Kaiser Foundation Health Plan Reimbursement Changes Highlight Need for HHS to Enforce ACA Provider Non-Discrimination Provision

ROSEMONT, Ill. — The American Association of Nurse Anesthesiology (AANA) issued the following statement in response to Kaiser Permanente’s announcement that Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc., effective November 1, 2024, will not reimburse anesthesia services when submitted without the appropriate modifiers identifying who performed the service, and that it will be reducing QZ services rendered by a Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists and nurse anesthetists to 85% of the Physician Fee Schedule.

It is attributable to AANA President Jan Setnor, MSN, CRNA, Col. (Ret), USAFR, NC.

“AANA strongly opposes the reduction of CRNA anesthesia reimbursements to 85% of the Physician Fee Schedule by Kaiser Permanente. This reimbursement reduction clearly discriminates against CRNAs based on their licensure because the policy does not affect any other anesthesia providers who offer the same services as CRNAs.

“This new anesthesia reimbursement policy will devastate healthcare delivery as it  impedes access to healthcare for patients, especially in rural and underserved areas and directly conflicts with the existing federal provider nondiscrimination law for commercial health plans.

“CRNAs put their patients’ well-being first. We must remain by the patient’s side making sure they are safe and comfortable for 100% of the surgical procedure just like other anesthesia providers. We also care for patients before and after surgery to ensure complete recovery which makes this new policy change to only reimburse CRNAs at  85% of the fee schedule even more confounding. It is a travesty that insurance providers do not appear to have the same concern for patients’ care.

“Kaiser’s announcement is the latest from insurance companies looking to limit reimbursement for anesthesia providers. 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 HHS Secretary Xavier Beccera 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 based on 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 Department of Health and Human Services (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 like Kaiser can jeopardize patients’ access to care through discriminatory policies.

“We call on Kaiser and other commercial payors to reverse course on these other discriminatory policies immediately. We also call on HHS to enforce the provider nondiscrimination provision of the ACA to protect patients’ access to care.

“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.”