I 
109TH CONGRESS 
2D SESSION 
H. R. 6184 
To amend title XVIII of the Social Security Act to provide for improved 
payments under the Medicare Program for academic anesthesiology pro-
grams for resident physicians and for academic programs for student 
registered nurse anesthetists. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 26, 2006 
Mr. ENGLISH of Pennsylvania (for himself, Ms. HART, Mr. POMEROY, and Mr. 
STUPAK) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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 amend title XVIII of the Social Security Act to provide 
for improved payments under the Medicare Program for 
academic anesthesiology programs for resident physicians 
and for academic programs for student registered nurse 
anesthetists. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Academic 
Anesthesiology and CRNA Payment Improvement Act of 
2006’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Since 1991, the Medicare program has re-
duced reimbursements for anesthesia services pro-
vided to Medicare beneficiaries by 50 percent in cer-
tain instances when education of student nurse anes-
thetists or anesthesiology medical residents is in-
volved, imposing financial disincentives against anes-
thesia education. These Medicare payment policies 
are known as anesthesia teaching rules. 
(2) In 2002, the Centers for Medicare & Med-
icaid Services (CMS) authorized an alternative pay-
ment system for certain cases involving nurse anes-
thesia education and subsequently for anesthesiology 
resident education, in which the agency allowed re-
imbursement for base units plus discontinuous time. 
However, the alternative has not propagated in the 
marketplace and CMS has declined to reform the 
anesthesia teaching rules further without an Act of 
Congress. 
(3) To ensure the access of patients to safe, 
high quality anesthesia care, society has a strong in-
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terest in providing for high quality anesthesia edu-
cational institutions. The population of the United 
States is aging, resulting in an increase in demand 
for health care requiring anesthesia and pain man-
agement services provided by anesthesiologists and 
certified registered nurse anesthetists (CRNAs). 
(4) Though the Institute of Medicine in 2000 
found the provision of anesthesia in such year to be 
50 times safer than the provision of anesthesia dur-
ing the 20 years previous to such year, continued 
evaluation, innovation, and quality improvements in 
anesthesia are required to further enhance patient 
safety. 
(5) As of August 2006, there are 130 anesthesi-
ology residency programs and 102 programs accred-
ited by the Council on Accreditation of Nurse Anes-
thesia Educational Programs in the United States. 
Under the current payment rules under the Medi-
care program, both anesthesiology residency and 
nurse anesthesia educational programs report chal-
lenges recruiting and retaining faculty. 
(6) Since part B under the Medicare program 
provides for reimbursement for the services of anes-
thesiologists and the services of CRNAs, reforms to 
the anesthesia teaching rules under the Medicare 
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program should treat teaching anesthesiologists and 
teaching CRNAs similarly with respect to anesthesi-
ology medical residents and student registered nurse 
anesthetists, respectively, and should not favor one 
provider over another. 
SEC. 3. PURPOSE. 
The purpose of this Act is to ensure financial stability 
of nurse anesthesia and anesthesiology educational pro-
grams to provide sufficient opportunities for student nurse 
anesthetists and medical residents to pursue the specialty 
of anesthesia so that patients continue to have access to 
quality health care. 
SEC. 4. SPECIAL PAYMENT RULE FOR TEACHING ANESTHE-
SIOLOGISTS AND TEACHING CERTIFIED REG-
ISTERED NURSE ANESTHETISTS. 
(a) FOR PHYSICIANS’ SERVICES.—Section 1848(a) of 
the Social Security Act (42 U.S.C. 1395w–4(a)) is amend-
ed— 
(1) in paragraph (4)(A), by inserting ‘‘except as 
provided in paragraph (5)(A)’’ after ‘‘anesthesia 
cases,’’; and 
(2) by adding at the end of paragraph (4) the 
following new paragraph: 
‘‘(5) SPECIAL RULE FOR TEACHING ANESTHE-
SIOLOGISTS.— 
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‘‘(A) IN GENERAL.—With respect to physi-
cians’ services furnished by a teaching anesthe-
siologist involved in the training of physician 
residents or student nurse anesthetists in a sin-
gle anesthesia case or two concurrent anes-
thesia cases, notwithstanding paragraph (4), 
the fee schedule amount to be applied for each 
such case shall be the amount described in sub-
paragraph (B) if both of the following condi-
tions are met: 
‘‘(i) The teaching anesthesiologist is 
present during all critical or key portions 
of the anesthesia service or case involved. 
‘‘(ii) At least one of the following indi-
viduals is immediately available to furnish 
anesthesia services during the entire case: 
‘‘(I) The teaching anesthesiol-
ogist. 
‘‘(II) An anesthesiologist with 
whom the teaching anesthesiologist 
has entered into an arrangement for 
such purpose. 
‘‘(III) In the case of the training 
of student nurse anesthetists, a cer-
tified registered nurse anesthetist with 
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whom the teaching anesthesiologist 
has entered into an arrangement with 
respect to such training. 
‘‘(B) AMOUNT DESCRIBED.—For purposes 
of subparagraph (A), the amount described in 
this subparagraph, with respect to anesthesia 
services furnished by a teaching anesthesiologist 
described in such subparagraph, is 100 percent 
of the fee schedule amount otherwise applicable 
under this section if the anesthesia services 
were personally performed by the teaching anes-
thesiologist alone. 
‘‘(C) CLARIFICATION
FOR
ANESTHESIOL-
OGISTS
WHO
MEDICALLY
DIRECT
TEACHING 
CERTIFIED
REGISTERED
NURSE
ANES-
THETISTS.—Subparagraph (A) shall not apply 
in the case of physician services furnished by an 
anesthesiologist who medically directs a cer-
tified registered nurse anesthetist who is in-
volved in the training of student nurse anes-
thetists in a single anesthesia case or two con-
current anesthesia cases.’’. 
(b) FOR SERVICES
OF CERTIFIED REGISTERED 
NURSE ANESTHETISTS.—Section 1833(l) of such Act (42 
U.S.C. 1395l(l)) is amended— 
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