I

106TH CONGRESS

2D SESSION H. R. 5286

To provide for a study of anesthesia services furnished under the Medicare

Program, and to expand arrangements under which certified registered

nurse anesthetists may furnish such services.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 25, 2000

Mr. WELDON of Florida (for himself and Mr. GREEN of Texas) introduced

the following bill; which was referred to the Committee on Ways and

Means, and in addition to the Committee on Commerce, 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 provide for a study of anesthesia services furnished under

the Medicare Program, and to expand arrangements

under which certified registered nurse anesthetists may

furnish such services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 5286 IH

1 SECTION 1. STUDY AND REPORT ON ANESTHESIA SERV2 ICES UNDER THE MEDICARE PROGRAM;

3 MODIFICATION OF REGULATIONS REGARD4 ING SUPERVISION OF CERTIFIED REG5 ISTERED NURSE ANESTHETISTS.

6 (a) STUDY.—(1) The Secretary of Health and

7 Human Services shall conduct a multistate comparative

8 study of mortality and adverse outcome rates of medicare

9 patients by providers of anesthesia services and by type

10 of such providers. In conducting the study, the Secretary

11 shall develop comparative outcome data for a representa12 tive sample of medicare patients based on the complexity

13 of the anesthesia services furnished to such patients.

14 (2) In conducting the study, the Secretary shall con15 sult with appropriate national professional organizations

16 with respect to the methodology, and shall use medicare

17 operating room reimbursement claims data verified by

18 sampling of actual patient records.

19 (b) REPORT.—Not later than January 1, 2005, the

20 Secretary shall submit to Congress a report containing the

21 results of the study conducted under subsection (a).

22 (c) PROMULGATION OF REVISED REGULATIONS.—

23 (1) IN GENERAL.—Pending the completion of

24 the study under subsection (a), the Secretary of

25 Health and Human Services shall revise any regula26 tions establishing conditions of participation under
3

•HR 5286 IH

1 the medicare program for hospitals and ambulatory

2 surgical centers under title XVIII of the Social Se3 curity Act relating to anesthesia services furnished

4 under such program to provide that nurse anes5 thetists may furnish anesthesia services as follows:

6 (A) Under the medical direction of an im7 mediately available anesthesiologist.

8 (B) Under the supervision of an imme9 diately available physician.

10 (C) If not under subparagraph (A) or (B),

11 then under a written collaboration agreement

12 with an immediately available physician or phy13 sician group that is (i) experienced in the ad14 ministration of anesthesia and (ii) credentialed

15 by the hospital or ambulatory surgical center to

16 participate in such collaboration.

17 (2) DEFINITIONS.—In this subsection:

18 (A) The term ‘‘medical direction’’ has the

19 meaning given that term in regulation promul20 gated by the Secretary pursuant to section

21 1887(a)(1)(A) of the Social Security Act (42

22 U.S.C. 1395xx(a)(1)(A)).

23 (B) The term ‘‘supervision’’ means the

24 medical management of the anesthesia services

25 furnished.
4

•HR 5286 IH

1 (C) The term ‘‘collaboration’’ means joint

2 management by a physician and a nurse anes3 thetist of anesthesia services furnished pursuant

4 to a jointly-developed written agreement that

5 defines the respective role of the collaborating

6 parties, consistent with the respective levels of

7 their education, training, and experience in fur8 nishing such services.

Æ