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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4291 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 4291

To direct the Secretary of Health and Human Services to revise existing 
 regulations concerning the conditions of payment under part B of the 
medicare program relating to anesthesia services furnished by certified 
         registered nurse anesthetists, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 21, 1994

Mr. Kreidler introduced the following bill; which was referred jointly 
      to the Committees on Ways and Means and Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
To direct the Secretary of Health and Human Services to revise existing 
 regulations concerning the conditions of payment under part B of the 
medicare program relating to anesthesia services furnished by certified 
         registered nurse anesthetists, and for other purposes.

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

SECTION 1. REVISION OF CONDITIONS OF PAYMENT RELATING TO ANESTHESIA 
              SERVICES FURNISHED BY CERTIFIED REGISTERED NURSE 
              ANESTHETISTS.

    (a) Promulgation of Revised Regulations.--The Secretary of Health 
and Human Services shall revise any regulations describing the 
conditions under which payment may be made for anesthesia services 
under the medicare program so that--
            (1) payment may be made for anesthesia services furnished 
        in a hospital or an ambulatory surgical center by a certified 
        registered nurse anesthetist who is permitted to administer 
        anesthesia under the law of the State in which the service is 
        furnished; and
            (2) the conditions under which payment may be made for a 
        physician service consisting of the medical direction or 
        medical supervision of a certified registered nurse anesthetist 
        meet the requirements of subsection (b)(1).
    (b) Requirements for Medical Direction Described.--
            (1) In general.--The requirements of this subsection are 
        that the conditions under which payment may be made for the 
        medical direction or medical supervision of a certified 
        registered nurse anesthetist--
                    (A) shall not restrict such nurse anesthetists 
                working with anesthesiologists from performing all the 
                components of the anesthesia service that such nurse 
                anesthetists are legally authorized to perform in the 
                State in which the service is furnished; and
                    (B) shall prevent fraud and abuse in payment for 
                anesthesia services by requiring that the physician 
                providing medical direction or medical supervision must 
                be physically present in the facility where the 
                certified registered nurse anesthetist's services are 
                performed and be available in a timely manner for 
                consultation or assistance if indicated.
            (2) Consultation required.--The Secretary shall revise the 
        regulations referred to in subsection (a)(2) after consultation 
        with representatives from professional associations of 
        certified registered nurse anesthetists and anesthesiologists.
    (c) Effective Date.--The revisions to the regulations referred to 
in subsection (a) shall apply to anesthesia services furnished on or 
after January 1, 1995.
    (d) Termination of Regulations on Medical Direction or 
Supervision.--The regulations referred to in subsection (a)(2) shall be 
repealed effective January 1, 1998.

SEC. 2. ENSURING PAYMENT FOR PHYSICIAN AND NURSE FOR JOINTLY FURNISHED 
              ANESTHESIA SERVICES.

    (a) Payment for Jointly Furnished Single Case.--
            (1) Payment to physician.--Section 1848(a)(4) of the Social 
        Security Act (42 U.S.C. 1395w-4(a)(4)), as added by section 
        13516(a) of the Omnibus Budget Reconciliation Act of 1993 
        (hereafter referred to as ``OBRA-1993''), is amended by adding 
        at the end the following new subparagraph:
                    ``(C) Payment for single case.--Notwithstanding 
                section 1862(a)(1)(A), with respect to physicians' 
                services consisting of the furnishing of anesthesia 
                services for a single case that are furnished jointly 
                with a certified registered nurse anesthetist, if the 
                carrier determines that the use of both the physician 
                and the nurse anesthetist to furnish the anesthesia 
                service was not medically necessary, the fee schedule 
                amount to be applied shall be equal to 50 percent of 
                the fee schedule amount otherwise applicable under this 
                section if the anesthesia service were personally 
                performed by the physician alone.''.
            (2) Payment to crna.--Section 1833(l)(4)(B) of such Act (42 
        U.S.C. 1395l(l)(4)(B)), as added by section 13516(b) of OBRA-
        1993, is amended by adding at the end the following new clause:
    ``(iv) Notwithstanding section 1862(a)(1)(A), in the case of 
services of a certified registered nurse anesthetist consisting of the 
furnishing of anesthesia services for a single case that are furnished 
jointly with a physician, if the carrier determines that the use of 
both the physician and the nurse anesthetist to furnish the anesthesia 
service was not medically necessary, the fee schedule amount shall be 
equal to 50 percent of the fee schedule amount otherwise applicable 
under this section if the anesthesia service were personally performed 
by the physician alone.''.
    (b) Uniform Treatment of All Multiple Concurrent Cases.--Section 
1848(a)(4) of such Act (42 U.S.C. 1395w-4(a)(4)) and section 
1842(b)(13) of such Act (42 U.S.C. 1395u(b)(13)), as amended by section 
13516(a) of OBRA-1993, are each amended--
            (1) by striking ``two, three, or four'' each place it 
        appears and inserting ``two or more''; and
            (2) by inserting ``or medical supervision'' after ``medical 
        direction'' each place it appears.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to services furnished on or after January 1, 1995.

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