CANA Statement on CMS Request for Information on Medicare CRNA Supervision

(Sacramento, CA) – Today, Joshua Carr, CRNA, President of the California Association of Nurse Anesthesiology (CANA), issued the following statement in response to the federal Administration publishing a Request for Information (RFI) seeking public input on Medicare’s physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs):

“CANA welcomes the decision to reconsider Medicare’s physician supervision requirement and opt-out policy for CRNAs. Though initially well-intentioned, this outdated federal regulation creates unnecessary barriers to delivering timely, high-quality anesthesia care to patients across the country, particularly in California where four rural counties rely exclusively on CRNAs to provide all anesthesia services.

“In 2001, the Centers for Medicare & Medicaid Services (CMS) began allowing state governors to request exemptions to the physician supervision requirement. More than two dozen states, plus Washington D.C. and Guam, have since exercised this “opt-out” option. Because California state law first enabled CRNAs to provide anesthesia services independently in 1984, Governor Schwarzenegger officially opted the state out in 2009. The decision was later upheld in court, demonstrating the importance of providing individual health care facilities the flexibility to determine the anesthesia delivery models that best serve their communities, and recognizing that decisions about anesthesia care should be guided by patient needs, provider qualifications, and state law rather than unnecessary federal mandates.

“Research has consistently found no difference in patient outcomes or complications when CRNAs practice without mandatory physician supervision. More recently, research published last year found that waiving supervision requirements during the COVID-19 public health emergency increased access to anesthesia care without increasing anesthesia-related complications.

“CRNAs are highly educated, trained, and qualified advanced practice professionals with an established record of providing safe, effective anesthesia care. Unnecessary regulatory restrictions not only limit access but are also unsupported by outcome data. By eliminating the federal physician supervision requirement for CRNAs, CMS can help increase access to care, address workforce capacity, and ease administrative burden to ensure all patients receive timely, high-quality anesthesia services regardless of where they live.

"CANA looks forward to submitting comments as part of this process and providing additional information regarding the impact of this requirement. CANA also encourages stakeholders to participate through the AANA comment portal.”