I 
119TH CONGRESS 
1ST SESSION H. R. 2234 
To direct the Secretary of Veterans Affairs to update certain standards 
regarding anesthesia and pain management services in the Veterans 
Health Administration. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 18, 2025 
Ms. UNDERWOOD (for herself and Mrs. KIGGANS of Virginia) introduced the 
following bill; which was referred to the Committee on Veterans’ Affairs 
A BILL 
To direct the Secretary of Veterans Affairs to update certain 
standards regarding anesthesia and pain management 
services in the Veterans Health Administration. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Veterans 
Timely Access to Anesthesia Care Act of 2025’’. 
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SEC. 2. ALIGNMENT OF STANDARDS REGARDING CER-
TIFIED REGISTERED NURSE ANESTHETISTS 
IN THE VETERANS HEALTH ADMINISTRATION 
WITH STANDARDS OF THE DEFENSE HEALTH 
AGENCY. 
The Secretary of Veterans Affairs shall update VHA 
Directive 1123 titled ‘‘National Anesthesia Program, De-
partment of Veterans Affairs Certified Registered Nurse 
Anesthetists Practice Guidelines’’ (or any successor direc-
tive) to recognize, in the Veterans Health Administration, 
certified registered nurses anesthetists as licensed inde-
pendent practitioners in a manner consistent with the 
practice standards described by section 3(f)(2) of Enclo-
sure of Defense Health Agency Administrative Instruction 
6025.07, dated November 8, 2023, as amended. 
SEC. 3. REQUIREMENTS OF ANESTHESIA PROVIDERS IN 
THE VETERANS HEALTH ADMINISTRATION. 
(a) CERTIFICATION.—The Secretary of Veterans Af-
fairs shall require an anesthesia professional employed by 
the Secretary as— 
(1) a physician anesthesiologist to be certified 
by the American Board of Anesthesiology or a simi-
lar body determined by the Secretary; and 
(2) a certified registered nurse anesthetist to be 
certified by the Council on Certification of Nurse 
Anesthetists or the Council on Recertification of 
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Nurse Anesthetists or a similar body determined by 
the Secretary. 
(b) DIRECT CARE.—The Secretary shall require an 
anesthesia professional described in subsection (a) to have 
completed at least 25 hours of direct patient anesthesia 
care (not including supervision of other anesthesia profes-
sionals). 
(c) ENFORCEMENT.—The Secretary shall suspend 
from employment in the Department of Veterans Affairs 
an anesthesia professional described in subsection (a) who 
has not complied with the requirements of this section. 
SEC. 4. GAO REPORT ON ANESTHESIA DELIVERY IN THE 
VETERANS HEALTH ADMINISTRATION. 
Not later than one year after the date of the enact-
ment of this Act, and annually thereafter, the Comptroller 
General of the United States shall submit to the Commit-
tees on Veterans’ Affairs of the House of Representatives 
and the Senate a report that contains the following, and 
which shall be made publicly available: 
(1) Data regarding outcomes regarding the fol-
lowing anesthesia models used in the Veterans 
Health Administration: 
(A) Delivery by an anesthesiologist. 
(B) Delivery by a certified registered nurse 
anesthetist under the supervision of a physician. 
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(C) Delivery by a certified registered nurse 
anesthetist without supervision. 
(2) A comparison of the cost effectiveness of 
the models described in paragraph (1), including— 
(A) the estimated cost to medical facilities 
of the Department of Veterans Affairs and tax-
payers for each such model; and 
(B) a breakdown of costs and savings to 
taxpayers and to veterans’ households associ-
ated with each such model. 
Æ 
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