetists or anesthesiology medical residents is in12 volved, imposing financial disincentives against anes13 thesia education. These Medicare payment policies 

14 are known as anesthesia teaching rules. 

15 (2) In 2002, the Centers for Medicare & Med16 icaid Services (CMS) authorized an alternative pay17 ment system for certain cases involving nurse anes18 thesia education and subsequently for anesthesiology 

19 resident education, in which the agency allowed re20 imbursement for base units plus discontinuous time. 

21 However, the alternative has not propagated in the 

22 marketplace and CMS has declined to reform the 

23 anesthesia teaching rules further without an Act of 

24 Congress. 

25 (3) To ensure the access of patients to safe, 

26 high quality anesthesia care, society has a strong inVerDate Aug 31 2005 02:00 Apr 20, 2007 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1932.IH H1932

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1 terest in providing for high quality anesthesia edu2 cational institutions. The population of the United 

3 States is aging, resulting in an increase in demand 

4 for health care requiring anesthesia and pain man5 agement services provided by anesthesiologists and 

6 certified registered nurse anesthetists (CRNAs). 

7 (4) Though the Institute of Medicine in 2000 

8 found the provision of anesthesia in such year to be 

9 50 times safer than the provision of anesthesia dur10 ing the 20 years previous to such year, continued 

11 evaluation, innovation, and quality improvements in 

12 anesthesia are required to further enhance patient 

13 safety. 

14 (5) As of August 2006, there are 130 anesthesi15 ology residency programs and 102 programs accred16 ited by the Council on Accreditation of Nurse Anes17 thesia Educational Programs in the United States. 

18 Under the current payment rules under the Medi19 care program, both anesthesiology residency and 

20 nurse anesthesia educational programs report chal21 lenges recruiting and retaining faculty. 

22 (6) Since part B under the Medicare program 

23 provides for reimbursement for the services of anes24 thesiologists and the services of CRNAs, reforms to 

25 the anesthesia teaching rules under the Medicare 


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1 program should treat teaching anesthesiologists and 

2 teaching CRNAs similarly with respect to anesthesi3 ology medical residents and student registered nurse 

4 anesthetists, respectively, and should not favor one 

5 provider over another. 

6 SEC. 3. PURPOSE. 

7 The purpose of this Act is to ensure financial stability 

8 of nurse anesthesia and anesthesiology educational pro9 grams to provide sufficient opportunities for student nurse 

10 anesthetists and medical residents to pursue the specialty 

11 of anesthesia so that patients continue to have access to 

12 quality health care. 

13 SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHE14 SIOLOGISTS AND TEACHING CERTIFIED REG15 ISTERED NURSE ANESTHETISTS. 

16 (a) FOR PHYSICIANS’ SERVICES.—Section 1848(a) of 

17 the Social Security Act (42 U.S.C. 1395w–4(a)) is amend18 ed— 

19 (1) in paragraph (4)(A), by inserting ‘‘except as 

20 provided in paragraph (5)(A)’’ after ‘‘anesthesia 

21 cases,’’; and 

22 (2) by adding at the end of paragraph (4) the 

23 following new paragraph: 

24 ‘‘(5) SPECIAL RULE FOR TEACHING ANESTHE25 SIOLOGISTS.— 


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1 ‘‘(A) IN GENERAL.—With respect to physi2 cians’ services furnished by a teaching anesthe3 siologist involved in the training of physician 

4 residents or student nurse anesthetists in a sin5 gle anesthesia case or two concurrent anes6 thesia cases, notwithstanding paragraph (4), 

7 the fee schedule amount to be applied for each 

8 such case shall be the amount described in sub9 paragraph (B) if both of the following condi10 tions are met: 

11 ‘‘(i) The teaching anesthesiologist is 

12 present during all critical or key portions 

13 of the anesthesia service or case involved. 

14 ‘‘(ii) At least one of the following indi15 viduals is immediately available to furnish 

16 anesthesia services during the entire case: 

17 ‘‘(I) The teaching anesthesiol18 ogist. 

19 ‘‘(II) An anesthesiologist with 

20 whom the teaching anesthesiologist 

21 has entered into an arrangement for 

22 such purpose. 

23 ‘‘(III) In the case of the training 

24 of student nurse anesthetists, a cer25 tified registered nurse anesthetist with 


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1 whom the teaching anesthesiologist 

2 has entered into an arrangement with 

3 respect to such training. 

4 ‘‘(B) AMOUNT DESCRIBED.—For purposes 

5 of subparagraph (A), the amount described in 

6 this subparagraph, with respect to anesthesia 

7 services furnished by a teaching anesthesiologist 

8 described in such subparagraph, is 100 percent 

9 of the fee schedule amount otherwise applicable 

10 under this section if the anesthesia services 

11 were personally performed by the teaching anes12 thesiologist alone. 

13 ‘‘(C) CLARIFICATION FOR ANESTHESIOL14 OGISTS WHO MEDICALLY DIRECT TEACHING

15 CERTIFIED REGISTERED NURSE ANES16 THETISTS.—Subparagraph (A) shall not apply 

17 in the case of physician services furnished by an 

18 anesthesiologist who medically directs a cer19 tified registered nurse anesthetist who is in20 volved in the training of student nurse anes21 thetists in a single anesthesia case or two con22 current anesthesia cases.’’. 

23 (b) FOR SERVICES OF CERTIFIED REGISTERED

24 NURSE ANESTHETISTS.—Section 1833(l) of such Act (42 

25 U.S.C. 1395l(l)) is amended— 


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1 (1) in paragraph (4)(B)(iii)— 

2 (A) by striking ‘‘In the case of’’ and in3 serting ‘‘(I) Subject to clause (II), in the case 

4 of’’; 

5 (B) by striking ‘‘1848(a)(5)(B)’’ and in6 serting ‘‘1848(a)(4)(B)’’; and 

7 (C) by adding at the end the following new 

8 subclause: 

9 ‘‘(II) Subclause (I) shall apply to a certified reg10 istered nurse anesthetist who is medically directed or 

11 medically supervised by a physician notwithstanding 

12 whether or not such certified registered nurse anesthetist 

13 is involved in the training of student nurse anesthetists 

14 in a single case or two concurrent cases.’’; and 

15 (2) by adding at the end the following new 

16 paragraph: 

17 ‘‘(7)(A) With respect to services furnished by a teach18 ing certified registered nurse anesthetist who is not medi19 cally directed and who is involved in the training of stu20 dent nurse anesthetists in a single anesthesia case or two 

21 concurrent anesthesia cases, the fee schedule amount to 

22 be applied for each such case shall be the amount de23 scribed in subparagraph (B) if both of the following condi24 tions are met: 


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1 ‘‘(i) The teaching certified registered nurse an2 esthetist is present during all critical or key portions 

3 of the anesthesia service or case involved. 

4 ‘‘(ii) The teaching certified registered nurse an5 esthetist (or other certified registered nurse anes6 thetist or anesthesiologist with whom the teaching 

7 certified registered nurse anesthetist has entered 

8 into an arrangement) is immediately available to fur9 nish anesthesia services during the entire case. 

10 ‘‘(B) For purposes of subparagraph (A), the amount 

11 described in this subparagraph, with respect to services 

12 furnished by a teaching certified registered nurse anes13 thetist described in such subparagraph, is 100 percent of 

14 the fee schedule amount otherwise applicable under this 

15 subsection if the services were personally performed by the 

16 teaching certified registered nurse anesthetist alone.’’. 

17 (c) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply to services furnished on or after 

19 January 1, 2008. 

Æ 


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