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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. REVISION OF CONDITIONS OF PAYMENT RE-
LATING 
TO 
ANESTHESIA 
SERVICES 
FUR-
NISHED 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 pay-
ment may be made for anesthesia services under the medi-
care program so that—
(1) payment may be made for anesthesia serv-
ices furnished in a hospital or an ambulatory sur-
gical center by a certified registered nurse anes-
thetist 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 medi-
cal direction or medical supervision of a certified
registered nurse anesthetist meet the requirements
of subsection (b)(1).
(b) REQUIREMENTS FOR MEDICAL DIRECTION DE-
SCRIBED.—
(1) IN
GENERAL.—The requirements of this
subsection are that the conditions under which pay-
ment may be made for the medical direction or med-
ical supervision of a certified registered nurse anes-
thetist—
(A) shall not restrict such nurse anes-
thetists 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 pay-
ment 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 regula-
tions 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 SERV-
ICES.
(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 amend-
ed by adding at the end the following new subpara-
graph:
‘‘(C) PAYMENT FOR SINGLE CASE.—Not-
withstanding section 1862(a)(1)(A), with re-
spect 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 de-
termines 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 physi-
cian 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 other-
wise applicable under this section if the anesthesia service
were personally performed by the physician alone.’’.
(b) UNIFORM TREATMENT OF ALL MULTIPLE CON-
CURRENT 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.
Æ