The COVID-19 Public Health Emergency ends on May 11, 2023. This will result in waivers issued by the federal government to allow greater access to healthcare providers during this healthcare crisis, to sunset. For CRNAs, this will mean that physician supervision requirements under Part A will be enforced effective May 12, 2023.
Although many waivers will expire, in 2023, Centers for Medicare & Medicaid Services (CMS) made permanent an interim regulation that allows CRNAs and other APRNs to supervise the performance of diagnostic tests. In addition, the Consolidated Appropriations Act, 2023, extended through December 31, 2024, the PHE telehealth flexibilities that allowed Medicare beneficiaries to access telehealth services in any geographic area in the U.S., allowed for telehealth in their homes and allowed for certain telehealth visits to be delivered audio-only. CRNAs should be aware of these waivers as they have been eligible for telehealth reimbursement in Medicare since 2015.
CMS has put out guidance on the ending of the public health emergency and what this will mean.
What Should CRNAs Who Serve as Chief CRNA in Their Facilities Know?
While it is ultimately the responsibility of the hospitals to ensure compliance, Chief CRNAs and CRNAs who serve as leaders in their facilities may consider working with hospital administrators to adopt AANA’s Efficiency-driven Anesthesia Modeling (EDAM) as a means by which to help cope with workforce shortages after the waiver ends. EDAM is a new way of approaching anesthesia staffing that organizes variables unique to an individual healthcare facility or health system while assessing requirements for best practices; limits duplication of services, improves effectiveness, increases access, and reduces costs; and reevaluates current anesthesia models to improve safe practice, cost-effectiveness, and accessibility. See our resources on EDAM.
What Should State Association Leaders Know?
For those state associations that are in states that have not yet opted out of the Medicare’s physician supervision requirement for CRNAs, we encourage these associations to be aware of the opt-out process, especially if they do not have any supervision requirements in their state laws. Per regulations from CMS, [1] in order to opt of the supervision requirements a Governor must send a written request to CMS. In the letter, the current Governor must attest that they consulted with the State Boards of Medicine and Nursing about issues related to access to and quality of anesthesia services and concluded that it is in the best interest of the citizens of the state to opt-out of the current supervision requirements and that the opt-out is consistent with state law.”
[1] 66 Fed. Reg. 56762.
What is AANA doing to Permanently Remove Physician Supervision?
AANA continues to actively advocate for the supervision waiver to be made permanent and submitted to CMS suggestions on how to fix the current regulations and allow for removal of supervision requirements. AANA continues to have meetings with Congress, federal agencies, and the White House.
AANA and the National Rural Health Association worked with Representative Sam Graves (R-MO) on the introduction of H.R.833 – Save America’s Rural Hospitals Act, which includes a provision to remove physician supervision of CRNAs. AANA is also working to reintroduce the ICAN Act, which also includes a provision to permanently remove physician supervision of CRNAs.
Share your Story: What Will Ending of the PHE and the Waiver for Physician Supervision Mean for CRNAs Who Work in Facilities?
Most CRNAs will likely not see any change or impact, especially if their facilities did not take advantage of the anesthesia waiver. CRNAs who have had flexibilities added at their facilities because of this waiver are encouraged to share with AANA their stories on how the flexibilities benefit either CRNA practice or increased access to care and what it means now that it is coming to an end. These stories will help AANA in advocating with Congress, the White House, and federal agencies, and with state advocacy efforts. Please email us at info@aanadc.com if you have a story to share.
For additional information on the end of the PHE and its impact on CRNA’s contact info@aanadc.com.