I
106TH CONGRESS
2D SESSION
H. R. 5286
To provide for a study of anesthesia services furnished under the Medicare
Program, and to expand arrangements under which certified registered
nurse anesthetists may furnish such services.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 25, 2000
Mr. WELDON of Florida (for himself and Mr. GREEN of Texas) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Commerce, for a period to
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To provide for a study of anesthesia services furnished under
the Medicare Program, and to expand arrangements
under which certified registered nurse anesthetists may
furnish such services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. STUDY AND REPORT ON ANESTHESIA SERV-
ICES 
UNDER 
THE 
MEDICARE 
PROGRAM;
MODIFICATION OF REGULATIONS REGARD-
ING 
SUPERVISION 
OF 
CERTIFIED 
REG-
ISTERED NURSE ANESTHETISTS.
(a) STUDY.—(1) The Secretary of Health and
Human Services shall conduct a multistate comparative
study of mortality and adverse outcome rates of medicare
patients by providers of anesthesia services and by type
of such providers. In conducting the study, the Secretary
shall develop comparative outcome data for a representa-
tive sample of medicare patients based on the complexity
of the anesthesia services furnished to such patients.
(2) In conducting the study, the Secretary shall con-
sult with appropriate national professional organizations
with respect to the methodology, and shall use medicare
operating room reimbursement claims data verified by
sampling of actual patient records.
(b) REPORT.—Not later than January 1, 2005, the
Secretary shall submit to Congress a report containing the
results of the study conducted under subsection (a).
(c) PROMULGATION OF REVISED REGULATIONS.—
(1) IN GENERAL.—Pending the completion of
the study under subsection (a), the Secretary of
Health and Human Services shall revise any regula-
tions establishing conditions of participation under
the medicare program for hospitals and ambulatory
surgical centers under title XVIII of the Social Se-
curity Act relating to anesthesia services furnished
under such program to provide that nurse anes-
thetists may furnish anesthesia services as follows:
(A) Under the medical direction of an im-
mediately available anesthesiologist.
(B) Under the supervision of an imme-
diately available physician.
(C) If not under subparagraph (A) or (B),
then under a written collaboration agreement
with an immediately available physician or phy-
sician group that is (i) experienced in the ad-
ministration of anesthesia and (ii) credentialed
by the hospital or ambulatory surgical center to
participate in such collaboration.
(2) DEFINITIONS.—In this subsection:
(A) The term ‘‘medical direction’’ has the
meaning given that term in regulation promul-
gated by the Secretary pursuant to section
1887(a)(1)(A) of the Social Security Act (42
U.S.C. 1395xx(a)(1)(A)).
(B) The term ‘‘supervision’’ means the
medical management of the anesthesia services
furnished.
(C) The term ‘‘collaboration’’ means joint
management by a physician and a nurse anes-
thetist of anesthesia services furnished pursuant
to a jointly-developed written agreement that
defines the respective role of the collaborating
parties, consistent with the respective levels of
their education, training, and experience in fur-
nishing such services.
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