AANA Files Petition to Compel HHS to Enforce ACA Provider Non-Discrimination Provision

AANA calls on Biden Administration to enforce Affordable Care Act to help ensure access to care for all patients

ROSEMONT, Ill. — The American Association of Nurse Anesthesiology (AANA) took action today to ensure access to high-quality, affordable anesthesia care for all patients. AANA filed a petition for a writ of mandamus in the United States District Court for the Northern District of Ohio asking the court to compel Xavier Beccera, Secretary of Health and Human Services (HHS), to perform a duty he is legally obligated to perform — enforce the provider non-discrimination provision of the Affordable Care Act (ACA) against insurance companies and health plans.

In 2010, the provider nondiscrimination provision in the ACA was passed to prohibit health plans/health insurance companies (commercial payors) from discriminating against providers on the basis of licensure, including setting up different reimbursement policies for those providers delivering the same high-quality healthcare services. In 2020, the No Surprises Act required the HHS, the Department of Labor, and the Department of Treasury to issue rules and enforcement policies within one year. However, there is still no level of enforcement in place. Until this is completed, commercial payors can jeopardize patients’ access to care through discriminatory policies.

“Unfortunately, now more than a decade later, HHS has not enforced the provider nondiscrimination provisions of the ACA which has allowed commercial payors to blatantly discriminate against providers. Enforcement is crucial to protect patients’ access to care and help lower healthcare costs,” said AANA President Jan Setnor, MSN, CRNA, Col. (Ret), USAFR, NC. “Until HHS steps up, commercial payors can jeopardize patients’ access to care through unchecked and discriminatory rate-setting practices, including continuing to significantly reduce reimbursement for CRNAs practicing independently.”

Both Anthem Blue Cross Blue Shield and Cigna have recently announced that Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists will receive 15% less than other anesthesia providers for delivering the same anesthesia services.

“These discriminatory policies often penalize hospitals or off-site ambulatory surgery centers that rely on CRNAs for patients’ anesthesia care. Even when the cost difference is not passed on to patients, it can impact the hospital’s ability to have funds for patient quality enhancements and other modernizations,” Setnor said. “This can drive harmful cost-shifting in healthcare delivery that puts patient access to care at risk, especially among the most vulnerable populations in rural and underserved areas. Access to quality anesthesia care should not be zip-code dependent.”

CRNAs administer more than 58 million anesthetics and pain management services each year to patients in the U.S. They are involved in every aspect of anesthesia in all types of settings – especially in rural areas. Despite this, CRNAs have now received reduced reimbursement rates from insurance plans.

CRNAs provide anesthesia for a wide variety of surgical cases and acute, chronic, and interventional pain management services. In many states, CRNAs are the sole anesthesia providers in nearly 100% of rural hospitals, affording these medical facilities obstetrical, surgical, trauma stabilization, and pain management capabilities. Today, CRNAs have full practice authority in every branch of the military and are the primary providers of anesthesia care to U.S. military personnel on front lines, navy ships, and aircraft evacuation teams around the globe.

As Advanced Practice Registered Nurses and members of America’s most trusted profession according to Gallup, CRNAs practice with a high degree of autonomy and are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure, and certification.