I

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.

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. REVISION OF CONDITIONS OF PAYMENT RE2 LATING TO ANESTHESIA SERVICES FUR3 NISHED BY CERTIFIED REGISTERED NURSE

4 ANESTHETISTS.

5 (a) PROMULGATION OF REVISED REGULATIONS.—

6 The Secretary of Health and Human Services shall revise

7 any regulations describing the conditions under which pay8 ment may be made for anesthesia services under the medi9 care program so that—

10 (1) payment may be made for anesthesia serv11 ices furnished in a hospital or an ambulatory sur12 gical center by a certified registered nurse anes13 thetist who is permitted to administer anesthesia

14 under the law of the State in which the service is

15 furnished; and

16 (2) the conditions under which payment may be

17 made for a physician service consisting of the medi18 cal direction or medical supervision of a certified

19 registered nurse anesthetist meet the requirements

20 of subsection (b)(1).

21 (b) REQUIREMENTS FOR MEDICAL DIRECTION DE22 SCRIBED.—

23 (1) IN GENERAL.—The requirements of this

24 subsection are that the conditions under which pay25 ment may be made for the medical direction or med-
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1 ical supervision of a certified registered nurse anes2 thetist—

3 (A) shall not restrict such nurse anes4 thetists working with anesthesiologists from

5 performing all the components of the anesthesia

6 service that such nurse anesthetists are legally

7 authorized to perform in the State in which the

8 service is furnished; and

9 (B) shall prevent fraud and abuse in pay10 ment for anesthesia services by requiring that

11 the physician providing medical direction or

12 medical supervision must be physically present

13 in the facility where the certified registered

14 nurse anesthetist’s services are performed and

15 be available in a timely manner for consultation

16 or assistance if indicated.

17 (2) CONSULTATION REQUIRED.—The Secretary

18 shall revise the regulations referred to in subsection

19 (a)(2) after consultation with representatives from

20 professional associations of certified registered nurse

21 anesthetists and anesthesiologists.

22 (c) EFFECTIVE DATE.—The revisions to the regula23 tions referred to in subsection (a) shall apply to anesthesia

24 services furnished on or after January 1, 1995.
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1 (d) TERMINATION OF REGULATIONS ON MEDICAL

2 DIRECTION OR SUPERVISION.—The regulations referred

3 to in subsection (a)(2) shall be repealed effective January

4 1, 1998.

5 SEC. 2. ENSURING PAYMENT FOR PHYSICIAN AND NURSE

6 FOR JOINTLY FURNISHED ANESTHESIA SERV7 ICES.

8 (a) PAYMENT FOR JOINTLY FURNISHED SINGLE

9 CASE.—

10 (1) PAYMENT TO PHYSICIAN.—Section

11 1848(a)(4) of the Social Security Act (42 U.S.C.

12 1395w–4(a)(4)), as added by section 13516(a) of

13 the Omnibus Budget Reconciliation Act of 1993

14 (hereafter referred to as ‘‘OBRA–1993’’), is amend15 ed by adding at the end the following new subpara16 graph:

17 ‘‘(C) PAYMENT FOR SINGLE CASE.—Not18 withstanding section 1862(a)(1)(A), with re19 spect to physicians’ services consisting of the

20 furnishing of anesthesia services for a single

21 case that are furnished jointly with a certified

22 registered nurse anesthetist, if the carrier de23 termines that the use of both the physician and

24 the nurse anesthetist to furnish the anesthesia

25 service was not medically necessary, the fee
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1 schedule amount to be applied shall be equal to

2 50 percent of the fee schedule amount otherwise

3 applicable under this section if the anesthesia

4 service were personally performed by the physi5 cian alone.’’.

6 (2) PAYMENT TO CRNA.—Section 1833(l)(4)(B)

7 of such Act (42 U.S.C. 1395l(l)(4)(B)), as added by

8 section 13516(b) of OBRA–1993, is amended by

9 adding at the end the following new clause:

10 ‘‘(iv) Notwithstanding section 1862(a)(1)(A), in the

11 case of services of a certified registered nurse anesthetist

12 consisting of the furnishing of anesthesia services for a

13 single case that are furnished jointly with a physician, if

14 the carrier determines that the use of both the physician

15 and the nurse anesthetist to furnish the anesthesia service

16 was not medically necessary, the fee schedule amount shall

17 be equal to 50 percent of the fee schedule amount other18 wise applicable under this section if the anesthesia service

19 were personally performed by the physician alone.’’.

20 (b) UNIFORM TREATMENT OF ALL MULTIPLE CON21 CURRENT CASES.—Section 1848(a)(4) of such Act (42

22 U.S.C. 1395w–4(a)(4)) and section 1842(b)(13) of such

23 Act (42 U.S.C. 1395u(b)(13)), as amended by section

24 13516(a) of OBRA–1993, are each amended—
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1 (1) by striking ‘‘two, three, or four’’ each place

2 it appears and inserting ‘‘two or more’’; and

3 (2) by inserting ‘‘or medical supervision’’ after

4 ‘‘medical direction’’ each place it appears.

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

6 subsections (a) and (b) shall apply to services furnished

7 on or after January 1, 1995.

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